Being nervous from time to time and feeling “sick to my stomach” is a normal part of childhood and, indeed, adulthood. Speaking as a parent, I think I was more anxious on the first day of Kindergarten than any of my three children were. They happily walked into class while I stood on the blacktop until my wife told me it was time to leave. Such situations are part of life and should not be considered an illness; had I not left the school yard, that would have been a different matter!
All children experience some anxiety; this is normal and expected. For example, when preparing for a test or a sporting event, many children will show distress; a young child with his or her own room may develop a fear of the dark. Such anxiety becomes a problem only when it interrupts a child’s normal activities, like attending school and making friends or sleeping. Persistent and intense anxiety that disrupts daily routine is a mental health problem that requires help.
There are several types of anxiety disorders. The list below describes those most common to children.
Generalized Anxiety Disorder
Children with Generalized Anxiety Disorder (GAD) have repeated fears and worries that they find difficult to control. They worry about almost everything: school, sports, being on time, even natural disasters. They may be restless, irritable, tense, or easily tired, and they may have trouble concentrating or sleeping. Children with GAD are usually eager to please others and may be “perfectionists" who are dissatisfied with their own less-than-perfect performance.
Separation Anxiety Disorder
Children with separation anxiety disorder have intense anxiety about being away from home and caregivers which affects their ability to function socially and in school. These children have a great need to stay at home or be close to their parents. Children with this disorder may worry a lot about their parents when they are apart from them. When they are together, the child may cling to parents, refuse to go to school, or be afraid to sleep alone. Repeated nightmares about separation and physical symptoms such as stomach aches and headaches are also common in children with separation anxiety disorder.
Social phobia usually begins in the mid-teens and typically does not affect young children. Young people with this disorder have a constant fear of social or performance situations such as speaking in class or eating in public. This fear is often accompanied by physical symptoms such as sweating, blushing, heart palpitations, shortness of breath, or muscle tenseness. Young people with this disorder typically respond to these feelings by avoiding the feared situation. For example, they may stay home from school or avoid parties. Young people with social phobia are often overly sensitive to criticism, have trouble being assertive, and suffer from low self-esteem. Social phobia can be limited to specific situations, so the adolescent may fear dating and recreational events but be confident in academic and work situations.
Obsessive-Compulsive disorder (OCD) typically begins in early childhood or adolescence. Children with OCD have frequent and uncontrollable thoughts (called “obsessions”) and may perform routines or rituals (called “compulsions”) in an attempt to eliminate the thoughts. Those with the disorder often repeat behaviors to avoid some imagined consequence. For example, a compulsion common to people with OCD is excessive hand washing due to a fear of germs. Other common compulsions include counting, repeating words silently and rechecking completed tasks. In the case of OCD, these obsessions and compulsions take up so much time that they interfere with daily living and cause a young person a great deal of anxiety.
Post-traumatic Stress Disorder
Children who experience a physical or emotional trauma such as witnessing a shooting or disaster, surviving physical or sexual abuse, or being in a car accident, may develop post-traumatic stress disorder (PTSD). Children are more easily traumatized than adults. An event that may not be traumatic to an adult, such as a bumpy plane ride, might be traumatic to a child. A child may “re-experience” the trauma through nightmares, constant thoughts about what happened, or reenacting the event while playing. A child with PTSD will experience symptoms of general anxiety including irritability or trouble sleeping and eating. Children may exhibit other symptoms such as being easily startled.
Substance Abuse and OCD/Social Phobia
There is a high correlation between substance abuse, OCD and Social Phobia. Substance abuse affects nearly double the amount of people with anxiety related disorders than those in the general population. Substance abuse often becomes a coping strategy for those who are experiencing severe OCD or Social Phobia. Teenagers may begin to use substances to reduce the severity of the obsessions /compulsions or to decrease the distress they experience because of their anxiety.
Because their anxiety-related symptoms can cause fallouts in school with failing grades or impairments in their relationships with family and friends, using drugs or alcohol can be a way of self-medicating to alleviate their distress and escape from their symptoms. Unfortunately, the use of substances may help the teenager to feel temporary relief but will almost always worsen their already existing problems as school performance and relationships will continue to deteriorate. It is important to find treatment that will focus on treating both the anxiety and the resulting substance abuse problems.
What Can Parents and Caregivers Do?
For many young children, supportive interventions from parents and caretakers can provide the structure needed to deal with their anxiety. It is important for parents to talk with their children about their concerns because not thinking or talking about their fears can be harmful to children. Parents may fear they are exacerbating their child’s anxiety by discussing the specific concerns but verbalizing them can actually create a sense of relief for the child. Parents should provide reassurance to their child and help them identify strategies that can assist them when the parent is not around.
For a younger child struggling with separation anxiety, it is important for parents to practice separation in short bursts by getting a reliable caretaker to watch the child when the parents go out. Despite the child’s protests when parents are about to separate from them, parents need to be consistent and set limits by not giving in to the child’s demands not to leave them. Develop a good-bye ritual with a special saying or kiss and then swiftly leave. Stalling or lingering will only create further uncertainty in the child and may teach them that the more they protest, the more they are likely to get their way. After a child has a difficult separation, parents should talk about the incident and praise their child for their efforts. This helps the child develop a sense of mastery and confidence even while experiencing anxiety.
In addition, a sense of structure and routine is critical for children experiencing anxiety. Getting exercise, eating well and getting enough sleep are critical for children to feel their best. Parents also need to set a positive example by reducing stress in their own lives and demonstrating an ability to remain calm in challenging situations. In addition, minimize exposure to scary television or unsettling news reports. Finally, offer choices to the child to give them a sense of control in the situation. For example, “Would you like Daddy to kiss you good-bye outside of the classroom or once you hang up your backpack and jacket?” or “Would you like to read one longer book at bedtime or two shorter books before we say good-night?”
For children who are experiencing intense and distressing symptoms of anxiety to the extent that their day to day functioning is impaired, identifying, diagnosing and treating these anxiety disorders early is essential for parents and others to help children reach their full potential. Anxiety disorders are treatable. Effective treatment for anxiety disorders may include some form of psychotherapy, behavioral therapy, or medications. Children who exhibit persistent symptoms of an anxiety disorder should be referred to and evaluated by a mental health professional that specializes in treating children. The diagnostic evaluation may include psychological testing and consultation with other specialists. A comprehensive treatment plan should be developed with the family and, whenever possible, the child should be involved in making treatment decisions.
To learn more about the Mental Health Association of Essex County and the programs and services it provides, residents can call 973-509-9777 for free, confidential information and referral services.
Robert N. Davison, M.A., L.P.C., is the Executive Director of the Mental Health Association of Essex County, Inc. The association is located at 33 So. Fullerton Avenuce, Montclair, NJ 07042. Davison's office can be reached at 973-509-9777. The website is available online here and on Facebook: Mental Health Association of Essex County