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Recognizing Anxiety in Kids

Smiling KidsMadison, Wisconsin - All children experience anxiety at some point. It might be a fear of strangers, or of the dark. It could even be a fear of seemingly random things, like mannequins in a store.

Usually, it’s temporary and kids eventually grow out of it. Some kids, however, aren’t able to, and without proper support, the anxiety can begin interfering with their day-to-day life.

According to Marcia Slattery, MD, UW Health child and adolescent psychiatrist, as many as one in four people have anxiety, but in children and teens, it is often undiagnosed or misdiagnosed as depression, ADHD or even bipolar disorder.

Dr. Slattery, who specializes in treating kids with anxiety, explains that the signs of anxiety can be hard to identify but there are some common behaviors and patterns parents can look for.

“Jekyll and Hyde”

For many children, how they are at school can be very different from how they are at home.

At school, teachers are full of praise – they’re quiet, helpful, high achievers, even model students. But at home, parents see a very different side. The same child is often very irritable, “touchy”, and families describe “walking on eggshells” to avoid doing something to anger the child.

“All the tension they bottle up all day comes spilling out and they have meltdowns with their parents or siblings,” comments Dr. Slattery.

The Perfectionist and Controller

Children with anxiety often are perfectionists, and set very high expectations of themselves. They try to control as much as possible around them, including the behavior of others; they may be “bossy” in telling their friends what they will play and do. They can be very rule-bound and are easily irritated by classmates who don’t behave in class. They’re also often very focused on routines, predictability, and organization.

“I say that they are born with clip boards in their hands,’’ she says. “They want to be ready. They’re attentive to everything going on around them, including keeping an eye on other kids who might cause problems in the class.”

The Fretter

Some kids constantly fret, worrying about day-to-day scenarios that are unlikely to happen – what if someone forgets to pick them up, what if they study the wrong materials for a test, what if they don’t know the answer when called on in class. It’s difficult for them to move beyond the “what if’s.” Their worries may keep them awake at night.

The Avoider

Sometimes kids show their anxiety by avoiding the situations that make them nervous. They will pretend to be sick to miss school or play dates, or quit a sports team because they are too stressed about their performance. Home is predictable and safe; activities away from home may catch them off guard. It can be difficult to know just what to do to support a child with anxiety. Families may change plans and their home life to accommodate a child’s feelings and difficulties.

And while it’s natural for parents to want to protect their child, the danger is in overprotecting and having the anxiety symptoms be the reason for choices, e.g. not going to school or not participating in social activities.

Helping Kids Cope with Anxiety

Luckily, says Slattery, anxiety disorders are treatable, with cognitive behavior therapy, or CBT, and, sometimes, medication.

“Therapy works by retraining the brain,” Slattery explains. “Instead of having the anxiety running on autopilot all the time and causing anxious thoughts, we teach kids how to identify the anxiety, and control the worries and anxious feelings.”

She works with children, and their parents, so they can practice being in situations that make them anxious, and learn to control the anxiety in those situations. While she admits kids don’t like that practice at first, avoiding the things that make us anxious only strengthens the anxiety.

“It’s important to learn how to deal with the anxiety in the moment in order for the brain to learn how to control the worries consistently,” says Slattery. “It’s much less effective if you just talk about strategies but don’t practice to get good at them. It would be like trying to train for a marathon by reading about running but rarely going out to practice .”

For example, Slattery runs a popular support group for children ages 8 to 10 who have anxiety issues. She works with them like a coach, anticipating stressful situations and having them practice what they will do. This may include role-playing situations with their fellow group members, and developing assignments to engage in something that’s anxiety- provoking to each kid outside of group such as talking to someone they don’t know well or going to a restaurant and ordering for themselves. And, she says she can see results in her young patients.

“They grow more confident as they achieve mastery over their anxiety and feel more in control of their emotions,” she observes. “Tenseness often decreases. It’s like the rubber band isn’t stretched as tight. They can go with the flow and think things through better.”

While CBT is always central to the treatment of anxiety, sometimes anxiety can be so severe that it prevents some kids from being able to do the CBT. In those cases, medications for anxiety may be used in addition to CBT, and the combination of treatments usually results in improvement.

If you suspect your child may have anxiety, the first step is to talk with your pediatrician. He or she will talk about your concerns and help you figure out the next best steps for your child and the entire family, including whether it may be helpful to consult with a child-anxiety specialist.


Date Published: 03/08/2013