Child and Adolescent Anxiety Program Recap

Thank you to Tatyana Shields from Behavioral Health Specialists at Capital Health for presenting on anxiety in children and adolescents. Anxiety in these populations is on the rise, especially in the wake of the pandemic and remote learning, so it is important to understand the signs and symptoms to try and address issues as soon as possible. While children and adults can experience many of the same types of anxiety, their manifestations might be very different. We will go through the different types of anxiety, signs of anxiety, and treatment options, so let’s dive right in.

What is Anxiety?

Anxiety is both a mental and physical state characterized by an increased arousal and apprehension in order to facilitate response to an unknown danger, real or imagined. Your body is trying to capture your attention and stimulate you to make necessary changes to protect what you care about. This can manifest in cognitive thoughts of dread in anticipation of some bad outcome or physical sensations such as jitteriness and a racing heart.

Occasional bouts of anxiety are natural and can even be productive, but it is when these bouts last for long periods of time and become more frequent that medical help may be necessary to address those issues.

Types of Anxiety in Children

Children may experience some of the same anxiety disorders as adults, but there may be significant difference is how they manifest and are addressed. Some common anxiety disorders in children include:

Separation Anxiety – An exaggerated fear of being separated from a parent or caregiver. It is most common in younger children and the symptoms are fairly easy to spot, including refusing to go to school or sleep alone.
Generalized Anxiety Disorder – Experience excessive and unrealistic worry and fear about everyday things, often looking at things from a “worst case scenario” perspective. Children may experience irritability, increased body aches, and difficulty sleeping.
Obsessive Compulsive Disorder – Obsessive thoughts, images, or ideas that cause anxiety that will not go away. Some of these obsessions may include extreme worry about bad things happening, worries about getting sick, or the preoccupation with order or symmetry. The other half of this disorder is compulsion, namely behaviors that have to be done, often repetitively, to relieve that anxiety. These can include counting things multiple times, excessive hand washing or showering, repeated checking, and repeatedly seeking assurances from friends and family.
Panic Disorders – Found more in adolescent children, panic disorders stem from a fear of loosing control and a detachment from oneself (depersonalization) or reality (derealization). Triggers can vary, from thunderstorms, to speaking in public, to receiving criticism. Symptoms can manifest physically, such as chest pains, dizziness, trouble breathing, or nausea.
Selective Mutism – The inability to speak or communicate in certain settings, such as at home or at school, and if left untreated, can lead to delays in language acquisition or developing social skills. Some symptoms include eye contact avoidance, use of nonverbal communication to express needs, and inability to speak in school and other specific social situations.

Signs of Anxiety in Children

While anxiety in children can be very similar to that in adults, there are some differences to watch out for. Signs of anxiety in children include:

Bedwetting, especially as they grow out of the potty training phase
Behavioral changes, such as moodiness, aggression, temper tantrums, clinginess or frequent crying spells
Complaints of stomachaches or headaches
Constantly worrying or have negative thoughts
Changes in appetite
Difficulty concentrating or sleeping
Withdrawing or isolating from friends
Irrational fears, such as the dark, being away from home, or interacting with peers
Hoarding items of seeming insignificance
Struggling with or refusing to go to school

Be sure to take notice of when these things happen and see if there may be a trigger that is causing them, such as a test, getting on the bus, or seeing a peer. It may be hard for children to recognize their anxiety and identify the causes, so it is important for parents and caregivers to be able to recognize these signs and talk to the child to better understand their situation. Anxiety is usually caused by a trigger so finding that trigger can help, such as a new routine (a new caregiver, recent move, or new sibling), family difficulties (divorce, financial issues), or a family history of anxiety or other mental illness.

Treatment for Anxiety in Children

Treatment of anxiety in children can vary, but there are 3 main types that are not mutually exclusive:

Pharmacology – The use of drugs prescribed by a licensed psychologist. Decisions should be made with input from the entire care team, including parents, physicians, and clinical therapists.
Psychotherapy – Meeting with a licensed clinical therapist or psychologist to discuss the anxiety and develop strategies to cope. This can happen in individual, group, or family therapy sessions with specific focus on discovering the triggers and symptoms.
Combination Therapy – The use of prescribed drugs and therapy to create a holistic approach to manage anxiety.

Psychotherapy approaches can vary so let’s take a look at some of the most common ones:

Cognitive Behavioral Therapy (CBT) – This approach focuses on understanding the Cognitive Triangle, or how our thoughts, feelings, and behaviors affect each other. It aims to identify unhelpful or distorted thinking that may be affecting one’s emotions. Strategies include how to Catch, Check, Change automatic thoughts, thought monitoring, and use of Pros and Cons.
Exposure Therapy – This approach encourages the systematic confrontation of the feared object, real or imagined. The goal is to reduce the person’s fearful reaction to the object and learn ways to turn that fear into control.
Mindfulness Based Therapy – Uses techniques to help the person focus on the here and now, on what they can control versus what they cannot control. In combination with CBT, mindfulness based therapy helps individuals better understand and manage their thoughts and emotions.

The benefits of psychotherapy include:

Developing and using relaxation techniques
Developing positive self-talk to help reduce anxiety
Identifying fears and worries
Increasing coping skills like socialization, physical activity, and self-assurance
Openly sharing thoughts and feelings

What Can You Do?

There are many ways that you can help your child deal with their anxiety. Don’t avoid what your child fears and instead help them learn to tolerate their fear through comfort and positive responses. Choose activities suited to their skills and rewarding progress while avoiding punishment. Inform teachers and others who work with your child of their anxiety and the strategies that work. Be sure to model coping skills, such as breathing, working to identify triggers, and help direct them to less anxiety-provoking things or tasks. Participate in an exercise known as the Grounding Technique, where you stop what you are doing and relax by focusing on 5 things you can see, 4 things you can feel, 3 things you can hear, 2 things you can smell, and 1 thing you can taste.

You can view a recording of Tatyana’s presentation at https://youtu.be/svw1vQAtQUU. If you have any questions, please contact Tatyana Shields at tgray@captialhealth.org.