Children & anxiety disorders.

Given that anxiety disorders are among the most common psychiatric conditions seen in children and adolescents, it's amazing that, as Jerilyn Ross, LICSW, of the Anxiety Disorders Association of American says, "Twenty years ago we didn't even think children had anxiety disorders."

Well, says pediatric psychiatrist Steve Pastyrnak, PhD, division chief of psychology at Helen DeVos Children's Hospital in Grand Rapids, MI, they can and they do. "Anxiety is a heck of a lot more common in kids than people realize," he said, with studies finding anxiety disorders in 5 to 10 percent of all children.

As in adults, anxiety disorders in children are hardly benign.

They can significantly affect a child's interactions at home, school and with friends, predict later risk for mood disorders, and be associated with suicide attempts and hospitalization. (22)

Children with anxiety disorders also have higher rates of depression, lower self-esteem and more attention and concentration problems than children without such disorders. (23)

Anxiety often looks different in children than adults, said Dr. Pastyrnak. Kids may initially complain of stomach problems, have problems sleeping and breathing and experience muscle tension and tingling in the hands and feet. They often act out, getting labeled with behavioral problems when, in fact, the emotional basis for their behavior is anxiety, he said. For instance, children may cry and have tantrums as they refuse to wear a certain dress, or eat a certain food, or touch certain things.

So how does a parent know when typical childhood behavior--like the separation anxiety of a two-year-old--has become a diagnosable anxiety disorder?

"When the behavior is not developmentally appropriate," said Dr. Pastyrnak. For instance, while a clingy two-year-old is appropriate, an eight-year-old who won't leave your side, go to a friend's house or go on sleepovers is not. While the years between three and six are typically years of high anxiety for kids, by age six most kids have developed greater confidence about the world and tend to move beyond their fears.

"But if very significant worries or fears are continuing beyond that age, then a referral (to a mental health professional) may be necessary."

Treatment depends on the child and the diagnosis. "The first step is identifying what's going on," said Dr. Pastyrnak. "Maybe just a couple of adjustments in the child's daily routine can help address the problem."

The next step is tinkering with routines at home or school. For instance, if a child has a difficult time separating from a parent, then creating incentives to encourage the separation may help. The third step is cognitive behavioral counseling (CBT), described in more detail on page 4.

Children learn skills they can use to overcome their fears, such as breathing techniques and self talk (such as, "I can handle this").

Although medication is some times used for pediatric anxiety disorders, it doesn't appear any more effective than counseling

"I would say in my own clinical practice that 70 to 80 percent of kids can have their anxiety problems and symptoms addressed through counseling alone," said Dr. Pastyrnak. If children do need medication, it's usually for a limited time.

Given the strong genetic component of many anxiety disorders, Sally Winston, PsyD, who codirects the Anxiety and Stress Disorders Institute of Maryland in Towson, urges parents to address their own anxiety issues so they can help their children understand that some level of anxiety is normal. So, for instance, if your child complains of butterflies in her stomach before a piano recital, don't tell her she doesn't have to play; instead, reassure her that everyone gets butterflies before a performance and "boot her onto the stage," said Dr. Winston.

"Then you're communicating that anxiety doesn't have to interfere with a performance, and you're saying there is no big deal about feeling anxious."

(22) Fisher PH, Tobkes JL, Kotcher L, Masia-Warner C. Psychosocial and pharmacological treatment for pediatric anxiety disorders. Expert Rev Neurother. 2006; 6(11):1707-1719.

(23 )Lyneham HJ, Rapee RM. Evaluation and treatment of anxiety disorders in the general pediatric population: a clinician's guide. Child Adolesc Psychiatr Clin N Am. 2005; 14(4): 845-861.