Jamie Williams’ son, Tanner, was always a sensitive child.

“It seems he was born with anxiety,” she says.

But after his grandfather died, the 4-year-old’s anxiety level reached a crisis point. He wouldn’t let his mother out of his sight. He refused to sleep alone. He worried when his father was working late, fearing he’d die and never come home.

“He was having panic attack after panic attack – hyperventilating, throwing up, his muscles would be convulsing,” Williams recalls. “I felt like a bad mother that I couldn’t comfort him.  No matter what we said, it made no difference.”

Finally, one night, “he said, ‘Mommy, is there someone who can help me? I need help. I don’t like feeling like this,’” Williams says. At that point, the family turned to a specialist in childhood anxiety.

While it’s normal – and even healthy – for all children to worry sometimes, mental health researchers estimate that 13-18 percent of children – and 25 percent of teens – have an anxiety disorder, in which worry becomes persistent and disruptive. Those estimates, based on statistics from the National Institute of Mental Health, make anxiety disorders the top mental health problem for youth.

“That’s more than kids with attention deficit disorder, more than kids with depression,” says Tamar Chansky, Ph.D., who worked with Tanner’s family and is the director of the Children’s Center for OCD and Anxiety near Philadelphia. She’s also the author of Freeing Your Child From Anxiety.

Typically, anxiety is not diagnosed before preschool age. However, if a younger toddler has anxiety symptoms outside the norm for his developmental stage, an anxiety disorder could be diagnosed, Chansky says.

Often, though, serious anxiety can be overlooked in children. Because childhood worries are common – from fear of dogs to anxiety over test-taking – “it biases us against seeing when a child is really struggling. We assume it’s a normal thing,” she adds.

In addition, anxious children don’t always act out, but may keep their worries bottled up. “These are not the squeaky-wheel kids. A lot of them are people pleasers,” Chansky says. “They don’t want their friends or teachers to know, then they come home and fall apart because they’ve been holding it together all day.”

Red Flags
“Anxiety is normal, worry is normal, fear is normal,” says Michael Tompkins, Ph.D., founding partner of the San Francisco Bay Area Center for Cognitive Therapy  and author of My Anxious Mind: A Teen’s Guide to Managing Anxiety and Panic. “They’re relatively transient in childhood. Kids outgrow them.”

But persistent stomachaches or headaches, an aversion to school or other activities, and trouble sleeping or sleeping alone are all red flags for possible problem anxiety. If it appears that your child is not outgrowing her worries, Tompkins says to consider “four D’s” in assessing whether it’s normal or reaching the level of an anxiety disorder:

• Is the child’s anxious response disproportionate to the situation?
• Is his anxiety disruptive to his or the family’s day-to-day functioning?
• Is the anxiety itself distressing to the child?
• What is the duration of the anxiety?

“If a child is fearful and worries in the same way for longer than six months, that may suggest there’s an anxiety disorder,” says Tompkins.

As was the case with Tanner, Harper Atkisson’s parents knew she was unusually anxious from a young age. Harper’s separation anxiety and long tantrums were particularly in contrast with the demeanor of her happy-go-lucky twin sister.

Her father had a “lightbulb” moment one day when Harper became incredibly upset that she couldn’t get her button collection lined up perfectly and knocked it from a table in frustration.

While her mother was baffled, “it made perfect sense to me because it [also] made me anxious and frustrated,” says Erik Atkisson, who has discovered more about his own anxiety issues in working with his daughter.

Experts say the children of anxious parents are seven times more likely to develop an anxiety disorder, and many anxious adults say their problems began as children.
Harper, now 7, has also been diagnosed with selective mutism – a form of anxiety in which a person won’t speak except to people she knows well – and sensory issues.

Oftentimes, her father says, her anxiety will play out as a sensory problem. If she’s worried about going to school, for instance, she may instead complain that her clothes don’t feel right and that she needs to change.

“The biggest challenge has been to recognize when she is starting to feel anxious, as opposed to the kind of childhood behavior you would need to punish or reprimand,” says Atkisson, recalling an episode in which Harper had a tantrum over ski pants, nearly ruining a family ski outing.

“You can become angry instead of realizing, she’s really hurting right now,” he says. “I try to remind myself and her, no matter how much she’s making life miserable for her siblings and parents, she feels worse.”

Working with therapists for her social anxiety has helped Harper make huge strides, to the point where she can now take gymnastics classes, something she’d been far too anxious to do before.

“Day to day, it can still be tough, but we’ve had huge improvements,” Atkisson says.

Getting Help
If you are concerned about your child’s anxiety, your pediatrician is probably the best place to start.

“But pediatricians’ attitude on something like this is often to watch and wait,” says Tompkins. “As a parent, you may have been watching and waiting for years. . . . Go through the ‘four D’s’ with your pediatrician and say, ‘This has been going on for a long time, I think it’s disruptive, and we need to have an evaluation with a mental health professional.’”
Also, look for any underlying causes that could be provoking anxiety, such as a learning disability or ADD, which can result in school stress.

Williams recommends seeking out an expert in childhood anxiety, having taken Tanner first to a therapist who provided little help. A specialist may recommend therapy, medication or some combination, particularly if therapy alone isn’t successful.

Chansky says medication is usually not the first response to childhood anxiety but can be necessary for some children, including those with severe anxiety or other factors including depression, attention deficit hyperactivity disorder or bipolar disorder.

The safety and efficacy of psychiatric medications, including selective serotonin re-uptake inhibitors (SSRIs) such as Prozac, for children is still being researched, and children using such medications should be screened and monitored by a child psychiatrist, he says.
When Tanner, now 5, began seeing Chansky, her cognitive behavior therapy approach gave him and his parents a new way of looking at and responding to worry.

She emphasized that Tanner’s “worry brain” wasn’t necessarily telling him the truth and that his “smart brain” could counter with the facts.

Armed with a new vocabulary, Tanner’s family started to address some of his fears, including his separation anxiety, in small steps. They started with Tanner sitting at the bottom of the steps with his mother at the top, talking the entire time. Gradually, she moved farther and farther away, until she could be out of his sight without him having a panic attack.

They researched topics like the wind, providing scientific explanations for something that before seemed mysterious and scary. At bedtime, Tanner imagines doors with happy topics behind them so he can fall asleep focusing on good thoughts and not let worry creep in.
Cognitive behavior therapy also involves teaching patients breathing and other relaxation techniques to combat the very real physical symptoms of anxiety, including nausea, stomachaches and headaches, breathlessness and a racing heart.

One thing Jamie Williams learned was to slow down and take time to listen to her son and to not dismiss his worries.

“I was rushing us through the day, saying, ‘It’s going to be all right’ or ‘That’s a silly thing to worry about,’” she says. “If I’m discounting his emotions, he’s not going to trust me.”
Both Chansky and Tompkins counsel parents to seek help sooner rather than later.
“There’s no reason for your kid to suffer,” says Tompkins. “Not every kid benefits from treatment, but most kids do, and most kids improve greatly.”

Tanner has improved significantly and in a relatively short period of time, William says, happily. “He’s ready for a sleepover at our in-laws!”

Janine DeFao is an associate editor with Dominion Parenting Media.


Resources

• American Academy of Child & Adolescent Psychiatry – www.aacap.org

• Anxiety and Depression Association of America – www.adaa.org/living-with-anxiety/children

• Children’s Center for OCD and Anxiety – www.worrywisekids.org

• International OCD Foundation – www.ocfoundation.org