Table 19-1 gives you some general guidelines about so-called normal childhood fears. However, independent of age, if fears seem especially serious and/or interfere with your child's life or schoolwork in a major way, they may be problematic and warrant attention. In addition, other anxiety problems we describe in the section "Inspecting the Most Common Childhood Anxiety Disorders," later in this chapter, are not particularly normal at any age.
If you have any doubts about the seriousness of your children's anxiety, you should consider a professional consultation. A mental-health counselor or your pediatrician should be well-equipped to handle your questions, quite possibly in a single visit. Anxiety problems sometimes predate other emotional difficulties, so you shouldn't wait to get them checked out.
Sleep terror in children
Childhood sleep disorders, one of the most common complaints brought to pediatricians, can disrupt the whole family. Children usually outgrow sleep disorders, such as bedwetting, frequent awakenings, and problems going to sleep.
Sleep terror, especially strange and frightening to parents, is relatively common, occurring among 1 to 6 percent of all kids; the incidence among adults is less than 1 percent. Sleep terror tends to present itself about an hour and a half after going to bed. The child typically sits up suddenly and screams for up to half an hour. During the episode, the child is actually asleep and is difficult to awaken and comfort. Children don't remember their sleep terror in the morning. Sleep terror most often occurs when children are between ages 4 and 10. By the time a child is a teenager, it usually disappears.
Direct treatments for sleep terror are unavailable as yet. But then again, because children don't remember it, sleep terror usually doesn't cause the children who have it any daytime distress. Too little sleep may increase the likelihood of sleep terror, so parents should make sure their children get enough sleep. And stress may also contribute to sleep terror, so parents should attempt to alleviate stress and other anxieties in their children.
Inspecting the Most Common Childhood Anxiety Disorders
Some fear and anxiety are normal for kids. You can probably remember being afraid of the dark, monsters, or ghosts. However, other types of anxiety, though not always rare, do indicate a problem that you should address. We briefly review the more common types of problematic anxiety in kids in the following sections.
Leaving parents: Separation anxiety disorder
As we show in Table 19-1, kids frequently worry about separations from their parents when they're as young as 6 months to perhaps as old as 4 years of age. However, significant fear of separation past about the age of 4, accompanied by the following, warrants intervention:
Excessive distress when separated from caregivers or anticipating such separation
Exorbitant worry about harm to parents or caregivers
Obstinate avoidance of school or other activities because of worries about separation
Refusal to go to bed without being near a parent or caregiver
Frequent nightmares about separation
Frequent physical complaints, such as headaches, stomachaches, and so on, when separated from parents
Among the various anxiety disorders, separation anxiety disorder (SAD) is relatively common in kids, but that doesn't mean it's normal. The average age at which it seems to start is around 7 to 8 years. The good news is that a large percentage of those with separation anxiety disorder no longer fulfill the diagnostic criteria for the disorder after three or four years.
The bad news is that quite a few of these kids go on to develop other problems, especially depression. For that reason, we suggest prompt intervention if it persists longer than a month or two and interferes with normal life.
The following story about Tyler and his mother Julie illustrates a typical presentation of separation anxiety in the form of a school phobia. Note that school phobia often also includes an element of social phobia (see the section "Connecting with others: Social phobia" later in this chapter).
Julie doesn't know what to do about her 7-year-old son, Tyler. Every day, she battles with him about going to school. At first, she thinks he's really sick, so she takes him to the pediatrician. After a complete physical, the doctor reassures her that Tyler is healthy. The doctor encourages Julie to send Tyler to school and warns that if she doesn't, Tyler's behavior is likely to escalate.
"My stomach hurts," whines Tyler. "I don't want to go to school."
"Now sweetie, you've missed so many days," soothes Julie, "you really should go today; you're not that sick."
"But my stomach really hurts; it really, really does Mommy." Tyler begins to sob. "Besides, the other kids don't like me."
"You will go to school today," Julie says firmly, grabbing Tyler by the hand. Tyler plants his feet and pulls away, screaming. Julie can't believe what he's doing. He actually seems terrified; Julie's never seen him behave this way. Frantically, Tyler runs to his bedroom and hides in his closet. Julie finds him huddled, sobbing.
Tyler suffers from school phobia, a common but serious childhood anxiety disorder involving anxiety about both separation from parents and social worries.
Wisely, Julie decides to seek further professional help. Most school counselors have had lots of experience in dealing with school phobias. See the sidebar "Getting back to school" for a typical treatment strategy.
Getting back to school
School phobia is a relatively common separation anxiety in childhood. The treatment for school phobia involves getting the child back to school as soon as possible. Children with school phobia often have parents who are slightly anxious themselves and care deeply about their kids. The first step is to convince the parents that they must be firm in their commitment to return the child to school.
A good way to calm the child and get him back to school is to allow for one brief contact between parent and child each day for a few weeks. The parent carries a cellphone. With agreement from the child's teacher, the child receives a get-out-of-class pass (usable only once each day) that allows the child to call his parent. The parent then speaks to the child for only an agreed-upon two minutes. The child is encouraged to save the pass for times of great distress and praised when he doesn't use the pass at all during a day.
This pass, allowing a parental phone call, gradually fades to one call every other day, one call a week, and so on. After the first few days, if the parents and teachers remain supportive and firm, the problem usually vanishes. If this strategy fails, there are many other techniques for overcoming school phobias. Consult a mental-health professional who specializes in child anxiety.
Sometimes, what appears to be a school phobia is actually a result of a child having been bullied at school. School counselors and teachers can help sort this out for you. Be sure to ask them to check into this possibility.
Worrying all the time: Generalized anxiety disorder
Based on what we know today, generalized anxiety disorder (GAD) is fairly common among kids and more common among older kids than younger ones. It most often develops at the onset of puberty or shortly thereafter and is characterized by
Excessive anxiety and worry about school, friendships, or family problems
Physical symptoms, such as stomachaches, headaches, or loss of appetite
Difficulty concentrating and/or irritability
Problems sleeping, restlessness, or agitation
Focusing on phobias: Specific phobias
Most young kids at one time or another exhibit fear of the dark or monsters in the closet. So don't worry if your child has these fears unless the fear becomes so intense that it disrupts daily living in a significant way. The typical age of onset of a real phobia (as opposed to the earlier, minor fears) is about age 8 or 9.
Specific phobias are exaggerated, intense fears that cause a child to avoid a particular object or situation. See Chapter 2 if you want more information on this type of anxiety.
Connecting with others: Social phobia
Some
kids are just plain shy. They're born that way, and relatives often make comments like, "He's just like his dad was at that age." Sometimes, shyness decreases with age, but when shyness swells and causes a child to fearfully avoid social encounters in everyday life, your little one may have a problem.
Social phobia usually doesn't manage to get diagnosed until around 10 years of age. Signs generally appear at a younger age, but parents often have trouble distinguishing it from shyness until then. You can pick up on it sooner if you observe your children carefully. If their fears of unfamiliar peers or adults show no improvement whatsoever by age 3 or so, you may want to check with a professional to determine whether the problem is serious. See Chapter 2 for more information about social phobia.
Anxious repetition: Obsessive-compulsive disorder
This type of anxiety is somewhat less common than SAD, GAD, specific phobias, and social phobia. Nevertheless, almost 1 in 50 teens has obsessive-compulsive disorder (OCD). Often beginning in childhood, OCD develops on average at around age 10. However, it can occur as early as 4 or 5 years of age; boys tend to get it earlier than girls do.
Obsessions are recurring, unwanted thoughts that your child can't stop (see Chapter 2 for more details). Some of the most common obsessions among children include
Excessive fear of intruders
Fear of germs
Fear of illness
Fixation on certain numbers
Compulsions involve rituals or various behaviors that your child feels compelled to repeat over and over. Common childhood compulsions include
Arranging objects in a precise manner
Excessive hand-washing
Hoarding items of little value
Repeatedly counting stairs, ceiling tiles, and steps taken while walking
Many children perform a few harmless rituals that involve magical thinking, such as not stepping on sidewalk cracks. However, any child that exhibits serious signs of OCD should be evaluated. It doesn't matter at what age it shows up, because OCD tends not to improve without treatment. The good news is that treatment really works!
Rare anxieties among children
A few anxiety disorders that occur in adults show up infrequently in children:
Agoraphobia is often a response to panic and involves avoidance of places or situations in which you feel no escape is readily available.
Panic disorder involves a sudden onset of intense fearfulness, terror, and physical symptoms. It usually doesn't appear until late adolescence or later.
Post-traumatic stress disorder is a response to some traumatic event in which the person develops hyper-arousal (a heightened state of alert), intrusive thoughts about the event, and avoidance of any reminders of the event.
See Chapter 2 for more details on all these anxiety disorders. If any of these anxieties show up in your children, we recommend a professional consultation.
Post-traumatic stress disorder among children
Although thankfully rather rare in children, PTSD symptoms are slightly different among kids than adults. Like adults, children can get PTSD from abuse or other directly experienced trauma. (PTSD among New York City kids spiked after the September 11 terrorist attacks. Fourth and fifth graders were particularly affected.) Also, similar to adults, kids can develop PTSD from witnessing trauma happening to others, such as seeing a parent beaten.
Children with PTSD become restless, agitated, irritable, and unfocused. Instead of having nightmares and intrusive thoughts, children may act out their terror in play. They may have bad dreams, but these usually don't have content specifically relevant to the trauma. Like adults, they become anxious and alert to any possible sign of danger. They also tend to overreact to trivial incidents, such as being bumped into or criticized.
Chapter 20: Helping Kids Conquer Anxiety
In This Chapter
Bringing up calm kids
Helping anxious children change
Finding professional help if you need it
We think it's pretty tough being a kid today. We picked up our granddaughter at school the other day. Before leaving, we wrote her name on a big sign and placed it on the dashboard. We waited in a line of minivans and SUVs for more than 30 minutes while teachers walked around with bullhorns calling out children's names so that the drivers could identify themselves. The children waited like cows in a secure, fenced-in area. Most of the vehicles in line had DVD players hanging like the screens in taxicabs — separating the adults from the kids, who become immobile prisoners in complicated car seats. Wow, just getting picked up from school can arouse anxiety.
How can parents and other concerned adults help children navigate this complex world without developing anxiety? In this chapter, we give parents and caregivers some guidance on how to prevent anxiety from taking root. But some kids will have anxiety despite parents' best intentions, so we also provide tips on ways to help those kids who do. Finally, we take a look at signs that indicate the possibility that a child needs professional help, who to seek for such help, and what to expect from mental-health professionals.
Nipping Anxiety in the Bud
How does anxiety begin? The risk for developing anxiety begins at conception. That's right, studies of twins have demonstrated that almost half of what causes anxiety lies in your genes. However, that's just the beginning. Many other factors come into play, and you can do much about these factors, as we explain in this section.
Anxiety's brain chemistry
Recent research at Columbia University explored the effect of the brain chemical serotonin (a neurotransmitter thought to influence mood), which is produced naturally in the body, on the development of anxiety. Experimenters bred mice that lacked important receptors for serotonin, which left them unable to use this important neurotransmitter. They found that mice between 5 and 20 days old without the ability to process serotonin developed mouse anxiety as adults. But when they raised mice with normal serotonin receptors and later depleted the mice of serotonin when they had reached adulthood, the mice didn't develop anxiety.
What does this research have to do with anxious kids? It points to the importance of biological factors in the development of anxiety. Even prenatal and early infantile experiences may affect emotional well-being long into the future. Perhaps treating childhood anxiety early can help to prevent future problems.
More research is needed to understand how all this works. However, we know that biological interventions (such as medications) affect serotonin levels, and it appears that behavioral strategies, such as those described in this book, also alter brain chemistry in productive ways.
Early mastery experiences
When a hungry or uncomfortable baby cries out and parents respond by feeding or comforting, the baby experiences a beginning sense of mastery. In other words, what the baby does results in a predictable outcome. This early opportunity can be repeated thousands of times over the next few years in various ways. For example, the toddler discovers how to use language to make requests that then get rewarded. If parents respond unpredictably and chaotically to an infant's attempts to control his or her environment, anxiety is likely to increase.
So to decrease the probability of anxiety, responding predictably to young children is imperative. For young infants, parents should respond with reasonable consistency to most of their distress. Later, predictability is still important but should occur only to age-appropriate distress or requests. In other words, you wouldn't want to reinforce a 2-year-old's temper tantrums by caving in.
As your children grow older, you should provide as many opportunities as possible for them to experience a feeling of mastery. You can do this by
Involving them in sports
Interesting them in hobbies that require some skill
Overcoming Anxiety For Dummies, 2nd Edtion Page 35
