Matthew Crouch MD

I just had a article on Anxiety Disorders in Citiscapes magazine (see below). This area is near and dear to my heart as I think myself as well as multiple members of my family have suffered from anxiety of different types. So many children are misdiagnosed with behavior problems, ADHD, and other problems that are better attributed to anxiety disorders:

Anxiety in Children

Fear is a normal part of human life and all children experience normal fears on a regular basis. Without fears, our children would be unsafe. Reckless, fearless behavior is certainly never healthy for a child. But some children have an inborn tendency toward too much fear or excessive reactions to fearful situations, and this fear impacts their ability to function in school and home. These children have anxiety disorders.

Anxiety disorders are the most common psychiatric diagnosis of childhood with about 10% of all children meeting the criteria for any anxiety disorder during school age. Unfortunately, most children with anxiety disorders do not get treatment. Many children cope with their anxiety internally and never tell anyone what’s really going on. Some families decide to wait and hope they’ll grow out of it. Some fear the stigma of going to the doctor about an anxiety problem. Some fear that medication will be the only answer. Many anxiety symptoms get mislabeled as defiance or ADHD, and treatment for these conditions can sometimes lead to worsening anxiety. The cause of anxiety disorders is thought to be a mixture of genetic and environmental factors, but anxiety is fundamentally a biological disorder. Anxiety is an inherited trait and is highly genetic; so many anxious children have anxious parents and even grandparents.

There are several common types of Anxiety Disorders. These diagnoses overlap and children can have features of more than one diagnosis at a time.

Generalized Anxiety Disorder (GAD) in childhood was formerly called overanxious disorder of childhood. GAD is marked by excessive fear and worry for more than 6 months. GAD has no specific triggering event and can be present in multiple settings like school, home, and church. Children with this disorder find it very difficult to not worry.

Post-traumatic Stress Disorder (PTSD) is triggered after a traumatic event such as physical or sexual abuse. Children with PTSD are bothered by recurrent memories of the event, always on guard, and avoid talking about the event.

Obsessive Compulsive Disorder (OCD) is characterized by the presence of persistent unwanted thoughts or worries that are paired with a behavior that helps the anxiety go away temporarily. Common obsessions include worries about germs and safety. Common compulsions include hand-washing, counting things, and checking windows and doors. Obsessive compulsive disorder is thought to be more common in boys.

Specific phobias are noted for their disabling and irrational fear of common situations which severely limits a child’s ability to function in the world.

Social Anxiety Disorder is marked by persistent fears of embarrassing oneself in public. Children with social anxiety avoid crowded situations or places that might lead to rejection or humiliation. Most children with this disorder are calm at home or around familiar people. The prevalence of social anxiety increases with age in childhood.

Separation anxiety disorder is diagnosed when children have excessive distress when they are away from their parents. They fear that the parents may be hurt while away or not be able to pick them up. Separation fears are normal in infants and toddlers, but are a problem in school-age children.

The common symptoms of an anxiety disorder fall under these categories: Concentration problems, Restlessness, Irritability, Muscle Tension, Energy, Sleep problems. Children may have problems with concentration and attention due to distraction by worry or fears. Many children with anxiety have trouble being still; they might pace or move around due to increased worry. Children with anxiety get angry easily about small frustrations or are very difficult to please. Body aches are common as well as headaches, stomach aches, and other physical complaints. Children with anxiety disorder complain of low energy and fatigue easily. Sleep Problems including difficulty falling asleep, sleeping too much, refusal to sleep alone, or waking in the middle of the night are all common.

Treatment of childhood anxiety always begins with therapy. Many older children are helped by individual therapy to learn coping skills for their worry, anger and low mood. Family therapy is very helpful to learn ways that the family can help to increase the child’s ability to tolerate difficult situations. Family therapy may also help the adults in a child’s life who often suffer from anxiety themselves. Many therapists incorporate play or art into sessions to help younger children open up in a nonthreatening and natural way. Cognitive behavioral therapy (CBT) has been shown to be the most effective therapy. This type of therapy involves getting kids to think about the way they think and to change their behavioral reactions to tough situations. In CBT, graduated exposure with response prevention is a common technique. This involves gradually exposing the child to the things that they fear and working on coping with the anxiety in a controlled way. Medications are also a helpful option when therapy has not helped enough or the problem is severe. Medication should be used in conjunction with therapy. There are multiple professionals within the Northwest Arkansas Community who have expertise in childhood anxiety disorders. Clinical social workers, professional counselors, psychologists, and psychiatrists can help with assessment and therapy for anxiety disorders.