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The worried child: age-appropriate insecurity or a symptom of an anxiety disorder?

While it is now estimated that more then twelve per cent of pre-teens and teenagers have an anxiety disorder, it has only been during the last few years that anxiety disorders have been recognised in children at all. Although, there is still a great deal of scepticism – mostly on the part of people who have never experienced the impact of an anxiety disorder on the lives of their family members – the situation is preferable to children’s behaviour problems and depression being blamed on their parents, as it generally was in years gone by. However, with the recent problems of pharmaceutical companies turning normal life events into triggers for anxiety disorders in their consumer advertising, and the exposure of physicians prescribing unapproved and ineffective SSRIs to children, it has become very difficult for parents to determine both when to seek help and who to trust.

A safe catalyst is when fear-related or avoidance behaviour that prevents the child from doing the things which he would otherwise want to do. There are several different anxiety disorders and their severity is related to the child’s age. For instance separation anxiety in a two-year-old could well be transient; in an older child, it is a disorder. Social anxiety is not surprising in adolescents; when it isolates him/her from his/her peers, it is a disorder. Children go through phases of obsessive behaviour; when it goes beyond the norm, it is a disorder. The greatest problems facing parents in making the decision to find help are the stigma the child will inevitably face by being labelled as having a mental health problem and, depending on the age of the child, the impact on him/her of being evaluated for a disorder – something which could have severe repercussions, especially if the initial problem turns out to be just a phase the child was going through in the first place. Yes, today, we all know that a mental illness is a medical condition, but that does not stop the stigma!

Once the decision is made, the next difficulties are in finding a mental health professional, who is experienced in treating many children and many different problems enabling him/her to evaluate the child’s behaviour objectively, and getting the entire family and, possibly, the child’s teacher, to co-operate in the evaluation process. Both are stressful situations and not to be undertaken lightly because, once done, you must bear the consequences of having exposed your child to stigma, whether or not it results in being the first step in recovery. The chances are that, having come this far, your decision to have the child evaluated will be vindicated. It is highly unlikely that you reached this stage without there being an anxiety disorder in the diagnosis. Next hurdle – how do we treat it?

It is generally agreed that cognitive behavioural therapy (CBT) is the most effective treatment for anxiety disorders. The cognitive part – the learning new information or skills, through repetition, to the point of thinking, acting and feeling differently – is sometimes actually easier for children than for adults because it is essentially the same process as learning at school, to which they are more attuned. However, CBT is hard for adults to undertake and, even tougher for children because the behavioural component requires that they confront the fear. Children (many adults, too) may simply be unable to do this.

Medication is the next best thing but, unfortunately, all to often is used as a frontline treatment. The specific medication, especially in the face of current controversy on the effectiveness of SSRIs for children, is something on which parents can only trust the mental health professional and should not allow themselves to be influenced by pharmaceutical advertising. Correctly used, medication will control the symptoms and allow the child to reach a point where he/she will understand the importance of and, hopefully, be able to undertake CBT. Medication alone creates a false security. Yes, symptoms will abate and the child will be able to enjoy a normal life sometimes even for months and years after stopping the medication, but they will eventually return. CBT, on the other hand, will restructure his/her thinking and equip him/her to confront the fear on a long term basis. This applies to treating the more transient anxiety disorders of childhood, too, since the months or years they last may otherwise impact on the child’s self esteem triggering mood or behavioural disorders in later life.

Copyright Jean Jardine Miller.


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