Anxiety Health Article

When to call the doctor

A qualified mental health professional should be consulted if a child's anxiety begins to affect his or her ability to perform the three main responsibilities of childhood: to learn, to make friends, and to have fun. Often fears and anxieties come and go with time and age. However, in some children, anxiety becomes severe, excessive, unreasonable, and long-lasting (usually considered as long-lasting if the child experiences the elevated level of anxiety for a month or more), interferes with the child's ability to function normally, and causes the child to be distraught and easily upset, thus necessitating professional intervention.

Diagnosis

Diagnosing children with an anxiety disorder can be very difficult, since anxiety often results in disruptive behaviors that overlap with other disorders such as attention-deficit hyperactivity. Children showing signs of an anxiety disorder should first get a physical exam to rule out any possible illness or physical problem. Diagnosis of normal versus abnormal anxiety depends largely upon the degree of distress and its effect on a child's functioning. The degree of abnormality must be gauged within the context of the child's age and developmental level. The specific anxiety disorder is diagnosed by the pattern and intensity of symptoms using various psychological diagnostic tools.

Treatment

Depending on the severity of the problem, treatments for anxiety include school counseling, family therapy, and cognitive-behavioral or dynamic psychotherapy, sometimes combined with antianxiety drugs. Therapies generally aim for support by providing a positive, entirely accepting, pressure-free environment in which to explore problems; by providing insight through discovering and working with the child or adolescent's underlying thoughts and beliefs; and by exposure through gradually reintroducing the anxiety-producing thoughts, people, situations, or events in a manner so as to confront them calmly. Relaxation techniques, including meditation, may be employed in order to control the symptoms of physiological arousal and provide a tool the child can use to control his or her response.

Creative visualization, sometimes called rehearsal imagery by actors and athletes, may also be used. In this technique, the child writes down (or draws pictures of) each detail of the anxiety-producing event or situation and imagines his or her movements in performing the activity. The child also learns to perform these techniques in new, unanticipated situations.

In severe cases of diagnosed anxiety disorders, anti-anxiety and/or antidepressant drugs may be prescribed in order to enable therapy and normal daily activities to continue. Previously, narcotics and other sedatives, drugs that are highly addictive and interfere with cognitive capacity, were prescribed. With pharmacological advances and the development of synthetic drugs, which act in specific ways on brain chemicals, a more refined set of antianxiety drugs became available. Studies have found that generalized anxiety responds well to these drugs (benxodiazepines are the most common), which serve to quell the physiological symptoms of anxiety. Other forms of anxiety such as panic attacks, in which the symptoms occur in isolated episodes and are predominantly physical (and the object of fear is vague, fantastic, or unknown), respond best to the antidepressant drugs. Childhood separation anxiety is thought to be included in this category. Psychoactive drugs should only be considered as a last treatment alternative, and extra caution should be used when they are prescribed for children.