What parents need to know and when to seek treatment

By Navneet Patti, MD
Psychiatric Center of Northwest Ohio at Caughman Health Center

Anxiety is a normal emotion essential for survival and functions as our brain’s inherent response to perceived danger. It facilitates the avoidance of danger in many scenarios, meaning it is adaptive and not necessarily pathological. 

While childhood and adolescence are a vulnerable age for the development of anxiety disorders, children also manifest many fears and anxieties that are developmentally appropriate. These include separation anxiety, nightmares, fears of thunder or monsters in toddlerhood, fears of ghosts, germs, and academic performance in school-age children, and fears of negative evaluation from peers in adolescence. These phenomena occur in most children over the course of their development and while they can be very stressful in the moment, they are often transient and do not necessarily need a child psychiatrist’s attention.

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The unique challenge in this case, however, is differentiating between healthy versus unhealthy anxiety, as children lack the cognitive abilities to effectively communicate thoughts and feelings. Naturally, it becomes our responsibility as caregivers to help them understand and differentiate between normal and abnormal anxiety. While we do not want to draw unnecessary attention to seemingly age-appropriate fears, we also don’t want to miss something that is affecting a child negatively. For example, secondary depression can often be a concerning outcome of anxiety disorders, affecting friendships and developmental milestones. 

Anxiety becomes maladaptive when it is pervasive, coupled with subjective distress, and causes persistent avoidance. This combination of excessive anxiety and disruption in life indicates that anxiety is no longer normal and has become problematic.

These disorders have a lifetime prevalence of about 15% to 20%, and the most common ones are separation anxiety disorder, specific and social phobias, obsessive-compulsive disorders and generalized anxiety disorder. It is crucial to understand that these have a natural tendency to wax and wane over time and that each one needs a unique approach. 

For mild to moderate anxiety symptoms in children, cognitive behavioral psychotherapy is the place to start. This is because children and teenagers tend to have black-and-white thinking. A lot of children aim for perfection, which causes repetition, making it difficult to complete work on time. This, in turn, frustrates caregivers, who might seek an evaluation for OCD. However, I often tell parents that they are their child’s best friend; children learn best through modeling. For example, through board games, parents can model that losing is a part of life and that there will be more opportunities to win. This helps them replace overly self-critical thoughts with positive, self-affirming thoughts. 

When it comes to children affected by social anxiety, they are not the ones who act out, but rather the ones who remain invisible, often experiencing physical symptoms including GI symptoms and an irritable mood. They get recognized when they avoid school, or their grades start to drop. One of the most common mistakes parents make is transferring children to online school, negatively reinforcing their social anxiety. The gold standard treatment is exposure therapy; this follows the extinction principle of classical conditioning, which involves exposing patients to the feared stimulus in a lab setting until the association is weakened and anxiety subsides. 

If significant anxiety symptoms persist despite psychotherapy, or the symptoms are in the moderate to severe range, medication management and therapy are recommended. If you are concerned about your child, a visit to your local psychiatrist never hurts. We are here to he