Helping Children & Teens with Anxiety

While adults with anxiety may be more likely to recognize that they need support, children and teenagers often need an adult to help them realize that the anxiety they are feeling could be treated, and that they don’t have to “just deal with it.”

While some stress is a normal part of growing up, children and teens whose anxiety causes problems with their daily functioning should see their pediatrician to determine whether they would benefit from behavioral health services.

Shirley Alleyne,
MBBS (MD), DFAACAP

Psychiatrist

At Lakeland Regional Health, we are dedicated to building awareness about mental health and providing education for our patients, so they feel confident, heard, and cared for each day.

During Mental Health Awareness Month in May, we are sharing information about different types of mental health challenges and their various treatment options. In this blog, we sat down with LRH psychiatrist Dr. Shirley Alleyne to learn about how anxiety affects children and adolescents, and how their families can get them the help they need.

About Dr. Alleyne

Dr. Shirley Alleyne is a board-certified adult, child, and adolescent psychiatrist, a Fellow of the American Psychiatric Association, a Distinguished Fellow of the American Academy of Child and Adolescent Psychiatry, and the mother of two adolescent boys.

Pediatric and adult psychiatrists use the tools of education, psychotherapy, and medications to support emotional-behavioral regulation and create positive changes in the lives of children, adolescents and adults. Dr. Shirley Alleyne works with patients at the new Harrell Family Center for Behavioral Wellness.

“I am dedicated to enhancing the quality of life of each person I treat. Over the last sixteen years, I have worked with individuals (and their families) across the lifespan to optimize their emotional wellness.”

What is anxiety and when should professional help be considered?

Anxiety is a feeling of worry, nervousness, or unease. Occasional mild anxiety, which is a physiological/bodily response to perceived threats, is normal. It often occurs when we are thinking about an important challenge, such as a task or upcoming event. Mild, brief anxiety can actually help us to be more focused and prepared for the task at hand.

However, severe, prolonged anxiety can become disabling, interfere with daily function, and is referred to as an anxiety disorder. It is people with anxiety disorders who would benefit most from professional help from a behavioral specialist. It is usually the adults who spend the most time with a child, such as parents, teachers, coaches, and family members, who will notice that a child’s reactions to certain situations may warrant further evaluation.

What are the common signs of anxiety in children and adolescents?

Children with anxiety disorders often first display somatic symptoms like stomach aches and headaches. They may avoid (or try to avoid) anxiety-provoking events, such as going to school or being in places with large crowds. This has a lot to do with the fact that their abilities to recognize and verbalize their feelings (as well as their ability to identify their triggers) are not fully developed. My colleague, Dr. Britney Galantino, a Child and Adolescent Psychiatrist here at Lakeland Regional Health agrees. She says that children should be encouraged to discuss their feelings, especially because anxiety in children can display differently than it does in adults. For example, children are more likely to exhibit irritability, while adults present with sadness.

While anxiety often causes similar somatic symptoms in adolescence, teens are generally more equipped to interpret their feelings. They may report additional symptoms of anxiety, such as incessant worrying, feelings of dread, tension, insomnia and fatigue, increased heart rate and breathing, and feeling overwhelmed. It’s important to note that even if a teenager does not report these symptoms, if they are observed by someone who sees the teen regularly, they should not be ignored.

Other symptoms may include:¹

Pronounced irritability/anger
Being very afraid when away from parents or home
Having extreme fear(s) about a specific thing or situation (phobias)
Afraid of school and/or other places where there are people
Very worried about the future and about bad things happening
Having repeated episodes of panic (sudden, unexpected, intense fear that may include heart pounding, trouble breathing, or feeling dizzy, shaky, or sweaty)

Anxiety and Depression in Children

What causes anxiety disorders?

Anxiety disorders have no single cause and are unique to each individual. While some anxiety disorders, such as PTSD, can be directly attributed to a particular traumatic event, in general there are biological/genetic and environmental factors that may play a role, as well as a child’s inborn personality.²

What are some possible types of anxiety children and adolescents may experience?

Generalized anxiety disorder (GAD) refers to anxiety with multiple symptoms and multiple triggers (even triggers that one may not expect to cause anxiety).
Children and teens who do not outgrow their fear of separation after young childhood may be diagnosed with separation anxiety disorder.
Kids who are constantly afraid of what others may do or say, or of how they are perceived, may have social anxiety disorder.
While these conditions are different from panic disorder, which causes panic attacks, they may happen concurrently.

How can anxiety affect children and adolescents during their daily life (at school, in social settings, and at home)?

Anxiety disorders are among the most common emotional health conditions in children and teens. Untreated anxiety disorders disrupt their lives and prevent them from engaging in important activities that are critical to achieving important social, emotional, and academic milestones.

Untreated childhood and adolescent anxiety disorders can also affect the functioning of the entire family. Severe anxiety can cause children and teens to avoid making new friends, participating in team sports, attending playdates, presenting projects, and completing school assignments. In extreme cases, children might stop attending school and interacting with their extended family members.

What are common treatment options for children and teens experiencing anxiety?

Anxiety disorders in childhood respond well to treatments when used correctly. Treatment choices are made considering the severity of symptoms, along with how much the anxiety is disrupting the child’s life.

Therapy-Psychotherapy for younger children may focus more on expressing their anxieties through play therapy and teaching behavioral techniques (such as deep breathing) to cope with the symptoms of anxiety.

The first line of treatment for mild and moderate anxiety in older children and teens is Cognitive Behavioral Therapy (CBT). CBT is an evidence-based psychotherapy that is typically conducted over at least 8 to 12 sessions.

Licensed psychotherapists who are trained in CBT will progressively help children and their parents understand how their way(s) of thinking can create anxiety, and teach the child to:

Identify and challenge anxiety-provoking thoughts
Recognize their symptoms of anxiety
Change negative patterns of behavior
Use relaxation techniques and problem-solving skills

CBT may include “homework” for the child and family to practice in between sessions to further improve results.

Medications-In cases of moderate and severe anxiety, where a child’s ability to function is significantly impaired, psychotropic medications may be recommended. These medications are designed to alleviate the physical symptoms of anxiety and help mitigate the worrying thoughts children experience. Common medications used are anxiolytic medications like fluoxetine (Prozac), sertraline (Zoloft), and duloxetine (Cymbalta).

Most of the commonly used medications for childhood anxiety take between four to six weeks to start working. These patients are monitored closely by their pediatrician or child/adolescent psychiatrist to identify and address potential side effects. Children who are treated with anxiolytic medications should also receive CBT to manage their anxiety disorder. This combination of medication and therapy will help them to build confidence in their ability to use the strategies they have learned to help prevent their anxiety from controlling their life.

To support long-term remission, in many cases continuing medication treatment for a minimum of six months after symptoms have resolved is highly effective.

Does someone who has anxiety as a child always have it as an adult?

Not necessarily. With proper treatment, some children and teens may be able to “outgrow” some or all of their anxiety symptoms. In others, while their anxiety disorder may never completely “go away,” the use of these effective treatments can make it very manageable, allowing each person to live a happier, mentally healthy life.

Harrell Family Center for Behavioral Wellness

Check out the services we offer →

If you or a loved one are experiencing a mental health crisis, there are resources to help.

In the event of a life-threatening emergency, always call 911.

To reach National Suicide Prevention Lifeline call 1-800-273-8255.

References:

¹CDC: Children’s Mental Health

²Anxiety Disorders Resource Center (aacap.org)