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Anxiety Disorders in Children

Anxiety can be a helpful signal that tunes us in to threats or problems in the environment. However, sometimes the "anxiety alarm" goes off when there is no danger. These anxiety "false alarms" are very upsetting for child and parent alike. When the false alarms occur on a regular basis it is known as an anxiety disorder.

Anxiety disorders that occur in children include: Separation Anxiety (fear, upset and worry about being away from parents), Panic Disorder (sudden onset of fear and panic associated with physical symptoms of racing or pounding heart, shortness of breath, sweating, and a fear one is dying or going crazy), Obsessive Compulsive Disorder (intrusive upsetting thoughts or images that the person knows are illogical but can't ignore; ritualized behaviors such as excessive hand washing; repeated checking of locks and doors etc; counting rituals; being able to stop an activity only when accompanied by a "right feeling") – check out www.ocfoundation.orgfor more information; Generalized Anxiety (multiple worries, feeling keyed and on edge on a persistent basis), Post Traumatic Stress Disorder (occurs after a life threatening event and in part consists of recurrent nightmares or intrusive thoughts about the event – young children may repeatedly act out the event in their play), Social Anxiety - or Phobia – (Intense, debilitating anxiety, including panic attacks, when meeting new people, when called on in class by the teacher or when having to give a verbal report in front of the class) and Phobias (excessive or unreasonable fears of specific situations, such as high places, flying, getting a shot or objects such as cats, dogs, red cars.)

What should I do if I suspect my child has an Anxiety Disorder?

A careful evaluation is important. Pediatric evaluation may be needed to make sure there is not another medical problem presenting as anxiety. Psychiatric evaluation and treatment is needed as children with anxiety hang back from normal social interactions and become isolated and have difficulty learning in school. Difficulties in these areas often lead to depression as well. A good evaluation will also assess what factors keep the anxiety going and will provide guidance on how to "break the cycle".

What treatments are available for anxiety disorders?

Most anxiety disorders that fall in the mild to moderate range may be treatable without medication. Specific cognitive and behavioral, therapies are effective and are the mainstay of treatment. When the child's anxiety has gotten the family to make accommodations to avoid upsetting the child family participation in treatment is critical. This is because while catering to the child's anxiety may temporarily ease the discomfort it actually keeps the anxiety going and growing. An experienced therapist will help parents know exactly what they need to do (and not do) at home and school to help their child overcome their anxiety and fears. An example of a specific treatment is Exposure and Response Prevention Therapy for Obsessive Compulsive Disorder.

When the level of anxiety so severe that psychotherapy is not possible or would take too long to give some relief medication can be very helpful. The role of medication then is to "turn down the volume" of the anxiety to a level where the psychotherapy and family interventions can be helpful. When anxiety disorders are treated with medication alone they frequently return when medication is stopped. When treated with the appropriate psychotherapy the children learn techniques that may keep the symptoms under control for good or for long periods of time.

Warren J. Steinmuller, M.D. 225 E. Kingston Avenue Charlotte, North Carolina 28203 (704) 376-7654 Child, Adolescent, and Adult Psychiatry

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