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Friday, May 22, 2015

Why Childhood Anxiety Often Goes Undetected (and the Consequences)

From the Child Mind Institute

By Roy Boorady, M.D.
May 12, 2015

Kids often keep their worries hidden, or express them in ways that are hard to read.

Anxiety is a natural thing. It is normal for very young children to be afraid of the dark, or for school-age children to worry about making friends. But for some kids, normal anxiety morphs into something more serious.

A young girl might be afraid to ever leave her mother's side, even to get on the school bus, or an anxious boy may need frequent reassurance over things that happened a month ago.

Kids can develop an anxiety disorder. Eventually the disorder can start interfering with a child's friendships, life at home, and work in school. Even so, the anxiety still might not be noticeable to parents and caregivers.

For one thing, being anxious doesn't necessarily mean that you can't function—it might just make some kinds of functioning more difficult. A homework assignment that should take twenty minutes might take an hour, for example.

With anxiety, it's important to remember how internal it is. It dominates a child's thoughts, but it might not be obvious to the people around her.

It's also worth noting that in my work as a child psychiatrist I see a lot of anxious kids who are still basically happy and enjoying life. Maybe they are only struggling in certain situations, which may make their anxiety all the easier to overlook.

Outward Signs of Anxiety

When anxiety is expressed outwardly, there can be a wide range of signs, which often complicates identification.
  • Kids may have trouble sleeping or complain about stomachaches or other physical problems.
  • They may become avoidant and clingy around parents or caregivers.
  • They might also have trouble focusing in class or be very fidgety—I like to say, "Not all that moves is ADHD," even though that's often the first thing we suspect from a hyperactive or inattentive child.
  • They may have explosive outbursts that make people think they are oppositional, when their fight-or-flight mechanism is triggered.

The words we use to describe our anxiety can distract, too. People use a lot of different words to describe what they're feeling—kids might say they are self-conscious, shy, apprehensive, worried, or afraid. These words do a good job capturing what they are struggling with, but fixating too much on them can distract from the fact that anxiety is underlying factor—not some personal failure in personality.

Consequences of Untreated Anxiety

If you look at the prevalence rates of anxiety disorders, you'll see that the numbers rise as children get older. That makes sense because anxiety disorders are cognitive, so they develop as our cognitive ability develops. Separation anxiety, for instance, develops early, whereas social anxiety disorder usually develops after puberty.

A study of more than 10,000 kids, interviewed by trained professionals, shows that more than 30 percent had developed an anxiety disorder some time before they were 18.

Anxiety frequently recurs, too, and childhood anxiety is often a precursor for adult anxiety, especially for kids who don't receive treatment. The same study showed that 80 percent of kids with anxiety do not get treatment. Many adults seeking help for anxiety remember feeling anxious when they were younger, which means that they've been struggling for a long time and could have benefited from treatment as children.

Avoidance Reinforces Anxiety

Kids with untreated anxiety also begin to develop poor coping skills. A common example is avoidance—people who are very anxious will try to contain it by avoiding the thing that makes them anxious. It's a short-term solution that unfortunately reinforces their anxiety instead of acclimating them to it.

Similarly, untreated anxiety can lead to lower self-esteem, academic dysfunction and self-medication through substance abuse.

Anxiety Leads to Depression

People living with anxiety for extended periods of time are also more likely to develop depression. It isn't uncommon to meet patients who come seeking treatment for depression or depressive symptoms and it turns out that they have been dealing with lifelong anxiety as well. In cases like this people need treatment for anxiety and depression.

Fortunately, we know a lot about how to treat anxiety. It responds very well to cognitive behavior therapy, and there are medications that work, too. Getting help makes a big difference, and treatment doesn't need to be a lifelong thing—although its positive effects will be.

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