The following Healthy Kids column originally appeared in the July 19, 2004 edition of the St. Louis Post-Dispatch.
Being a parent can be hard work. And young people might tell you that being a kid is no picnic, either.
It seems these days that all of us – parents and children alike – are under increased stress to perform and succeed. This stress can produce anxiety, some of it self-induced and some originating with an outside source. But whatever the cause, stress and anxiety can be as unhealthy for our children as they are for us adults.
Some level of fear and anxiety is normal during a child’s development. Over time, most of this anxiety subsides as children begin to learn what to expect from their environment and relationships with others.
When those fears and anxieties fail to fade, however, parents should seek a medical evaluation. Anxiety disorders are among the most common mental health problems faced by children and adolescents, according to the National Mental Health Association. (See attached box for descriptions of the most common childhood anxiety disorders.)
"Stress and anxiety in children can lead to a variety of difficulties. Depending on the developmental age of the child, the child may present with temper tantrums, bed-wetting, perfectionist tendencies, school performance concerns, peer relationship concerns, avoidance of a specific anxiety-provoking situation or other emotional concerns,” says Donna Gfeller, PhD, Director of Psychology & Psychiatry at SSM Cardinal Glennon Children’s Hospital. “Excessive anxiety may also be associated with chronic headaches or stomachaches, irritability, sleep disturbance, or regressive behaviors in children."
In one large-scale study of children between the ages of 9 and 17 years, as many as 13 percent were reported to have had an anxiety disorder in the previous year, according to The Children’s Hospital of Philadelphia. Other studies estimate that 5 to 20 percent of children will develop some type of anxiety disorder.
Short of medical intervention, one of the best things parents can do is to learn to communicate with their children. As simple as it sounds, a key component of communicating with your child is learning to listen.
By listening and allowing a child to initiate conversation, parents can build a trusting relationship that encourages the child to talk through their problems and find solutions. While it’s a good thing to assist with problem solving, the foundation of communication is best laid by resisting the urge to force grown-up solutions on young people.
Other good ideas for fostering open communication are to acknowledge your child’s emotions, help him to explore his feelings by talking openly about them, and involving your child in creative activities that allow him an outlet for his feelings.
Perhaps the best day-to-day tactic for helping children avoid anxiety is to be positive and upbeat, even when faced with your child’s shortcomings. Whether it’s a poor grade in school or something as simple as spilled milk, a parent’s reaction can make or break a young person’s self-image. Harsh responses can lead over time to depression, less occupational success, difficulty accepting failures, lack of motivation and reluctance to try something new.
If, on the other hand, a parent encourages a child to look at the positive angle of a bad situation and try hard to do better next time, the effect can be spectacular. By modeling a positive outlook, you can lead your child to fly high and succeed in later life.
Dr. Bob Wilmott is Chief of Pediatrics at SSM Cardinal Glennon Children’s Hospital and is a Professor of Pediatric Medicine at St. Louis University School of Medicine. If you have a child health question for Dr. Wilmott, go to the “Ask Dr. Bob” section of the Cardinal Glennon Web site at www.cardinalglennon.com.
The following information is provided by the National Mental Health Association:
What Are the Most Common Anxiety Disorders in Children?
There are several types of anxiety disorders. The list below describes those most common to children.
Generalized Anxiety Disorder — Children with generalized anxiety disorder (GAD) have recurring fears and worries that they find difficult to control. They worry about almost everything—school, sports, being on time, even natural disasters. They may be restless, irritable, tense, or easily tired, and they may have trouble concentrating or sleeping. Children with GAD are usually eager to please others and may be “perfectionists,” dissatisfied with their own less-than-perfect performance.
Separation Anxiety Disorder — Children with separation anxiety disorder have intense anxiety about being away from home or caregivers that affects their ability to function socially and in school. These children have a great need to stay at home or be close to their parents. Children with this disorder may worry excessively about their parents when they are apart from them. When they are together, the child may cling to parents, refuse to go to school, or be afraid to sleep alone. Repeated nightmares about separation and physical symptoms such as stomachaches and headaches are also common in children with separation anxiety disorder.
Social Phobia — Social phobia usually emerges in the mid-teens and typically does not affect young children. Young people with this disorder have a constant fear of social or performance situations such as speaking in class or eating in public. This fear is often accompanied by physical symptoms such as sweating, blushing, heart palpitations, shortness of breath, or muscle tenseness. Young people with this disorder typically respond to these feelings by avoiding the feared situation. For example, they may stay home from school or avoid parties. Young people with social phobia are often overly sensitive to criticism, have trouble being assertive, and suffer from low self-esteem. Social phobia can be limited to specific situations, so the adolescent may fear dating and recreational events but be confident in academic and work situations.
Obsessive-Compulsive Disorder — Obsessive-compulsive disorder (OCD) typically begins in early childhood or adolescence. Children with OCD have frequent and uncontrollable thoughts (called “obsessions”) and may perform routines or rituals (called “compulsions”) in an attempt to eliminate the thoughts. Those with the disorder often repeat behaviors to avoid some imagined consequence. For example, a compulsion common to people with OCD is excessive hand washing due to a fear of germs. Other common compulsions include counting, repeating words silently, and rechecking completed tasks. In the case of OCD, these obsessions and compulsions take up so much time that they interfere with daily living and cause a young person a great deal of anxiety.
Post-Traumatic Stress Disorder — Children who experience a physical or emotional trauma such as witnessing a shooting or disaster, surviving physical or sexual abuse, or being in a car accident may develop post-traumatic stress disorder (PTSD). Children are more easily traumatized than adults. An event that may not be traumatic to an adult—such as a bumpy plane ride—might be traumatic to a child. A child may “re-experience” the trauma through nightmares, constant thoughts about what happened, or reenacting the event while playing. A child with PTSD will experience symptoms of general anxiety, including irritability or trouble sleeping and eating. Children may exhibit other symptoms such as being easily startled.
What Can Parents and Caregivers Do?
By identifying, diagnosing and treating anxiety disorders early, parents and others can help children reach their full potential. Anxiety disorders are treatable. Effective treatment for anxiety disorders may include some form of psychotherapy, behavioral therapy, or medications. Children who exhibit persistent symptoms of an anxiety disorder should be referred to and evaluated by a mental health professional who specializes in treating children. The diagnostic evaluation may include psychological testing and consultation with other specialists. A comprehensive treatment plan should be developed with the family, and, whenever possible, the child should be involved in making treatment decisions.