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Normal Worry — or Worse? Anxiety Disorders on the Rise Among Children

  • One of many drawings depicting anxiety hangs outside the offices of therapists at Mountain Valley Treatment Center in Pike, N.H., Oct. 26, 2017. (Valley News - James M. Patterson) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Valley News photographs — James M. Patterson

  • Dr. Tim DiGiacomo left a position as a clinician and acting director of the child team at West Central Behavioral Health to become clinical director at Mountain Valley Treatment Center in Pike, N.H., in May 2016. DiGiacomo was photographed in Pike, N.H., Oct. 26, 2017. (Valley News - James M. Patterson) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. James M. Patterson

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    Canaan Elementary School teacher Allison Porreca acts out hitting the "worry wall" with students in her fourth-grade class on Oct. 27, 2017 in Canaan, N.H. Students were giving ideas on how to cope when worried about something. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Jennifer Hauck

  • Third-grade students Sawyer Harrington, left, and Alex Averine listen in class at the Canaan Elementary School on Oct. 27, 2017 in Canaan, N.H. Students were engaged in a conversation about ways for students to self-regulation in controlling their emotions and impulses. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Jennifer Hauck

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    Special Educator Stephanie Corey talks with her third-grade class about how they may deal with emotions in an exercise called "zones of regulate" at the Canaan Elementary School on Oct. 27, 2017 in Canaan, N.H.(Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Jennifer Hauck

  • Canaan Elementary School fourth grade teacher Allison Porreca works with student John Ignacio on Oct. 27, 2017 in Canaan, N.H. The class was talking about ways to feel better when worried about something. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Valley News — Jennifer Hauck

  • Canaan Elementary School special educator Brooke Ross-Limero is handed work by fourth-grader Micah Sperry after students talked and wrote down ideas on how to help themselves when they were worried about something. The class worked on ideas together on Oct. 27, 2017 in class in Canaan, N.H. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Valley News — Jennifer Hauck

  • Amy Reiter, a special education behavioral coach at Canaan Elementary in Canaan, N.H., talks with a student about a field trip the student would be on that day on Oct. 27, 2017. Reiter wanted to help prepare the student for the trip and talk about expectations for her. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Jennifer Hauck

  • A fourth-grade student at Canaan Elementary School writes down ways that might help when feeling worried, on Oct. 27, 2017 in Canaan, N.H. (Valley News - Jennifer Hauck) Copyright Valley News. May not be reprinted or used online without permission. Send requests to permission@vnews.com. Valley News — Jennifer Hauck

Valley Parents Correspondent
Published: 11/3/2017 11:55:30 AM
Modified: 11/3/2017 1:55:45 PM

Most parents have dealt with separation anxiety in their toddler or young child. Their 4-year-old may refuse to let go of her mother’s leg when dropped off at preschool, or cry as her parents head out the door for dinner. Or maybe an elementary school child is afraid of the dark.

These fears are a perfectly normal part of childhood, and most children pass through these phases and are able to separate from their parents or go to sleep without worry.

However, for many children and adolescents, being fearful and anxious is the norm, and anxiety prohibits them from fully participating in everyday activities. In extreme cases, anxiety may prevent them from functioning in a typical, developmentally expected manner.

According to the Child Mind Institute, a national nonprofit organization that provides mental health education, support and resources to children and families, nearly 32 percent of children under the age of 24 in the U.S. have or have had an anxiety disorder.

It’s by far the most prevalent psychiatric disorder among youth, followed by attention-deficit hyperactivity disorder and disruptive behavior (19.6 percent) and depression and bipolar disorders (14.3 percent).

Unfortunately, according to the institute, 80 percent of youth never get treatment for their anxiety disorder.

“Anxiety is a normal and a healthy emotion,” said Sarah Stearns, a pediatric psychologist at Deer Creek Psychological Associates in Hanover. “It serves a protective factor. There are physical and emotional components that result when we have a sense that we are threatened or in some kind of danger. It’s a little like having brakes on a car; we want kids to have brakes, but what happens sometimes is they get stuck, like their ‘emergency brake’ is engaged.”

Stearns said there are many types of anxiety, and likened it to ice cream: There are many different flavors and one can have more than one scoop in one’s bowl. A child could have generalized anxiety and separation anxiety at the same time, or post-traumatic stress disorder and panic at the same time. Obsessive-compulsive disorder is another form of anxiety.

The Child Mind Institute reports that the median age of onset for anxiety is 6, but anxiety can affect children of all ages. Stearns has clients from 3 to 22, and said she sees an uptick around fourth grade, when children are becoming more independent, and getting more homework.

Transitions — such as from elementary to middle school, or high school to college, or when there are big changes (whether developmental, physical or within the family unit) — can also bring on anxiety disorders in children.

Are Parents Passing Their Anxiety To Their Children?

As with most traits, anxiety in children can sometimes be traced back to parents, but that does not mean parents are knowingly or even consciously making their children anxious. According to Stearns, the majority of anxious children have at least one anxious relative, often a parent. So there is likely a genetic component. But modeling can also be an important factor.

“If you’re not sure if your child is going to be OK at a birthday party and you say, ‘OK, Billy, are you going to be OK if I leave? Are you sure? I’ll be right here, I’ve got my phone, and you’ve got your phone, OK?’ You’re passing along that message that maybe it’s not OK to be at that birthday party,” Stearns said.

The way a parent reacts to stress can play a role, too. Tim DiGiacomo, a clinical psychologist and the clinical director at Mountain Valley Treatment Center in Pike, a residential facility that treats children and teens with severe anxiety disorders, suggested that parents reflect on how they react in anxiety-provoking situations, and what their responses may be teaching their children.

“We all need to shine the light on ourselves on things we could do better, but that can turn into just beating ourselves up. I think there are a lot of families out there who are really struggling and parents can be pretty hard on themselves,” DiGiacomo said.

“Doing what you need to do to help your kid, including perhaps personal therapy, is different from just ruminating and beating yourself up.”

How Much Anxiety Is Too Much?

Given that most of us, including children, are anxious from time to time, it can be difficult for parents to differentiate typical anxiety (stage fright or nervousness before a test) from an anxiety disorder that may need professional treatment.

DiGiacomo said it’s important to look at the level of distress in the child as well as how the parent is coping.

“First, parents should look at how much of it is getting in the way of a kid doing typical things, like going to school or spending times with friends or having sleepovers,” he said.

“Another way of looking at it is, if parents notice themselves starting to overly accommodate in order to keep the child calm, and that causes interference in the family. When they notice they are doing things that are counter to their values that don’t seem to be helping, but seem to be accommodating the anxiety, that may be a point where they want to reach out for help,” DiGiacomo said, hastening to add that this is not an indictment of the parents.

Getting Help

Since anxiety in children often affects how they function in class, the school is a good place to start when seeking support or guidance for treatment. Most schools have guidance counselors, and many in the Upper Valley have good relationships with mental health facilities or therapists in private practice.

“Schools are a pivotal piece of the partnership with parents and counselors,” said Amanda Isabelle, principal at Canaan Elementary School. “It allows for nice alignment when everyone can work together using the same language.”

Amy Reiter, a special education behavioral coach at Canaan Elementary, has been an educator for 35 years. She’s not a therapist, but often works with children who have anxiety, sometimes related to trauma (see sidebar, page 13) to help them learn to soothe themselves.

“They can pick things that work for them. Sometimes it’s self-talk, telling themselves they can do something,” Reiter said. “I have kids write themselves notes and tape them to their desk. Pushing something heavy, carrying something heavy, jumping jacks, wall push-ups; there is definitely a physical component. We say, try this and if it works for them we can put it in their individual toolbox. They might have half a dozen things that work for them. Not every student who has anxiety is going to use this, but it can be very useful for some.”

Canaan Elementary teaches these lessons to all students; not just those who have diagnosed anxiety disorders.

The family doctor can also be a great resource. As Stearns pointed out, the child’s pediatrician will know what’s developmentally typical. More important, the pediatrician will know the child and, if there is a long-standing relationship, will have seen the child through various developmental phases. Doctors also have good relationships with therapists and can make personal recommendations or referrals.

Increasing Anxiety to Reduce It

The most common and successful treatments for anxiety disorder are cognitive behavioral therapy, which is a short-term practical approach to problem-solving used to change patterns of thinking or behavior, and exposure therapy, in which the person with anxiety is exposed to the thing or situation that brings on the anxiety.

“What we are doing is asking kids to tell us what is actually causing them discomfort, what is causing anxiety, what are they afraid of, and what do they fear,” DiGiacomo said. “And then we’re asking them to work with us to engage in situations that evoke that fear, that make them uncomfortable. The more that you engage in exposure therapy, when done correctly, you’re actually going to see a reduction in the anxiety,” he said, adding that there needs to be a willingness on the part of the children and families to engage — and experience — the discomfort.

A common cause of anxiety among teenagers is academics and fear of not doing well in school. Seoka Salstrom, a clinical psychologist who owns the Hanover Center for Cognitive Behavioral Therapies and who has been treating anxiety in children for 16 years, worked with a fourth-grade girl in Chicago with “intense academic perfectionism.” She insisted on perfect handwriting and had a very low tolerance for mistakes or indecision, and worried constantly about her grades.

“One of the first things we did was to have a lot of conversations with the girl’s teachers to give them a heads-up,” Salstrom said. “We went to her house, to see exactly where and how the anxiety was showing up, and did her homework together. Instead of looking up answers she wrote her best guess. I had her write very quickly or messily, or write very neatly and then scribble on the paper. Maybe we would put capital letters in weird places or leave words out of sentences. She learned to hang out with the anxiety without giving in to its demands. She learned to make room for it and at the same time choose to focus on what was most important to her, like her genuine curiosity and interest in learning, which had gotten lost in the mix.”

That particular sequence of exposures took three to four sessions, but it addressed just one of the girl’s many OCD symptoms. Salstrom said that, while it’s possible to make great progress on one particular area, anxiety is a shape-shifter, and it will find a new threat to hold on to. Eventually, they worked through them all, and the girl is now a senior in high school and doing well.

“The roots of the tree are intolerance of uncertainty and intolerance or unwillingness to have distress or discomfort. If every single practice is to help a person become more willing to experience discomfort, every single time you treat a symptom, you are increasing that willingness; it’s a cumulative effect,” Salstrom said. “When you create exposure hierarchy then the others fall off. Do the most challenging thing that the client is a willing to do. A lot of the other ones become obsolete.”

None of us will ever be entirely free of anxiety, and that shouldn’t be the goal. Parents can help their children learn to cope with typical levels of anxiety, and seek treatment if the anxiety is infringing on the child’s ability to function happily. Above all, it’s critical to help children understand that there is nothing wrong with them, that they are not alone and that they didn’t do anything to cause the anxiety.

“It’s important to know that feelings don’t come in good and bad,” Salstrom said. “Anxiety is simply a human emotion, but we talk about it like it’s something bad that we have to get rid of because it can be so unpleasant, and that whole agenda is a big part of the problem. The problem is not that we experience that emotion, it’s that we give it too much power. We assume it’s accurate without questioning it. The idea is to change our relationship with our anxiety and focus on what really matters to us. The bigger our life gets, the smaller our anxiety gets.”

Correction

This story has been corrected to show that clinical psychologist Seoka Salstrom owns the Hanover Center for Cognitive Behavioral Therapies.




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