From the April 2019 issue

Anxiety in Kids: Identifying and Treating This Mental Health Issue

Anxiety in kids is common, but pinpointing these disorders can be tricky, thanks to subtle symptoms that aren't clear to parents – let alone the kids themselves.

A young girl surrounded by a forest-like tangle of vines
Illustration by Lainey Yehl

Editor’s note: This report on anxiety in kids is part I of III in a series on mental illness in kids. Read about depression in kids and ADHD in kids, too.

As a kid, Phil La Duke recalls being plagued by worry. At times his thoughts avalanched to the point he felt incapacitated.

“I had a hellish childhood, even though from the outside it would look idyllic,” says La Duke, an author and corporate safety consultant living in Allen Park. For many of his growing-up years, La Duke figured everyone dealt with those same overwhelming feelings.

It wasn’t until he was in his 30s that La Duke was diagnosed with an anxiety disorder. It was a watershed moment. The thoughts, feelings and emotions that had overpowered him at times finally had a cause. Still, even with his own experiences and symptoms, he didn’t recognize those emerging in his daughter.

“All the signs were there, but I just attributed it to other circumstances,” says La Duke, the father of three girls. “As parents, you look at your kids, and you have a sample of one or two or three – and so your vision of what’s normal and what’s abnormal is skewed.” As a teen, his daughter, now an adult, was also diagnosed with anxiety.

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Anxiety in kids is increasingly common. Nationwide, 1 in 8 children deal with the effects of anxiety disorders – the most common type of mental health illness in kids, according to the Anxiety and Depression Association of America. But despite the prevalence, children often aren’t getting the help they need.

In a report from the University of Michigan in early 2019, researchers found about half of all children in the U.S. diagnosed with the three most common, and treatable, mental health disorders – anxiety, depression and ADHD – weren’t receiving treatment. Here in Michigan, that figure fared slightly better – 40 percent weren’t getting treatment. That’s an estimated 100,000 kids.

The reasons why kids aren’t getting the mental health care they need are complex. But when it comes to most issues, including anxiety in kids, awareness is one of the simplest starting points.

Regular worries vs. anxiety disorders

Feeling anxious in childhood isn’t necessarily a sign of an underlying mental health disorder. In fact, expressing worry in childhood is common – it’s not unusual for kids to be afraid of the dark or maybe the first day of school or even for them to spend a sleepless night concerned about taking a big test.

Yet when those worries blossom into something that impacts how they’re living their lives, that’s when parents should consider seeking expert help.

When trying to figure out the difference, Eric Herman, M.A., a clinical psychologist at Children’s Hospital of Michigan in Detroit, says it boils down to how much the child’s worries disrupt their everyday lives.

“It’s one thing to be nervous, and for kids that’s normal,” Herman says. “It’s another thing for them not to be able to sleep every night and for them to be constantly worried and tearful and to get stuck on certain things.”

Compounding that, children often have difficulty verbalizing their feelings, he adds – so their anxiety can come out in the form of headaches, stomachaches or irritability.

So just how does a parent know his or her child may need professional help with their feelings of worry? Jennifer Buswinka, a master’s level psychologist in Northville, says, “If a child seems to be really distressed and (it’s) wreaking havoc on their life, that would mean there’s a problem.”

She is also quick to point out that separating normal worries from something more can be challenging in kids.

“One of the things that a lot of parents don’t know about anxiety in children is that it doesn’t look like anxiety in adults,” says Buswinka, who also runs an anxiety program for kids ages 7-17. “Sometimes (kids) aren’t mature enough to be able to identify what’s happening, what they’re feeling.”

Symptoms of anxiety disorders

Anxiety disorders encompass a list of different types, including generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), obsessive-compulsive disorder (OCD), specific phobias and others.

Additionally, anxiety disorders often are associated with other mental health disorders, like depression. Overall, the symptoms can vary widely and differ from one child to the next. The American Academy of Pediatrics notes these common signs:

  • Recurring fears and worries about routine parts of everyday life
  • Physical complaints, like stomachaches or headaches
  • Trouble concentrating
  • Trouble sleeping
  • Fear of social situations
  • Fear of leaving home
  • Fear of separation from a loved one
  • Refusing to go to school

“I would say that generalized and social phobias are the most frequent ones that I see,” Buswinka says of the children who come to her practice. While symptoms can vary, Buswinka describes one common scenario for parents to watch for: Children can’t seem to let something go. And that feeling will mushroom to the point that they can’t function.

For example, consider a child who feels like he performed poorly at a sports practice or game. “Most kids will say, ‘Oh well.’ But a child with anxiety will be beating themselves up all day, maybe telling themselves, ‘That’s so stupid, now my friends are talking about me, the coach doesn’t like me’ – they think this over and over again,” explains Buswinka.

“This child may see this with lots of different things – when they don’t get the grade they want, when they don’t make the goal.

“A child with extreme anxiety takes it to another level, just beating themselves up about it.”

Along with various symptoms, risk factors for anxiety disorders, according to the ADAA, include genetics, brain chemistry, personality and life events.

Treating anxiety in kids

Just as anxiety disorders look different in children when compared to adults, the treatment is different, too. The good news is that anxiety disorders are highly treatable – and early intervention can greatly improve a child’s ultimate outcome.

When treating anxiety in kids, Herman notes, a holistic approach is key. For example, he uses several tools – including talk therapy and, when needed, medication – to address the anxiety disorder. But it’s also important to treat not just the child, but also the family.

Herman works with kids to help recognize and name their feelings – including what he aptly calls the “worry monster.”

“Many kids who I’ve worked with, once you identify the worry monster, it becomes easier, because we all know what we’re dealing with. We’re all speaking the same language.” That shared language includes parents, who can guide their kids through episodes of anxiety by helping the child identify the worry monster.

“So it’s not a stomachache, it’s not the flu – it’s the worry monster. As the child is able to talk, they feel better, their parents feel better and (the family) starts having some success. Things improve, and it just builds on itself.”

In Buswinka’s practice, she also sees the importance of working with a child’s family toward a treatment solution, as opposed to just the child. She guides kids and their parents to identify “unhelpful” or “negative” thoughts.

Children with anxiety often get flooded with negative feelings. Buswinka helps kids unpack those by having them evaluate and question the thoughts to de-escalate them. Then she encourages parents to work with their kids to do the same.

Finding a mental health professional

The University of Michigan researchers boiled down the factors influencing the gap among kids receiving adequate mental health treatment to three factors: accessibility, affordability and social stigma.

Put simply, there aren’t enough mental health professionals available for those who may or may not be covered with a family’s health insurance, and it can be challenging as a parent to accept your child needs mental health help.

Herman acknowledges the difficulty for parents seeking treatment for anxiety in kids, and suggests parents ask friends for recommendations, or look online at MHweb.org, for mental health professionals.

He also reminds parents of the immeasurable benefits of treatment. “I know kids that I’ve followed through their treatment from the time they were little until their graduation from college,” says Herman. “They might not have had the same type of success without treatment, they might have self medicated with drugs and alcohol.

“Treatment makes a difference. It makes a difference in parent-child relationships, too. A parent understands a child is not just being difficult, they’re dealing with anxiety. A parent sees their child in a new way and the child feels loved and understood. It changes everything.”

How parents can help

Try these suggestions from Buswinka, the licensed psychologist in Northville, who works with anxiety in kids.

  1. Give social media a break. Social media use can exacerbate feelings of anxiety. “For the majority of my adolescents, they feel like they’re failing their friends if they’re not available all the time,” Buswinka says. Some of her patients’ families have found it’s helpful to designate a phone basket or shelf where all the phones are put to “bed” at a certain time each night.
  2. Model good behavior. Parents can go a long way toward modeling for children how to deal with feelings of stress. Bushwinka notes this extends to social media use, too. If kids see their parents constantly on their phones checking messages, they’ll feel like they need to do the same.
  3. Practice 4-7-8 deep breathing. “You can find tutorials online to watch with your kids, but essentially, in moments of stress to calm down, breathe in for 4 counts, hold your breath for 7, then breathe out for 8 counts.”
  4. Revisit feelings at a better time. When kids feel overwhelmed or flooded with emotion, parents can be tempted to dismiss them. Buswinka suggests listening to, and validating, your child’s concerns. “Let the child experience the pain and recognize the feeling,” says Buswinka. At a later time, when kids have calmed down, talk to them about their feelings.
  5. Join a support group. In her practice, Buswinka holds a “Coping Cat” Anxiety Program for kids ages 7-17, that helps provide behavioral techniques to manage their feelings.

Note: If you have any concerns that your child may have an anxiety disorder, you should see a qualified mental health professional for evaluation.

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