More than 1 in 20 U.S. children age 6-17 years have anxiety or depression according to a Centers for Disease Control and Prevention Study.
I spoke to Kelly McCullough, a clinical social worker at La Jolla Therapy Center, and Katherine Williams, Ph.D. child & adolescent psychologist about the rise in anxiety in children.
Macaroni Kid: What does anxiety look like in children?
Katherine Williams & Kelly McCullough: Children may explicitly talk about certain fears or worries to their parents, peers, and/or teachers. Social situations, school performance, separating from parents, medical procedures, and the dark are all common themes children may develop fears around. Some children, especially younger children, may not be able to vocalize their fear and instead show physical symptoms and/or behaviors. Children often complain of physical symptoms such as stomach pain, headache, and muscle tension that worsens either in anticipation of or in response to one of their feared situations. Anxiety symptoms can become so difficult to tolerate children may try to avoid their fears. This avoidance can cause children to miss out on activities they once used to enjoy. For example, a child with social anxiety disorder who is afraid of being judged by peers may skip out on going to their best friend's birthday party. Children may also try to avoid activities are necessary for daily life. For example, a child with a fear of medical procedures may avoid going to the dentist to get regular teeth cleaning. This can result in a lot of parent-child conflict when parents try to encourage children to attend events and/or complete tasks that may be anxiety provoking. Children, especially younger children, also often exhibit anxiety symptoms behaviorally by crying, screaming, and protesting. These behaviors also often play a role in the avoidance cycle.
Are we seeing a rise in anxiety in children in the U.S.? If yes, why is it escalating?
Studies do show both childhood anxiety and depression in the US have been on the rise since 2012. While it is impossible to definitively identify a single cause to this trend, there are many factors that may may be contributing, such as increased exposure to social media and significant increase in academic demands. For example, a child may see a peer post a picture of a social event they were not invited to, which may then cause negative self-thoughts about why they were not invited and potential anxiety when faced with the peer at school the next day. In my private practice, I see increasing academic competition with a drive on students being admitted to a high profile school has even impacted elementary and middle school children I work with. Often the fear is "if I don't get into a good school I'm not going to get a good enough job."
A lot of children with ADHD, and Autism also suffer from anxiety why is that the case?
Children with ADHD and Autism experience and relate to the world with a different perspective then individuals without ADHD and Autism. Children with ADHD experience deficits related to sustained attention, executive functioning, and organizational skills. These deficits often impair their ability to both learn in a traditional classroom setting and to participate in structured extracurricular activities. Often children with ADHD experience failures in structured settings if their special needs haven't been adequately addressed by school staff. Children with ADHD may then develop fears surrounding their ability to perform and succeed at the level of their peer who do not have sustained attention challenges in a typical classroom setting given this history of past failures. Alternatively, children with Autism often experience difficulty modulating their sensory input due to impairments related to sensory processing. This can result in certain sensory experiences being perceived as completely overwhelming to an individual with Autism. What could be a mundane daily task, such as going to the mall, can be a sensory challenge for an individual with Autism. Difficulty understanding and processing the different smells, sounds, and sights may make a child with Autism more susceptible to anxiety.
If a parent thinks that their child has anxiety, what can they do to alleviate their anxiety and stress levels?
The number one thing a parent can do to help an anxious child is to encourage the child to face their fear. This means bringing the child to school even if they are complaining of a stomach ache (after a medical work up by the pediatrician) or saying they don't want to go. Some relaxation training techniques can be helpful to manage anxiety symptoms, such as paced breathing, listening to calming music, and visualizing a peaceful scene. Parents can also help their children to practice mindfulness strategies by helping them to stay focused in the present moment as a way to distract and cope with anticipatory anxiety. For example, if a child is worried about a shot she is getting the next day, parents can tell their children "you have all of tomorrow to worry about the shot, right now let's focus on enjoying soccer practice."
Does anxiety become worse if left untreated?
Anxiety is normal; everyone experiences anxiety. In fact, it is a helpful response for humans to survive. However, in this modern world, there are too many false cues telling people to be anxious. When anxiety starts to interfere with the child's day-to-day life (e.g., refusing to go to school), then it moves from normal anxiety to a possible anxiety disorder. In this case, anxiety can and many times does worsen when left untreated. Well-meaning parents can inadvertently contribute to their child's anxiety worsening by allowing them to avoid anxiety-provoking tasks or situations. When children avoid tasks that are anxiety-provoking, their anxiety often worsens (e.g., the fear gets stronger).
How can parents assure their kids without coddling them?
The most important thing a parent can do is help to encourage children to face their fear! Statements like "I know this is really hard for you, and it is still important that we face your anxiety" can be helpful. Parents can use language about children "defeating their anxiety monster" or "challenging their anxiety super villain" to help encourage children to face their fears. Parents can remind their children of other times they have been successful facing their fear in the past, such as recalling prior presentations the child gave or other shots the child received when she was younger. Parents can provide incentives to motivate children to face their fears, such as a special outing (park, pet store, dog walk) or a free choice (allowing children to pick where they eat for dinner, what movie to watch that evening). External incentives can be very helpful in anxiety treatment especially when the drive to avoid is very strong. Parents can remind children to use their relaxation skills and can model deep breathing when parents themselves are feeling stressed as well.
Is there anything else you would like to add?
Don't be afraid to seek professional help if needed. Anxiety is something we all experience to varying degrees, but it can become debilitating in severe cases. Anxiety is very treatable and responds very well to cognitive-behavioral therapy, specifically exposure therapy. If your child is routinely missing out on activities they used to enjoy and/or is unable to complete tasks that are required for their well being (going to school, going to doctor, etc), it may be a good time to reach out for support.
For More Information Visit: www.lajollatherapycenter.com
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