Anxiety Disorders in Children and Teenagers #27

We learnt from blog posts #1 and #2 that a mental disorder or illness is caused by a disturbance in one or more of the six domains of brain function. When we are stressed, anxious, scared or shocked, the signaling domain in the brain is triggered and the flight, fright, fight response is activated as a way of alerting us to potential danger and helping us to prepare and pay attention. Reactions such as fear, stress and anxiety are normal mental health responses to unexpected changes, and once the stress has passed, the flight, fight, response goes back to sleep mode. However, in many children/teenagers, this does not happen, and they remain in hyper alert mode.

Anxiety is the most common of mental disorders affecting approximately 30 percent of adults and 10 to 15 percent of children and teenagers.

The types of anxiety disorders include:

  • Generalized anxiety disorder
  • Post traumatic disorder
  • Social anxiety disorder
  • Obsessive compulsive disorder
  • Panic disorder
  • Phobias, agoraphobia
  • Separation anxiety disorder

Causes
Anxiety disorders appear to be caused by a combination of biological factors, psychological factors and life experiences, including:

  • Family history
  • Childhood development issues
  • Alcohol, medications, illegal drugs
  • Traumatic life event
  • Other medical and/or psychiatric problems

Generalized Anxiety Disorder (GAD)

GAD is a mental disorder characterized by incessant worrying and undue stress about everyday things. A key distinguishing factor in GAD is that the anxiety is focused on internal triggers such as performance in school or sports and can result in extreme studying, practice. Children/teenagers with GAD seek constant reassurance in an attempt to assuage their fears and worries. Studies show that GAD appears to be more common in girls than boys. GAD impacts a child/teenager’s quality of life and ability to participate in social activities, school, etc. Of interest, children/teenagers with ADHD appear to experience more episodes of GAD.

Signs and symptoms
Persistent, excessive, unrealistic worry about everyday things
Inability to relax, irritable, rigid
Sleeping problems including night terrors
Difficulty concentrating
Fatigue, nausea, headaches, stomach aches
Muscle tension
Startles easily, ‘on edge’
Heart racing, clammy skin, shaky limbs

Diagnosis
For a diagnosis of GAD, the anxiety must be present for at least six months, is focused on different things, causes significant distress and have one or more of the symptoms listed above.

Treatment
Treatment for GAD usually comprises psychotherapy and medications:

Cognitive behavioural therapy
Exposure therapy
Antidepressants (SSRIs) – GAD responds well to SSRIs
Anti anxiety medications may be prescribed if GAD is severe e.g. Buspirone
Mindfulness: breathing exercises, relaxation techniques
Holistic approach to daily life
Coping strategies
Promote healthy lifestyle: diet, exercise
Research shows that children and teenagers with GAD are at an increased likelihood of developing depression.

Social Anxiety Disorder

Unlike general anxiety disorder, the focus is not on perfectionism but rather what others will think of the child/teenager resulting in a persistent fear of embarrassment, ridicule or humiliation in social setting such as school or social event. Children and teenagers with this disorder are terrified that they will humiliate themselves in front of their peers, friends, family by saying something inappropriate, becoming embarrassed, stammering words, turning red, even shaking and/or vomiting. In many
instances, the disorder usually develops after an embarrassing and stressful incident.

Signs and Symptoms
Excessive worrying before school/event
Excessive preparation for exam or class presentation
Crying
Tantrums
Excessive clinging or social withdrawal
Somatic complaints such as stomach pain, headaches, body aches

Diagnosis
For a diagnosis of social anxiety disorder, the anxiety must be present for at least six months, must be consistent in similar settings e.g. classroom and must occur in peer settings.

Treatment
Cognitive behavioural therapy
Medications
Relaxation techniques: meditation, yoga, breathing exercises, music
Holistic lifestyle

Panic Disorder

Panic disorder is characterized by panic attacks that occur at least once a week. A panic attack is a brief, (about 20 minutes) episode of intense fear that is usually accompanied by the following symptoms:

Rapid breathing
Sensation of choking
Pounding heart, chest pain, feels like having a heart attack
Sweating, palpitations
Feels numb, detached, going crazy
Intense fear, trembling, flashbacks
Feels faint, dizzy

Panic disorder is more common in teenagers than young children, and panic attacks can occur in any anxiety disorder, usually in response to the focus of the disorder (Merck Manual, 2019).

Follow up with a doctor is imperative to rule out any medical conditions and to help determine what is the cause for the panic attacks. An important point to remember is that a medical condition such as asthma can trigger a panic attack and panic attacks can trigger asthma.

Diagnosis
To receive a diagnosis of panic disorder, one must experience spontaneous panic attacks, seemingly ‘out of the blue’ along with physical, emotional and cognitive symptoms.

Treatment
Panic disorder is usually treated with a combination of medications and behavioural therapy. Self-help strategies for managing the panic attack are also developed.

Management of a panic attack

Deep breathing (it may be helpful to breathe in and out of a brown paper bag)
Recognise it is a panic attack and it will pass
Close eyes
Practice mindfulness
Focus on an object, an image, a sound
Muscle relaxation techniques
Picture your happy place
Repeat a mantra
Take medications if prescribed
Use cool compress on neck and forehead

Tips for Parents

Early intervention and treatment for an anxiety disorder can help a child/teenager understand and manage his/her feelings and reactions and help prevent further complications. Some suggestions to help your child/teenager manage his/her anxiety disorder include:

  • Stay calm when child/teenager becomes anxious
  • Be understanding, supportive, show love
  • Recognize and praise small accomplishments
  • Follow up with psychotherapy, medical appointments, etc.
  • Pay attention to your child/teenager’s feelings, listen to any fears and/or concerns
  • Practice self-help strategies with child/teenager e.g. deep breathing, relaxation exercises
  • Do not intimidate, joke, force, threaten or invalidate feelings
  • Maintain daily routine
  • Promote healthy lifestyle: diet, exercise
  • Work with school
  • Talk with family, friends, siblings and offer suggestions on how to help

In my next Blog #28
I will talk about mental health tips for surviving the holiday season

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