Counseling for Children with Anxiety Disorders

Q: What are anxiety disorders?

A: Anxiety disorders are a group of diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (i.e. DSM) that include phobias, generalized anxiety, social anxiety, separation anxiety, panic disorder, selective mutism, and agorophobia. A common element of these is feeling fear and acting in a manner that reflects this.

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Q: What is obsessive-compulsive disorder (OCD)?

A: Obsessive-compulsive disorder is a challenge affecting over 1 out of every 100 Americans. It includes presence of obsessions, compulsions, or both. An obsession is an intrusive distressing thought. A compulsion is a behavior that is done repetitively in an attempt to reduce anxiety or intrusive thoughts. OCD is impactful, and prevents a child from living a typical life - impairing how they interact with family or friends, how they act at home, how they behave at school, or their abilty to interact in any other important area (e.g. extracurriculars). 

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Q: What is a phobia?

A: A phobia is an intense fear of something that prevents being able to have typical social interactions, or impacts how a child functions at school, home, or another major area of life. There is often avoidance related to the phobia (tantrums, refusal behaviors) as well. Common phobias include fear of an animal or insect (e.g. dogs, bees), certain weather/nature conditions (e.g. storms), injections or needles, and also things like fear of vomiting, fear of small spaces, etc. Not all anxiety is a phobia, but all phobias include intense anxiety. 

 

Q: Does my child have an anxiety disorder? Why would it be difficult to tell if my child has anxiety?

A: It can be tricky at times to determine if a child has an anxiety disorder, as there are a couple of different elements of this that can mask this in children. For one, many children present with physical concerns, and their issue appears medical rather than clearly anxious. Examples of this include when symptoms are very much dominated by stomachaches - even vomiting and diarrhea. There can be other physical symptoms present, but this one is highly common in children with anxiety, and, as the stomachaches and/or gastrointestinal symptoms are very real, it can be very difficult to distinguish. If your child presents with a highly physical symptom picture, we will often need to rule out any medical issues first (e.g. a dairy intolerance, Chron's) and establish a history of any triggers or other patterns. This often includes a referral to the pediatrician and/or a specialist. 

 

Secondly, many children's anxiety appears highly behavioral. Given that avoidance of something in children often requires defying adult directions, this can look much like a child has a purely behavioral issue, and the anxiety can go overlooked. For example, refusal to go to bed at nighttime can be related to separation anxiety from the parent(s), fears of the dark, or even phobias related to the potential appearance of bad weather. In these situations, parents may believe their child is simply being defiant, and may be unable to recognize the root cause being anxiety. It can lead to conflict around bedtimes or other times triggering anxiety (e.g. school/school refusal). 

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Q: What is a panic attack? What does a panic attack look like in a child?

A: Panic attacks are intense moments of anxiety that present in a highly physical manner. These include difficulty breathing, racing heart, shaking - and, in chidren, this often could look like hysterical crying, tantrum-like behaviors, and refusal behaviors. Individuals with panic attacks feel a sense of doom, and therefore are genuinely afraid for their health and safety at the moment this is occurring. Parents can often feel as though their child is simply being defiant or is upset, but your child's therapist can work with you to explore if these might actually be symptoms of panic attacks. 

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