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Johns Hopkins Health - Getting Anxious

Fall 2008
Issue No. 2

Getting Anxious

Date: September 24, 2008

Girl in thunderstorm

Anxiety is on the rise in children. Identifying and treating it early can avoid big problems later on

When he was barely 7, one boy brooded about death and worried that his grave might not be alongside his mother’s. Then he refused to ride the bus and dreaded the beginning of the school week. Another boy, age 13, went to the ER twice with panic attacks, complained of headaches and stomachaches, and compulsively checked his heart rate because he was concerned about overexerting himself.

In both cases, the parents were confounded, left searching for a cause and wondering, “Where is this coming from?”

But in the vast and complex spectrum of childhood anxiety disorders, that kind of thinking is futile, says Johns Hopkins child psychologist Golda Ginsburg, Ph.D. In fact, parents may create their own anxiety trying to figure it out.

Anxiety on the Rise
“It’s rare that specific events cause an anxiety disorder,” Ginsburg says. “There are usually complex reasons why it can happen, and why it can be more intense for some kids than for others.”

What is clear, says Mark Riddle, M.D., director of the Johns Hopkins Division of Child and Adolescent Psychiatry, is that childhood anxiety is a lot more common than most people think: As many as 20 percent of children between the ages of 5 and 16 experience some type of anxiety. Compare that to the 5 percent of kids worldwide with attention deficit/hyperactivity disorder (ADHD).

Whether children are feeling more pressured at earlier ages and where those pressures come from—parents, peers, school, media—may be less important than recognizing there is a problem in the first place.

“In a way, it’s really a silent epidemic,” Riddle says. “Most of the time adults aren’t bothered by it in their children until it’s severe and disruptive enough for professional help—if even then.”

That’s unfortunate, he says. Anxiety in childhood is a good predictor of depression and anxiety later in life. So, while it may seem minor in kids, it can lead to bigger problems down the road if left untreated. Social anxiety, for example, is the No. 1 nonacademic reason for dropping out of high school. Repeated and long-term panic attacks—a severe form of anxiety—may morph into phobias such as fear of leaving the home or going into crowded places.

“It can really stunt a child’s growth,” Riddle says.

Symptoms and Solutions
The good news is that childhood anxiety is very treatable and even reversible. The trick is to identify those early signs and symptoms and take steps to address them. For that, parents might first turn to themselves and their own histories. Research shows a strong genetic basis for anxiety. If you tend toward anxiety or have been treated for it, your children are more likely to have the same tendencies.

So how do you know if your child is suffering? And what can you do about it?

“Watch your kids for those behaviors that you may be already all too familiar with,” Ginsburg says. “And understand that for some children with anxiety disorders, all the reassurance in the world won’t help.”

Other things to look for include unreasonable fears that don’t go away; physical symptoms that include heart palpitations, sweating, chills, stomachaches and headaches; and children who continually avoid situations or become upset at having to endure them. Parents can help first by not accommodating the fears or avoidance.

“Pay attention to the anxiety,” says Johns Hopkins child and adolescent psychiatrist John Walkup, M.D. “But don’t play into the avoidance yourself and don’t use that and overprotectiveness as strategies.”

It’s counterproductive, Walkup says, and may undermine a child’s capacity to cope, tolerate and learn about the world—generating even more anxiety. Instead, children, like adults, must face their fears. For some parents, helping their children do that may be as simple as walking the aisles of their local bookstores or libraries.

“There are very good books for parents on helping children with anxiety,” Ginsburg says.
Psychologically speaking, parents need to be fearless themselves, Walkup says. “We live in a safer world than ever, but parents are more afraid for their children than they’ve ever been,” he says. Anxious parents transmit that fear to their kids, whether they realize it or not.

“We can’t underexpose our kids,” Walkup says. “Without forcing it, we need to let them feel the challenge of new or difficult situations.”

When to Seek Help
When anxiety is uncontrolled and lasts longer than six months or is debilitating, parents should turn to professionals for help. Pediatricians and school guidance counselors are on the front lines and can direct parents to the best resources. Depending on the degree of anxiety and its symptoms, children may be referred to child psychologists or psychiatrists. Treatment may involve cognitive behavioral therapy, medication or both.

“The important thing to know is that childhood anxiety is very treatable,” Riddle says. “We can help children and their families.”

All in the Family
Research shows compelling evidence that anxiety has a genetic basis, which means that children of anxious parents are at a higher risk for developing anxiety disorders.

A Johns Hopkins study showed that family-based preventive interaction helps.

If you’re a parent with a history of anxiety who is interested in participating in a similar study, please call 443-287-4349.

Childhood Anxiety: When to Get Help
It may be difficult for parents to know when to seek professional help for childhood anxiety, but here are some questions to ask:

  • Is my child’s behavior disproportionate to a specific situation?
  • Have the physical symptoms of anxiety (stomach- and headaches, restlessness, fatigue, etc.) persisted for longer than six months?
  • Does it impair my child’s life (i.e., stops him or her from going places and/or doing things)?

Avoidance in particular is a huge red flag, says child psychologist Golda Ginsburg, Ph.D. Parents shouldn’t try to accommodate that, but need to help their children manage and face their anxiety.

Aches and Pains
A Johns Hopkins study showed that physical symptoms, particularly restlessness and stomachaches, are highly prevalent in children and adolescents with anxiety disorders. Other common physical (or somatic) symptoms include palpitations, muscle tension, sweating, headaches, and trembling or shaking.

Higher levels of aches and pains were associated with more severe anxiety that included avoidance and interference with family relationships.

“The study also showed that treatment with SSRIs [selective serotonin reuptake inhibitors] successfully reduced most somatic symptoms,” says study author and child psychologist Golda Ginsburg, Ph.D.

Anxiety Disorders Defined
The most common anxiety disorders in children are:

  • Separation anxiety—marked stress when separated or anticipating separation from a parent or other loved one. Physical complaints such as stomachaches commonly accompany this disorder.
  • Social phobia—intense, persistent fear of being watched, judged and laughed at by others, as well as doing things that would embarrass or humiliate. These children usually are excessively self-conscious and perceived as shy.
  • Generalized anxiety disorder—exaggerated worry and tension about a variety of everyday problems. Children with this disorder live with a sense of dread and frequently seek reassurance.

Learn more at (go to “Anxiety Disorders in Children and Teenagers”).

If you think your child may have an anxiety disorder, please call 410-955-5335 to schedule a consultation.