Addressing anxiety before it becomes a problem

afraidBy Gary Gosselin, MD, Medical Director of Inpatient Psychiatry at Children’s Hospital Boston:

Anxiety is the evolutionary survival instinct wired into our brains that allows us to adapt to dangerous situations. In essence, it’s there to help us survive. But it becomes a problem when it no longer allows us to adapt – when it actively interferes with our ability to function.

With baseball season starting this Sunday, the recent case of Texas Rangers’ infielder Khalil Greene is a perfect example. This is a man whose livelihood is completely based around his ability to perform on the baseball diamond, yet Greene recently contacted his team and told them he’d be unable to report for spring training due to his struggles with social anxiety disorder, which is an extreme fear of social situations. He was consequently cut from the team. Without treatment, maladaptive anxiety can have costly outcomes- in this case it may have cost Greene his career.

About 20 percent of adults in this country have suffered from anxiety-related disorders at some time in their lives. Anxiety disorders are also among the first disorders that declare themselves in young children. We have epidemiologic evidence showing that 8 percent of children between the ages of 5 and 17 suffer from difficulties due to anxiety. Unrecognized and untreated, fallout from anxiety can start with poor school attendance and performance and stay with a child through his or her development, leading to more serious consequences like depression and substance abuse.

The signs of anxiety in a child can be difficult to pinpoint because all children should have a certain amount of normal anxiety. Beyond basic fears of the dark or strangers, younger children are exquisitely sensitive to their caregivers and environments. A child’s danger warning circuits signal them when things are unsafe. For example, the distress call of “Ma!” by the toddler unable to locate their mother quickly in an unfamiliar situation.

Absence of caregivers, neglect of basic emotional and physical needs and exposure to other stressful environments can push a child’s anxiety response too far. This is not to say that a child from a perfectly happy environment is immune to anxiety. In anxiety disorders, warning circuits in the brain can be too sensitive, causing worry or fear responses in safe situations.

There are signs of anxiety difficulties that parents can notice when a child’s fears seem out of proportion to reality and begin to interfere with life. Do they interfere with your child’s ability to go to bed, get in the car or go to school? Is anxiety consistently undercutting your child’s ability to function in social settings? School work and the social aspects of school can cause anxiety, especially when a child is being bullied.

Anxiety also expresses itself through the body. Did you ever experience stomach “butterflies” or sweaty palms in a stressful situation? There’s a difference between normal butterflies and the severe stomach cramps or nausea that can occur in an anxiety disorder. Keep an eye out for patterns- are your child’s tummy aches or headaches consistently occurring on school days or right before soccer games? Do the physical feelings prevent them from participating? These red flags should be brought to the attention of your child’s pediatrician, who may refer you to a child and adolescent psychiatrist for an evaluation.

The first step toward recognizing and treating anxiety disorders is also the most basic- check in with your child. Catch him at a time when things are going well. Ask him if he ever worries. What makes him afraid? Does he ever change his plans because he’s afraid of a person, place or thing? Talk about the things that might be worrying him.

Anticipate the unpleasant or unexpected situations by working with your child to come up with a plan. Preview the day, anticipating where the difficult spots are going to occur. Deal with the hallway at school- could there be chance encounters your child isn’t prepared to cope with? See if he can buddy up with a friend or pick a go-to staff person.

Finding the time to check in regularly on the positives and negatives of your child’s daily life will help you to tune into his sensitivities and strengths. With a better understanding of your child’s experience, and a plan in place, you’ll be better equipped to help him deal with anxiety successfully and hopefully avoid a lifetime of significant social disruption.

3 thoughts on “Addressing anxiety before it becomes a problem

  1. Do you think nailbiting in a 4 year old is a sign of heightened anxiety? She also seems to have lost ground on independent play, much more concerned lately that one of us is close by, calls out frequently to see exactly where we are. Should i be concerned?

  2. Do you think nailbiting in a 4 year old is a sign of heightened anxiety? She also seems to have lost ground on independent play, much more concerned lately that one of us is close by, calls out frequently to see exactly where we are. Should i be concerned?

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