Specific fears, worries, and anxious thoughts are common among children and adolescents. As kids grow and learn about the world around them, they begin to form their own thoughts and feelings about potential dangers and sources of stress. While many young children grapple with fears about the dark, dogs, and monsters (to name a few), older children can become anxious about death, loss, and personal safety.

Some anxiety among children and adolescents is a perfectly normal part of development. Some children, however, experience an overwhelming sense of anxiety and dread. Some experience symptoms of panic attacks. Some become so preoccupied with their triggers and symptoms that they struggle to attend to normal daily activities. Childhood anxiety can negatively impact life in school, family relationships, peer relationships, and even the physical health of the child.

Treatment of anxiety disorders

There are several types of anxiety disorders that can affect children and adolescents, and getting an accurate diagnosis is a crucial first step toward treatment.

Assessment

A comprehensive evaluation of your child will help determine your child’s level of functioning and the best course of treatment. The evaluation will include the following:

    • A thorough review of current symptoms, duration, and intensity. It helps to jot down any patterns of symptoms you and your child have noticed prior to this appointment.
    • A review of your child’s development and background.
    • A complete family history – including any family psychiatric history. Anxiety disorders can have a genetic component.
    • A mental status exam.
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Creating a Treatment Plan

According to a study funded by the National Institute of Mental Health, treatment that combines Cognitive Behavioral Therapy (CBT) with medication is most likely to help children with anxiety disorders, but either treatment on its own can also be effective.1

Creating a treatment team that helps children and adolescents across multiple domains is also important. This can include the parents or guardians, the treating physician, the psychotherapist or psychologist, the classroom teacher, and the school psychologist. Family therapy and education can also be effective in helping an anxious child thrive in the home environment, and accommodations in the classroom can help children and adolescents manage their symptoms in the classroom setting.

Cognitive Behavioral Therapy (CBT)

CBT is grounded in the fact that how we think and how we act both affect how we feel. When we learn to change distorted thinking and dysfunctional behavior, our emotional state improves. Children and adolescents with anxiety struggle with cognitive distortions that increase their anxious feelings. Helping children learn to identify their triggers, understand how anxiety affects their behaviors, and how to replace their distorted thoughts using cognitive reframing teaches them to manage their symptoms.

Through CBT, children learn to work through their triggers in incremental steps. Children learn to replace negative thought patterns with positive ones and learn to separate realistic thoughts from unrealistic ones. CBT involves some “homework” to practice new thought patterns and adaptive coping skills at home and provides kids with skills that will last a lifetime.

Does My Child Need Medication?

Therapeutic interventions require time and patience. While CBT helps children and adolescents reframe their anxious thought patterns and develop a toolkit of adaptive coping strategies, it isn’t an overnight success. Children with anxiety disorders need parent support as they work through this process.

Some kids, even with CBT and family therapy in place, continue to struggle with excessive anxiety that prevents them from attending school or maintaining focus, disrupts family and social functioning, and negatively impacts other areas of functioning. Watch for these signs of continued elevated anxiety even with CBT or other therapeutic intervention in place:

  • Excessive worry most days of the week
  • Restlessness or feeling on edge
  • Difficulty falling asleep, staying asleep, or daytime fatigue related to sleep disturbance
  • Irritability
  • Lack of focus or concentration

These symptoms can negatively affect the day-to-day functioning of the child and can result in poor academic performance, poor sleep and eating patterns, and physical illness.

Before deciding on medication for your child, it’s important to meet with your physician and treatment team to weigh the pros and cons of medication, discuss any improvements made through CBT and other non-medication interventions implemented, and discuss other options.

Types of Medication

Selective Serotonin Reuptake Inhibitors (SSRIs) increase the levels of the brain chemical serotonin. SSRIs are commonly prescribed for children with depression and anxiety because they are non-addictive and have relatively few side effects. Examples of SSRIs include: paroxetine (Paxil); escitalopram (Lexapro); sertraline (Zoloft); fluoxetine (Prozac); fluvoxamine (Luvox); and citalopram (Celexa).

Side effects of SSRIs generally go away within the first few months of treatment, but can include weight loss, gastrointestinal upset, drowsiness, and headaches. Any side effects should be reported to the treating physician and parents should never stop treatment with SSRI’s without close medical supervision.

Benzodiazepines are used less often than SSRIs for children but can be used to treat “acute” anxiety. Acute anxiety includes panic attacks and symptoms of post-traumatic stress disorder that interfere with a child’s ability to carry out everyday activities. This class of drugs is used for short-term treatment. Kids can build up a tolerance to these medications and require increased doses to experience the same effects. Examples of benzodiazepines include: alprazolam (Xanax); clobazam (Onfi); clonazepam (Klonopin); clorazepate (Tranxene); chlordiazepoxide (Librium); and diazepam (Valium).

Treating anxiety disorders takes time and the right combination of tools. Parents often find that improvement ebbs and flows throughout the course of treatment. This is to be expected as children and adolescents learn to understand their anxiety, identify their triggers, and find adaptive coping strategies that work for them.

If you think you or someone you care about may be suffering from anxiety or any other mental health condition, PsyCom strongly recommends that you seek help from a mental health professional in order to receive a proper diagnosis and support. We have compiled a list of resources (some even offer free or low-cost support) where you may be able to find additional help at https://www.psycom.net/get-help-mental-health.

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Last Updated: Dec 1, 2017