Anxiety Treatments for Children

The affects of anxiety in the daily lives of individuals who experience its symptoms can be extremely troubling. Some symptoms of anxiety include, but are not limited to: excessive worry and tension, an unrealistic view of problems, restlessness or a feeling of being on edge, irritability, muscle tension, headaches, chest pain, sweating, difficulty concentrating, nausea, trouble breathing, need to go to the bathroom frequently, tiredness, trouble falling or staying asleep, trembling, and being easily startled.

Individuals who experience anxious symptoms for more days than not during a period of at least six months can be diagnosed with Generalized Anxiety Disorder or GAD (medicinenet.com). The individual’s symptoms must interfere with daily living in order for GAD to be diagnosed. For children, this may mean missing school, sports practice, or social withdraw. Other disorders related to GAD include panic disorder, obsessive compulsive disorder (OCD), post traumatic stress disorder, and social anxiety disorder. These disorders are related in that they all stem from similar feelings of stress, worry, lack of control, and fear which, when excessive, can create serious problems in a person’s life.

Relevant Statistics

The following list contains statistical information about anxiety and related disorders (panic disorder and OCD) from anxietycentre.com and anxietyconnection.com:

• While 4 million Americans suffer from GAD during the course of a year, only 400,000 will receive proper treatment.
• 65% of North Americans take prescription medications daily, 43% take mood altering prescriptions regularly.
• Paxil and Zoloft (two of the more popular anti-anxiety medications) ranked 7^th and 8^th in the top ten prescribed medications in the US.
• Almost three fourths of people with anxiety disorder have their first anxiety episode before the age of 21.5. The average age when GAD begins is 31.
• Substance abuse and/or depression often co-exist with anxiety disorders. 
• Women are twice as likely as men to be diagnosed with Generalized Anxiety Disorder. 
• Women are twice as likely as men to develop panic disorder. 
• Both men and women are equally affected by OCD. 
• Approximately 2.2 million people in the U.S. are diagnosed with OCD. 

Cultural Issues

Studies have revealed the following information regarding the prevalence of anxiety across cultures:

• Commonly, anxiety has been considered a condition among mostly affluent individuals, but new studies find anxiety to be just as common in poorer countries. A recent program which identified and treated individuals who suffered from anxiety in India (a developing country) reported a huge need for treatment among its people (counselingresource.com).

• Non-Hispanic whites are at a significantly higher risk for anxiety disorders than Non-Hispanic blacks and Hispanics. People in Western society (non-Hispanic whites) are arguably facing more stress today, than at any other point in human history. With rapidly changing societal norms and growing technologies, Western cultures have changed more in the past 30 years than they have in the past 300 years (Kessler et. al., 2005).

• Mental health personnel involved in treating individuals from India (also from Japan, China, Latin America, and Africa) do not use the diagnoses of “anxiety”, but used words like, “stress,” and, “tension,” instead. These terms are used as a substitute because of the stigma of mental illness, patient denial, fear of undetected physical or medical problems, and fears of medication among these cultures (counselingresource.com).

• Low education is associated with a higher risk of anxiety disorders (Kessler et. al., 2005).

• Individuals with marital trouble are also associated with higher rates of anxiety disorders (Kessler et. al., 2005). Considering the percentage of divorces among Americans, which was 40% in 2008, the prevalence of anxiety in the US is not surprising.

Developmental Issues Relevant to Prevention and Intervention

Childhood and adolescence are key phases during the development of anxiety symptoms. In a study of developmental differences in universal preventive intervention for child anxiety, universal intervention was found to be successful in reducing anxiety symptoms in children. Primary school children, ages 8-10, reported the greatest changes in anxiety symptoms following the intervention, suggesting that earlier preventive intervention is potentially more valuable than later intervention in adolescence (Bartlett et.al., 2005). Universal interventions to prevent anxiety in children at the elementary school level are ideal and it is important to utilize interventions that are appropriate for the ages of the individuals targeted. Cognitive awareness and the ability to self-reflect are skills that sharpen with age and maturity; therefore interventions should always be age-appropriate considering the individual or group being treated. 

Intervention Strategies and Aspects of Key Elements that should be Considered when Developing Intervention Strategies

In order for anxiety disorders to be thoroughly treated, intervention strategies need to focus on the three key aspects of the condition; that is the psychological, the behavioral and the physiological aspects of anxiety. These three aspects can be addressed and treated through non-medicinal and/or medicinal strategies (Bourne, 2005).

Non-medicinal Strategies

In some cases, individuals may find that the use of medication to relieve their anxious symptoms is not necessary. In these cases, the following interventions are crucial to consider:

• Positive changes in nutrition and the addition of appropriate dietary supplements
• Utilizing a daily/routine exercise program
• Daily practice of relaxation and meditation exercises
• Changes in Self-Talk that encourage a more relaxed, less worry-driven, way of thinking
• Gaining support from other people who will demonstrate their love and compassion
• Simplifying life and the environment to reduce levels of stress

These interventions are typically most useful when they are discussed and practiced in individual or group counseling sessions (Bourne, 2005).

One counseling resource that focuses on cognitive behavioral techniques for anxiety is, “The Anxiety and Phobia Workbook,” written by Edmund J. Bourne, 2005. This book is a wonderful resource and offers therapeutic solutions to use with individuals who struggle with overcoming panic attacks, generalized anxiety, chronic worry and phobias. In particular, Chapter 8 of this book focuses on “Self-Talk” as a cognitive behavioral technique to help individuals who are anxious and having panic attacks. This is chapter defines self-talk, types of negative self-talk (the worrier, the critic, the victim and the perfectionist), and exercises that can help an individual learn how to counter negative self-talk and use positive statements and thoughts to overcome panic attacks. The book includes a variety of worksheets including:

• The Sub-personality Awareness Worksheet which helps the individual learn counter positive statements for each of their negative sub-personalities
• The Worry Worksheet which helps the individual describe their anxious self-talk and then write counterstatements and coping strategies
• The Cognitive Distortion Worksheet which provides an opportunity for individuals to identify the type of distorted thinking they are relying on, and then to come up with rational counterstatements

"The Anxiety and Phobia Workbook" was designed to be used with adults; however these techniques would work extremely well with high school adolescents. The content and the worksheets are easy to understand, especially if the counselor is working through them with the student. 

Another incredible resource for intervention strategies for elementary school and middle school age children who suffer from anxiety is, “Helping Students Overcome Depression and Anxiety”, by Kenneth W. Merrell, 2008. This book provides behavioral interventions for anxiety such as systematic desensitization, relaxation training, and variations on reinforcement procedures. Also, cognitive behavioral interventions are described such as self-control training, self-instructional training, the “Coping cat” program, the transfer-of-control approach and social skills training. Worksheets and activity outlines are presented in the book as well, making it an excellent resource for school based professionals like school psychologists and school counselors, or any other mental health care professionals who work with children.

Medicinal Strategies

In some cases, medication is found to be incredibly helpful when it is coupled with other non-medicinal intervention strategies such as those mentioned previously.  Medication is often unnecessary as an indefinite treatment option, but when used at the right time and for an appropriate duration medication can be a key element in the treatment of anxiety. Referral of the individual to a psychiatrist for medical treatment should be considered when the anxiety/ panic attacks are so severe and frequent that the individual’s personal life suffers. Their job life may suffer, their family or personal relationships may suffer, and/or their general sense of security and control over their lives vanishes. When symptoms are severe (i.e.: difficulty functioning and/or are experiencing high levels of personal distress) and exist consistently for a two to three week time period, medication should be considered. Also, when agoraphobia interferes with the ability to encounter real-life situations, the individual may benefit from the use of medications (Bourne, 2005).

The medicinal treatment of anxiety typically includes two components: the use of antidepressants and the use of tranquilizers. Antidepressant medications include SSRI’s such as Celexa, Luvox, Lexapro, Paxil, and Zoloft (or generic versions of these medications). Tranquilizing medications include Xanax, Klonopin, and Ativan (or generics). Medication is typically used for a time period ranging between six months to two years at the appropriately monitored dosage (Bourne, 2005). Feelings of mild anxiety symptoms are important during exposure to interventions so that the individual can learn to identify the anxiety or panic and address the feelings as necessary. For this reason, prescription of medication at the appropriate dosage is extremely important. Consultation with a psychiatric professional is extremely important for maximum success with medicinal treatment.

References

Anxiety Centre: http://www.anxietycentre.com/

Barrett, Paula M. et.al. (2005). Developmental Differences in Universal Preventive Intervention   for Child Anxiety. Clinical Child Psychology and Psychiatry, Vol. 10, No. 4, 539-555.

Bourne, Edmund J. 2005). The Anxiety & Phobia Workbook (Fourth Ed.). Oakland: New             Harbinger Publications, Inc.

Counseling Resource: http://counsellingresource.com/features/2008/03/14/depression-anxiety-crosscultural/

Kessler, Ronald C. PhD, et.al. (2005). Lifetime Prevalence and Age-of-Onset Distributions           of DSM-IV Disorders in the National Comorbidity Survey Replication. Arch Gen           Psychiatry /Vol 62. American Medical Association.

Medicine Net: http://www.medicinenet.com/anxiety/article.htm

Merrel, Kenneth W. (2008). Helping Students Overcome Depression and Anxiety (Second Ed.).   New York: The Guilford Press.