KIDS' STUFF
while not overreacting, which could fuel the anxiety more. in the 1960s-70s.
Anxiety disorders are the most common psychiatric illnesses
of children, garnering 30% of psychiatric diagnoses. Researchers
analyzed data from the 2016 National Survey of Children’s Health
(NSCH) to report nationally representative prevalence estimates
of anxiety among children that revealed 7.1% of children aged
three to 17 years have current anxiety problems. The ability to
determine epidemiologic data on prevalence can be questionable.
Most surveys are filled out by parents. Unfortunately, the survey
input is dependent on parental ability to recognize (or not) any
child’s anxiety or other psychiatric symptoms. Overestimation of
symptoms coupled with the waxing and waning of anxiety make it
difficult to obtain accurate data. Two additional therapies that are currently being utilized are
ACT (Acceptance and Commitment Therapy) and DBT (Dialec-
tical Behavioral Therapy). ACT uses strategies of acceptance and
mindfulness to help cope with unwanted thoughts and feelings.
DBT highlights taking responsibility for one’s problems and then
aids in helping the child determine how he or she will respond to
conflict and emotions.
Anxiety disorders in children can include being away from
parents/caregivers (separation anxiety), having extreme fear of
specific things or situations (phobias), being afraid of school and
other places (social anxiety), being worried about the future and
bad things happening (general anxiety) and having repeated epi-
sodes of sudden, unexpected, intense fear that comes with physical
symptoms (panic disorder).
As a pediatrician in Louisville, I have seen anxiety become more
prevalent in my patients and families. The reasons for this are unclear
but may reflect improvement in identification of anxiety, increased
utilization of mental health resources, or an actual increase. While
children who experience developmental disorders such as speech
and language delay have a greater likelihood of resolving the delay,
children with anxiety do not follow the same course. Their families
may experience stress and financial hardships based on treatment
options, which are difficult to identify or obtain in a timely manner.
Early recognition for treatment is important to disrupt the pat-
terns of behavior that can be repetitively reinforced, and it allows
for earlier development of successful coping skills. Teaching par-
ents includes both ways to help the child and alerting the parents
to their own anxious behavior. Anxiety definitely runs in families,
with some vulnerability which is awakened under stress; an anxious
parent copes less well and then so does the child, who may mirror
that behavior. Teaching the parent better coping skills helps the
child as well. Referral to a counselor/therapist early can really pay
off for both.
Cognitive Behavioral Therapy (CBT) is based on the idea that
our thoughts cause our feelings and behaviors, not external things
such as people, situations or events. The benefit of this approach
is that we can change the way we think to feel and or act better
even if the situation does not change. Thus, it is imperative that a
good, therapeutic and working relationship develop, since CBT is
effective. It emerged from work in learning theory and cognitive
psychology and was considered controversial, but gained acceptance
Medication in conjunction with therapy can help. Selective
Serotonin Reuptake Inhibitors (SSRI) have been most commonly
utilized. In a recent JAMA psychiatry publication that entailed
a systematic review and meta-analysis including 36 trials, SSRIs
and SNRIs were more beneficial compared to placebo in treating
common pediatric psychiatric disorders, yet also led to significantly
more treatment-emergent and severe adverse events. “There is some
evidence for the benefit of selective serotonin reuptake inhibitors
and serotonin-norepinephrine reuptake inhibitors in children and
adolescents, but owing to the higher risk for severe adverse events,
a cautious and individual cost-benefit analysis is of importance.”
Therapy in children helps them to identify their negative thinking
patterns and the ensuing behavior with the subsequent replacement
of a more positive pattern in thinking and behavior. The goal of
therapy also aids in the identification of unrealistic thoughts with the
replacement of realistic thoughts. Lifestyle changes can be beneficial
and provide additional relief. Support from physicians, caregivers
and peers are instrumental in the treatment process.
Numerous resources exist for physicians, caregivers and for the
patient themselves. SAMHSA (Substance Abuse and Mental Health
Service Administration), National Institute of Mental Health and
National Center for Complimentary & Integrative Health, and AAP
(American Academy of Pediatrics) offer educational support with
handouts available for caregivers and patients on understanding,
approaching and addressing anxiety. As physicians, we can offer
improved patient care with the identification and treatment of
anxiety in our patients.
Dr. Purcell practices pediatric medicine at East Louisville Pediatrics.
Endnotes
1. J Am Academy Child Adolescent Psychiatry. 2010 Oct;49(10):980-9.
2. National Survey of Children’s Health (NSCH) - Census.gov.
3. Mary Margaret Gleason, Edward Goldson, Michael W. Yogman. (2016)
Addressing Early Childhood Emotional and Behavioral Problems. Pediatrics,
Volume 138/Issue 6.
4. Definition of CBT National Association of Cognitive-Behavioral Therapists.
http://www.nacbt.org.
5. Cosima Locher, PhD1; Helen Koechlin, MSc1,2; Sean R. Zion, MA3; et
al,.(2017) Efficacy and Safety of Selective Serotonin Reuptake Inhibitors,
Serotonin-Norepinephrine Reuptake Inhibitors, and Placebo for Common
Psychiatric Disorders Among Children and Adolescents A Systematic
Review and Meta-analysis.JAMA Psychiatry,2017;74(10):1011-1020.
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