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Anxiety disorders

  • Overview

    Watching your child struggle with anxiety is incredibly difficult for any parent. While all children go through periods of anxiety, your child may have an anxiety disorder if she:

    • worries excessively about a certain situation, or about multiple situations
    • feels significantly distressed because of his worry
    • finds his schoolwork, home life and/or friendships disrupted by his anxiety

    Anxiety disorders:

    • can’t just be “shaken off” or “gotten over” without help
    • are common among children and adolescents
    • are treatable with the guidance of trained clinicians

    There are several different types of anxiety disorder, including:

    How Children’s Hospital Boston approaches anxiety disorders

    Children’s has long been at the forefront of providing expert, compassionate care to children and adolescents with mental and behavioral health issues. Our Department of Psychiatry team members are leaders in researching, diagnosing and treating anxiety disorders, as well as:

    Children’s approach to mental health care is evidence-based—which means that our treatments have been tested and proven effective through scientific studies, both here at our hospital and by other leading institutions worldwide. We use “talk therapy” as our primary method of treatment for anxiety, focusing on teaching children helpful thinking and coping skills to overcome symptoms and adopt new, healthier thought patterns and behaviors.

    In certain instances, we might recommend that your child begin an anti-anxiety medication regimen—always in conjunction with talk therapy. Children’s has a dedicated Psychopharmacology Clinic to help determine whether medication might be a helpful addition to your child’s treatment plan.

    Our team is always aware that your child is, first and foremost, a child—and not merely a recipient of care. You and your family are essential members of the treatment team, and our compassionate mental health professionals will include you in the therapeutic process at every step of the way.

    Anxiety disorders: Reviewed by David R. DeMaso, MD
    © Children’s Hospital Boston; posted in 2011

    Boston Children's Hospital
    300 Longwood Avenue
    Boston MA 02115
     617-355-6680


  • In-Depth

    What causes anxiety disorders?
    All of us are born with the instinctive “fight or flight” response that helped our ancestors escape predators and other threats. When we are afraid, concerned or stressed, the part of our brain responsible for the fight or flight response will generate the nervous, fearful sensation we call anxiety.

    While everyone experiences anxiety at times, people with anxiety disorders feel excessive worry that does not subside the way normal anxiety does.

    Anxiety disorders are linked to:

    biological factors

    The brain has special chemicals, called neurotransmitters, that send messages back and forth to control the way a person feels. Serotonin and dopamine are two important neurotransmitters that, when “out of whack,” can cause feelings of anxiety.
     

    family factors
    Anxiety and fear can be inherited. Just as a child can inherit a parent’s brown hair, green eyes and nearsightedness, a child can also inherit that parent’s tendency toward excessive anxiety. In addition, anxiety may be learned from family members and others who are noticeably stressed or anxious around a child. For example, a child whose parent displays perfectionist tendencies may become a perfectionist, too.
     

    environmental factors

    A traumatic experience (such as a divorce, illness or death in the family) may also trigger the onset of an anxiety disorder.

    What do kids with anxiety disorders worry about?
    The exact subject of the anxiety depends on the type of anxiety disorder the child has:

    Don’t all kids worry about things, sometimes unreasonably?
    Children with anxiety disorders might worry about the same subjects as children who do not have an anxiety disorder. The difference is that for the child with an anxiety disorder, there is no “on-off” switch for the worry: it is ever-present and so extreme that it interferes with the child’s ability to relax, concentrate and enjoy activities.

    What are the symptoms of a possible anxiety disorder?

    Unlike adults, children usually don’t realize how intense or abnormal their feelings of anxiety have become. It can be difficult for a child to determine that something is “wrong.”

    If your child has an anxiety disorder, she may need frequent reassurance from you or other family members, or from teachers or classmates at school.

    Other symptoms can include:

    • worrying about things before they happen
    • a need for everything to be “perfect”
    • ongoing worries about friends, school or activities
    • constant thoughts and fears about safety (of self or of others, such as parents and siblings)
    • reluctance or refusal to go to school
    • frequent stomachaches, headaches or other physical complaints
    • frequent muscle aches or tension
    • trouble sleeping at home and away
    • "clingy” behavior with parents
    • feeling the sensation of a “lump in the throat”
    • fatigue
    • inability to concentrate
    • becoming easily startled
    • irritability
    • inability to relax

    Your child may be diagnosed with an anxiety disorder if these symptoms:

    • are present for at least six months
    • cause significant distress for the child
    • do not subside, no matter how much the child tries to relax or stop worrying
    • impair functioning at home, at school or with peers

    What are the treatments for an anxiety disorder?

    Here at Children’s Hospital Boston, our expert team of psychiatrists, psychologists and social workers can help you, your child and your family by:

    • tailoring therapy plans according to your child’s age, specific symptoms, family and school situation and overall medical history
    • using psychotherapy (which is also referred to as “talk therapy”), or a combination of medication and therapy, to help your child feel and function better

    Psychotherapy

    The traditionally accepted best treatment for all anxiety disorders is psychotherapy (“talk therapy”). Therapy is designed to help your child understand why and how feelings of anxiety emerge. It will also teach her important new skills for overcoming those feelings and replacing them with healthier, more constructive behaviors.

    Your child may receive individual therapy, or may participate in group sessions with other kids who are also working to overcome an anxiety disorder. We also offer family counseling, which allows parents, siblings and other family members to take part in a child's therapy sessions and learn new strategies as a team.

    Coping strategies learned in therapy may include:

    • identifying and talking about worries and other feelings
    • stopping recurring negative thoughts as soon as they start
    • relaxing the mind and body during times of stress 
       

    Anti-anxiety medications

    If your child’s anxiety disorder does not adequately respond to psychotherapy, your clinician may recommend adding an anti-anxiety medication to his treatment plan. These medications can help your child feel more relaxed and comfortable while he is working on learning and practicing coping skills in therapy.

    Here at the Children's Department of Psychiatry, we never prescribe mental health medication as a standalone treatment. Instead, we always consider medication as part of a two-pronged approach, with psychotherapy as a necessary component. Our Psychopharmacology Clinic can help determine whether medication might be a useful addition to your child's talk therapy.

    Commonly prescribed anti-anxiety medications include:

    • Alprazolam (Xanax)
    • Lorazepam (Ativan)
    • Diazepam (Valium)
    • Clonazepam (Klonopin)
    • Diphenhydramine (Benadryl)
    • Hydroxizine (Vistaril)

    Less commonly prescribed medications that have also proven effective for treating anxiety include:

    • Buspirone (BuSpar)
    • Zolpidem (Ambien)

    Learn more about psychiatric medications for children and adolescents.

    Learn more about your child’s specific anxiety disorder

    generalized anxiety disorder (GAD)

    obsessive-compulsive disorder

    phobias

    separation anxiety disorder

    social anxiety disorder

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