Anxiety in children

Do you know a child who exhibits signs of anxiety? BeWell spoke with Dr. Hans Steiner, professor emeritus of psychiatry and behavioral sciences (child and adolescent psychiatry and human development) about what adults can do to better understand and manage anxiety in children.

What percentage of children experience anxiety?

That depends on how you define it. Children with a diagnosed anxiety disorder approximate 7-10% of the population segment. Those children with isolated symptoms make up another 10 to 15%. So anxiety is common, but not dominant.

Have those numbers changed over your career?

The percentages have risen as epidemiological studies have gotten better. The questions get more refined and the numbers have drifted up from 6 to 10%. However, I don’t think we are seeing an increase in illness; we are just better at finding it.

Are some children more susceptible than others?

Most definitely, as is best illustrated by the work of Harvard psychologist, Jerome Kagan. In his book, Galen’s Prophecy, Kagan follows children as young as two years old into adulthood, showing that anxious traits tend to persist and that anxious kids usually grow up to be anxious adults. Not always, but usually.

What is the biggest misconception surrounding anxiety and children?

There are two reactions, neither of which is terribly helpful. The first reaction is to become overprotective — trying to spare the child anything that causes him/her discomfort. Overprotecting makes them ill-prepared to face the world. Unless you are striving to raise a Victorian spinster, you need to get them out there and enable them to take care of themselves. Or, even better, get them to take care of you! [laughter]

The other problematic reaction is to ignore the issue, which is equally harmful. The child cannot ignore his anxiety, which has a way of making itself heard. Ignoring anxiety leaves the child equally unprepared because there is no instruction and modeling coming from you as to how they need to deal with it.

Are there parenting behaviors that can help?

First, make sure the child is healthy and make sure there is no underlying medical condition that could bring on anxiety. A wide range of medical conditions can bring on anxiety, the most common being hormonal conditions.

Second, strive to take the child at face value and bring him or her to a zone of new comfort. Help him/her to react to novelties and challenges, without ignoring the adaptive signal function of anxiety. One function of anxiety is to signal when there is danger. Obviously, this is extremely adaptive and we would die without it. However, we want this system to function within certain useful parameters. The parenting piece involves expanding or contracting that range for kids who are too inhibited or for kids who are essentially oblivious to anxiety and do things — which may even be outright dangerous actions — that they shouldn’t.

Are there cultural changes we could make?

I think so. The current electronic deluge has a negative impact on people with high anxiety. Too much anxiety causes you to freeze and prevents you from paying attention to incoming stimuli. Too much information overwhelms you, often resulting in you doing nothing in response. With so much information coming in, if you don’t twitter (et. al.), you feel like you are not keeping up with the modern world.

How do parents know when/if their child needs help?

Seek help when there are a lot of symptoms. However, do not overreact. As long as the symptoms do not interfere with function, there is no need to go the extra mile and get professional help.

Regarding functioning, there are four relevant domains:

1. Academic or vocational
2. Relationships (family or friends)
3. Care of the body (sleeping, eating, exercising, doctor visits, etc.)
4. Recreation (unstructured time, play, time to re-charge the batteries, etc.)

The first exercise I do with parents who come to see me is ask them to put down a percentage of time each domain receives in a week. Often they report having two or fewer hours a week dedicated to recreation. They don’t think about — or give enough weight to — the domain of recreation.

Is there a simple change adults can make?

Watch and balance these domains. Remember, parents can do a lot to help by balancing the pushing (making demands) and the letting go (backing off). The most common scenario I see on the Peninsula is anxious kids who are immersed in demands and who feel like they are falling behind and not keeping up with where they are expected to be.

… any final thoughts?

We’ve talked about anxiety in children. Importantly, realize that it gets more complicated with teenagers, who are independent and find their own solutions (such and alcohol and drugs). I recommend two relevant books on this topic:

H. Steiner (ed.), The Handbook of Developmental Psychiatry. World Scientific and Imperial College Press, 2011.

H. Steiner (ed.), Treating Adolescents. San Francisco, Jossey-Bass, 1996. (Revision IN PROGRESS, 2013)

Interview conducted by Julie Croteau and edited by Lane McKenna Ryan.

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