Identifying Serious Anxiety in Your Child

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We are talking wellness at MemorialCare Health System. It’s time for a weekly dose of wellness. Here's Deborah Howell.

Deborah Howell
And welcome to the show I am Deborah Howell and today we'll be talking about how to identify serious anxiety in your child. Our guest today is Doctor Ioana Powell. Doctor Pal is the clinical psychologist at the Stranski Children Developmental Center, MemorialCare Miller Children and Women Hospital, Long Beach, where she supports the medical team through psychological assessments, appropriate referrals, treatment recommendations and support for patients and their families. Welcome, Doctor Pal.

Ioana Pal, PsyD
Thank you so much for having me.

Deborah Howell
So nice to have you on. Anxiety is treatable, but about 80% of kids with diagnosable anxiety disorder are not getting treatment. Doctor pal, what is the difference between normal anxiety and anxiety disorders?

Ioana Pal, PsyD
So typical healthy anxiety is sporadic and may be brought on by various events, experiences, people or places, but it stops. Think about a child who's just afraid of Uncle Bob's Dog. For example, there's an end without fear, because that child is only scared of Uncle Bob's dog. It is a rational reaction toward a stable or dangerous situation, but when that anxiety or stress is severe or repetitious, it becomes unhealthy. Anxiety disorders include reaction to triggers that are disproportionate or irrational to specific events, experiences, different people or places. So instead of a child being afraid of Uncle Bob's dog, for example, that child may be afraid of all dogs no matter what. So, anxiety disorders include. Excessive fear, worry, and other behaviors that continue over time, the operative word being excessive.

Deborah Howell
OK, and what are some of the different types of anxiety disorders?

Ioana​​​​​​​ Pal, PsyD
Sure, there are couple. Currently the anxiety disorders are separation anxiety disorder, selective mutism, specific phobias, social anxiety, also known as social phobia, panic disorder, agoraphobia, generalized anxiety disorder, substance or medication-induced anxiety and other anxieties that are not specific to a trigger.

Deborah Howell
Wow, that's a lot of different types. How common is social anxiety among adolescents and teens?

Ioana​​​​​​​ Pal, PsyD
A lot. It is actually very common, and although it affects a significant portion of the 12- to 25-year-old population, it is much more common and actually still on. Rise in high school students. It is also more prevalent in girls. Anxiety is also significantly higher than depression and college students, so it's more prevalent than we actually know, and recent data suggests that about 6% of children are affected by social anxiety. Which it can start as early as age 5 and peaks around the age of 12. So developmentally, it's important to remember that social anxiety affects friendship, quality, rejection, experiences and intimacy. Therefore, untreated anxiety before the age of 12, for example, can significantly affect future relationships.

Deborah Howell
So, what are some of the symptoms of anxiety disorders that parents should look out for?

Ioana​​​​​​​ Pal, PsyD
There are actually quite a few, so I'm just going to list them, but keep in mind that no two children are alike, and some children may experience only two or three of those. Others may experience a lot of them, but the parents should definitely look out for headaches, stomach problems, sleep difficulties angry outburst constant, worrying checking things, irritability, racing thoughts, poor concentration, even eating difficulties, changes in habits, just crying bouts, missing school and generally just extreme reactions to typical situations. Specific signs that parents can also look for are their children being more quiet, keeping to themselves, becoming more withdrawn if encouraged to talk, being passive, being overly concerned with negative evaluations, increased fear of embarrassment and humiliation, even physical signs like crossing their arms and keeping their heads down more often and showing limited facial expression. Poor school performance is another one not participating in class, projects or group activities even being scared to speak up in class or not wanting to go to class if they're late that morning.  Sitting alone more often at lunch, they may have fewer friends avoid going out, or even avoiding eye contact, but some teens may also be self-medicating nowadays, and given everything that I said, it's also difficult or it could be more difficult for parents to notice these signs if they experience anxiety themselves.

Deborah Howell
And what are some of the common treatments for these anxiety disorders?

Ioana​​​​​​​ Pal, PsyD
Our treatment usually includes therapy, medication, or a combination of both. The most successful form of therapy is based on cognitive behavioral therapy techniques. Trauma focused cognitive behavioral therapy can also be used depending on a child's history, exposure therapy, or virtual reality. Aided exposure therapy is the most successful and the most comfortable form of therapy. So, if we go back to the dog example, exposure therapy would be gradually getting a child who's afraid of all dogs to come be OK with small dogs with puppies for example and working gradually until that child does not fear old dogs and may have a good reason to fear Uncle Bob Dog, for example, but it's not irrational under forms of therapy.

Deborah Howell
Got it.

Ioana​​​​​​​ Pal, PsyD
Could include equine or pet therapy and even yoga.

Deborah Howell
Yeah, that helps just calm the mind and reduce stress, huh?

Ioana​​​​​​​ Pal, PsyD
It helps with breathing and regulating a heartbeat, and it can be very, very helpful in helping children in the long run.

Deborah Howell
I can imagine that all the benefits of you know, maybe doing yoga as a family might bring. What are some of the barriers that prevent people from seeking treatment?

Ioana​​​​​​​ Pal, PsyD
Logistics and finances. Actually, most of the time busy lives, shame, denial that there's a problem.

Financial burdens other members of the family having mental health problems or medical problems cultural, even religious beliefs about mental health. The other barrier is the belief that everyone has anxiety, therefore dismissing it as a problem. So, people just assume it's normal, even though it's going to be debilitating, so they don't do anything about it.

Deborah Howell
Absolutely. Now are there some factors that may increase a child's risk of developing an anxiety disorder?

Ioana​​​​​​​ Pal, PsyD
Absolutely, in general, an overactive fight or flight response due to past or current trauma. So a child panics or freezes depending on what the situation may be. So, for example, with the dog example, if a child just sees a dog come no matter how far away it is, they may just react instead of thinking. Oh, it's not anywhere close to me, or it's on a leash and it can bite me. Struggling with social acceptance is another factor that can increase anxiety. Bullying actually perpetuates the cycle and also high demands from school from parents from friends and even self-imposed children who are not ready or mature enough to deal with the aftermath of those fears tend to feel more out of control and experience anxiety like emotional chaos.

Deborah Howell
Right so Doctor Pal, what's the first step that parents should take if they're worried about their child?

Ioana​​​​​​​ Pal, PsyD
I would say listen, learn to accept, identify and verbalize feelings from a very early age. Like I mentioned before, this can start as early as five, so having open conversations with your child can definitely help. Taking judgement and failure out of the equation when talking about fear providing understanding and being open to whatever the subject is. There's channeling feelings into something creative or positive, like yoga or art or sports and monitoring. Our social media. Actually, interestingly enough, the hashtag of self-harm 3 M's at the end has over 2.5 million mentions, so children actually communicate about their fears and express themselves over social media a lot more nowadays. So, if parents can educate and provide boundaries for their children, it should definitely help some. And in addition to that, yes.

Deborah Howell
Please go on.

Ioana​​​​​​​ Pal, PsyD
I was just going to say in addition to that, regardless of cultural or religious beliefs, parents should be open to having their children at least evaluated by a professional.

Deborah Howell
Got it and where can parents go to find out more about the Stransky children Developmental Center?

Ioana​​​​​​​ Pal, PsyD
We have a website that parents can go through the Miller children Long Beach website as well, but our website Stramskicenter.com

Deborah Howell
Thank you so much doctor pal for being on the show today. We really, really enjoyed having you and appreciate what you offered today.

Johanna Pal, PsyD
Thank you so much, Deborah.

 Deborah Howell
To learn more, or to hear a podcast of this show. Please go to memorialcare.org. That's memorialcare.org, that's all for this time I'm Deborah Howell. Have yourself a terrific day.