What Should I Look For If I'm Concerned About a Child Struggling with Anxiety?

Question

Answer

There are some red flags that we look for when we're considering whether or not kids are struggling with anxiety. Some of the very typical red flags that we see for kids who have anxiety disorders, probably the number one is stomach aches or headaches without a medical cause. It's very typical that I'll see kids coming into my clinic who have already been to their physician because they have regular stomach aches, stomach aches in the mornings before they go to school, stomach aches, or needing to rush to the bathroom over and over again during the day, or headaches. Even very young children might complain of headaches when it's related to anxiety.

Interestingly, there are two main reasons that kids get stomach aches when they're anxious and they both have to do with the physiological response to anxiety. When we get anxious, our body starts the fight, flight, or freeze response. We call it the three Fs, fight, flight, or freeze. That prepares us to react to something that's dangerous. So, if something dangerous happens to us or we are getting ready to walk out in the middle of a busy street, our body is supposed to do a few things. It's supposed to speed up our heart rate, speed up our breathing, or make our breathing more shallow so we can breathe more quickly. Our muscles tense, our thoughts start to race very quickly, and our body gets ready to either fight (fight off an attacker), freeze (if there's an attacker coming we would be safer if we just froze), or flee (run from an attacker). If we're out in the middle of the road, theoretically, we're going to want to run from the middle of this busy road. Our body prepares us to do those things and that's very healthy. When we get anxiety, because there's no danger present, our body still reacts in the same way, it doesn't know the difference. For these kids, their fight, flight, or freeze response causes all of those physiological things to happen to their body, and one of those that I had mentioned was that their muscles tense and muscles are in their stomach as well, so their stomach muscles tense up and squeeze. The other cool thing that happens to our body when we are in the fight, flight, or freeze response is that all of those physiological responses occur but it also stops our body from doing anything that's not absolutely necessary to keep us safe. One of the things that's not absolutely necessary to keep us safe is digestion. For these kids, when they get anxious, their stomach muscles tense and squeeze, digestion stops, and they’ve got all this kind of undigested or in the process of being digested food that's now being squeezed in the stomach muscles and that's why you get nausea and stomach aches.

These kids with anxiety often times have difficulty sleeping, especially without parents. I would say it's incredibly uncommon that a family comes into my clinic who doesn't say that parents end up sleeping with the child or the child ends up coming into the room at night unexpectedly or has a difficult time either going or staying asleep. Other things you might see include reoccurring nightmares and the reluctance to interact with new people or try new things. Kids with anxiety tend to be very slow to approach unfamiliar objects, places, or activities and they're easily overwhelmed. Irritability is common in this population. We often see frequent crying and tantrums because a lot of kids, zero to five, don't have the capacity, or the verbal skills, to describe or use their words when they get anxious. They have a hard time saying, I'm really worried about whether or not you're going to come back to pick me up after school, mom, and so instead, we get crying and tantrums which might look like oppositionality or defiance but isn't.

Another red flag is a family history of anxiety. We know that anxiety runs in families and there is a genetic predisposition toward anxiety. It could be that Aunt Nancy has panic attacks, Grandma had some social anxiety, Dad has generalized anxiety, and Son has separation anxiety. Genetically, we think it's all very similar, and so, if you're genetic light switch is flipped on, you might get any of those presentations. Anxiety is really concerning to psychologists and adults and caregivers in general, not just because of the problems that it causes in the moment, but also because we know that anxiety left untreated or un-intervened, really relates to or leads to negative outcomes in adulthood. If you look at prevalence rates of anxiety, about 13% of American children and adolescents will at some point be diagnosed or have a diagnosable level of anxiety. It's the greatest predictor of mood disorders, depression, alcohol and substance abuse in adulthood, so we know that it's not something that kids typically grow out of. Instead, typically, it gets worse and more pervasive and it becomes habitual and it's increasingly difficult to intervene with.

This Ask the Expert is an edited excerpt from the course entitled Understanding and Supporting Children with Anxiety, by Aimee Kotrba, PhD.