Assisting parents with managing overly anxious children – Part Two

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Assisting parents with managing overly anxious children – Part Two

Anxiety – a universal phenomenon- finds its roots in a very small, almond-shaped structure, the Amygdala, which resides in a very primitive part of our brain. It is here that the brain assesses and responds to stimuli that it perceives as threatening.

In the previous article it was established that anxiety, as such, is not a bad thing – Anxiety becomes debilitating when it is excessive and no longer gives an accurate appraisal of what represents threatening stimuli.

A first step in managing the excessive anxiety of your child, is to recognise how excessive anxiety influences your own life, decisions and behaviours. If the parent does not have effective anxiety management strategies in places – then it is very difficult for children to learn useful ways of regulating their anxiety.

Four common examples of excessive anxiety in children

I WANT MY MOMMY!!!!!

There are times when it is appropriate for a child to feel distress when separated from a parent. If not, it may indicate some level of Attachment Disorder. On the other hand, excessive and inappropriate anxiety when having to separate from a loved one can be quite debilitating.

Separation Anxiety Disorder consists of persistent and excessive anxiety beyond that expected for the child’s developmental level related to separation or impending separation from the attachment figure, as evidenced by at least 3 of the following:

  • Recurrent excessive worry when anticipating or experiencing separation from home or from major attachment figures;
  • Recurrent excessive worry about losing major attachment figures or about possible harm to them;
  • Recurrent excessive worry about experiencing an untoward event that causes separation from a major attachment figure;
  • Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation
  • Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings
  • Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure
  • Repeated nightmares involving the theme of separation
  • Repeated complaints of physical symptoms when separation from major attachment figures occurs or is anticipated

In order to meet criteria for this disorder, it must cause clinically significant distress or impairment in social, academic, occupational, or other important areas of functioning and is not better explained by another mental disorders.

Separation anxiety is often the precursor to school refusal.

I’M NOT A PERFECTIONIST, I JUST DON’T LIKE MISTAKES…

A common denominator in children with Generalised Anxiety, is that they perceive mistakes as threats and often respond with strong protective behaviours, be that, (1) aggression / controlling / tantrums, (2) over-accommodating / pleasing and (3) freezing. The core of Generalised Anxiety is to avoid mistakes at all costs.

This worry, which typically occurs for at least 6 months and is clearly excessive, presents as worrying even when there is nothing wrong or in a manner that is disproportionate to the actual risk.

In children, the worry is more likely to be about their abilities or the quality of their performance (for example, in school) and may be accompanied by reassurance-seeking from others.. The worry, which is experienced as very challenging to control, may shift from one topic to another.

In children, only one symptom is necessary for a diagnosis of GAD):

  • Edginess or restlessness
  • Tiring easily; more fatigued than usual
  • Impaired concentration or feeling as though the mind goes blank
  • Irritability (which may or may not be observable to others)
  • Increased muscle aches or soreness
  • Difficulty sleeping (due to trouble falling asleep or staying asleep, restlessness at night, or unsatisfying sleep)

Many children with GAD also experience symptoms such as sweating, nausea, or diarrhea.

The anxiety, worry, or associated symptoms make it hard to carry out day-to-day activities and responsibilities. They may cause problems in relationships and other important areas. Furthermore, the symptoms should be unrelated to any other medical conditions and cannot be explained by the effect of substances including a prescription medication, alcohol, or recreational drugs. Lastly, these symptoms are not better explained by a different mental disorder.

THEY ARE JUDGING ME, THEY DON’T LIKE ME….

The shy and the extroverted have this in common – that they both fancy they are the center of attention –  Robert Breault

Children with Social Anxiety struggle to cope in social situations in which they feel vulnerable. It could even start by them anticipating that they won’t cope, generating such a lot of anxiety that they would ultimately choose to avoid the situation. These children are expert “mind-readers” – they often anticipate what they think others may be thinking of them (mostly negative evaluations) and act based on these faulty assumptions. In addition, children with social anxiety may be extremely self-critical to the point self-loathing.

The following diagnostic features are mentioned in the DSM V:

  • A persistent fear of one or more social or performance situations in which the child is exposed to unfamiliar people or to possible scrutiny by others. The child fears that he or she will act in a way that will be embarrassing and humiliating.
  • Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed Panic Attack. 
  • The person recognizes that this fear is unreasonable or excessive.
  • The feared situations are avoided or else are endured with intense anxiety and distress.
  • The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person’s normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
  • The fear, anxiety, or avoidance is persistent, typically lasting 6 or more months.
  • The fear or avoidance is not due to direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder…

GET ME TO THE ER!!!!

It is in the nature of man and animal that, when they are threatened, certain physical changes will take place: the pupils will dilate (the better see you with, my child), the person may grimace (snarling, baring of teeth in animals), muscles may tense up as Adrenalin is pumped into the body by the brain, rate of breathing increases to get oxygen to the muscles, blood is diverted from the gut to areas, such a muscles, that may need to go into action at the drop of a hat. Blood is withdrawn from extremities to avoid excess bleeding during conflict. In other words, there is a normal physical response to threat.

Panic Disorders occur when this physical response becomes disproportionate to the actual threat. In addition, the child could experience panic / excessive anxiety about having another panic attack.

The DSM V notes the following characteristics:

  • recurrent, unexpected panic attacks, i.e. an abrupt surge of intense fear or intense discomfort that reaches its peak within minutes. It can occur in a cal, or anxious state.
  • Palpitations, pounding heart, or accelerated heart rate
  • Sweating
  • Trembling / shaking
  • Sensations of shortness of breath / smothering
  • Feelings of choking
  • Chest pain / discomfort
  • Nausea or abdominal distress
  • Dizzy, light-headed, faint or unsteady
  • Chills / heat sensations
  • Numbness or tingling sensations
  • Derealisation or depresonalisation
  • Losing control / “going crazy”
  • Fear of dying

Followed by:

  • Worry about additional attacks
  • Avoidance of behaviours that ccould potentially cause pani
  • Not better explained by other mental disorder

Other examples

There are conditions such as Selective Mutism and a variety of phobias that also occur under the umbrella of Anxiety Disorders. Furthermore, there are also conditions, such as OCD, which resort under Impulse Control Disorder Disorders, but which have a strong anxiety component. Bipolar Mood Disorders (Type 2) alse feature high anxiety / panic levels as part of their presentation.

In closing

It may be interesting for the parents to review their own history as well as that of previous generations to see how and to what degree above conditions manifest over generations.

The next article deals with ways in which the parent can manage their own anxiety levels.

Dr Anthony Costandius, www.dr-costandius.co.za