DEAR DOCTOR K: I believe my second-grader suffers from anxiety. How is anxiety treated in children?
DEAR READER: Many kids have anxiety disorders. There are several different kinds, and most are suffered both by kids and adults, such as generalized anxiety disorder, social phobias, panic disorder and post-traumatic stress disorder. Some anxiety disorders affect only children. The prime example is separation anxiety — an extreme difficulty being away from home or loved ones.
Before your child is diagnosed with an anxiety disorder, however, consider this: Some children who are anxious have good reason to be afraid. For example, your child may be a victim of abuse by a relative or a classroom bully. Try to find out if this is the case.
If your child is diagnosed with an anxiety disorder, the treatment options are:
— Cognitive behavioral therapy (CBT). CBT is the best-confirmed treatment for anxiety disorders in children.
A common CBT method is called graduated exposure. In this method, young children with phobias, for example, are placed near the feared object while doing something reassuring and enjoyable. Older children can learn how to use deep breathing or muscle relaxation, or they can be taught to talk themselves out of fear-provoking thoughts. Another technique is modeling. This involves asking the anxious child to emulate the therapist or another child who shows no fear.
— Drug therapy. The FDA has not approved any drugs for childhood anxiety disorders. (The only exception is the use of selective serotonin reuptake inhibitors (SSRIs) for obsessive-compulsive disorder.) But some SSRIs are effective and approved for the treatment of anxiety disorders in adults. As a result, many doctors prescribe these antidepressants for anxious children.
— Combination treatment. Among children and teens especially, combining CBT and drug therapy is often successful.
You and other family members can also help your child. For example, learn techniques for managing your child’s anxiety. Provide models of self-confidence and problem-solving, and give rewards for overcoming fears.
Sometimes a family problem is the source of the child’s anxiety, or an anxious child may think he or she is the cause of any trouble in the family. In that case, joint family therapy may be a good idea.
Many years ago, a patient of mine was having trouble in his marriage. He and his wife were very different personalities. With some marriages, people of like mind find each other. With other marriages, opposites attract.
That was their marriage. He was meticulous, cautious, a man of few words who rarely expressed emotion. She was a volcano — always on the go, talked a blue streak, and emotional every minute of her life except when she was asleep. They grew apart.
Their 12-year-old daughter, who had been a confident and independent child, became fearful and insecure. Therapy revealed that she blamed herself for breaking up their marriage. Sessions with her parents finally absolved her of that guilt — and of her suffocating anxiety.
(Dr. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K,10 Shattuck St., Second Floor, Boston, MA 02115.)