Childhood anxiety often misdiagnosed

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      UBC counselling psychology professor Lynn Miller says it’s understandable that people don't want to do things they dislike. As an example, she tells the Georgia Straight over the phone that kids will sometimes try to avoid going to school, the dentist, or a birthday party.

      But she says that when children become filled with fear and dig in and resist, parents should seek input from a teacher, a school counsellor, or a mental-health expert about whether anxiety may be the root cause of this behaviour. She points out that, on a biological level, anxiety is characterized by an overwhelming flood of neurotransmitters and hormones, including cortisol, which can elevate stress to unmanageable levels.

      “Anxiety is also known as a fight-or-flight response,” Miller says. “The majority of people will flee if they can.”

      When Miller began her career, she had no idea she was on a path to becoming an expert in childhood anxiety. She just wanted to prevent kids from having difficulty at school. She says she soon realized that psychological issues were often a major factor undermining children’s success.

      According to Miller, anxiety is the most common mental-health problem facing people of all ages. “Anxiety masquerades as a whole bunch of other things,” she emphasizes.

      Miller, director of the Anxiety Projects Lab at UBC, estimates that approximately 10 percent of school-age children and adolescents have enough anxiety symptoms to interfere with how they function at home, with friends, or at school. She recommends that parents ask themselves if their child is more frightened or worried than other kids his or her age.

      “It is very often misdiagnosed as ADHD [attention deficit hyperactivity disorder],” Miller says. “Comparatively, anxiety is four times more common than ADHD.”

      Problems can arise when children experiencing anxiety are prescribed drugs like Ritalin and Dexedrine, which are meant to treat ADHD. Miller says these medications “make things worse in a big hurry” for kids who are anxious because they stimulate the nervous system, leaving them feeling more out of control.

      She notes that certain physical symptoms are associated with anxiety in children. She says that among elementary-aged kids, the most common is a persistent stomachache. For adolescents, frequent headaches are often an indicator. Another sign of anxiety is a reluctance to go to sleep due to a fear of what might happen the following day. She advises turning off electronic devices around young children two hours before they go to bed.

      “We want kids to be getting a lot of sleep at all school ages,” Miller says. “Lots of times, that’s vastly underevaluated when people are thinking, ‘Why is my child struggling?’ Really, sleep is a huge [common] denominator for everybody.”

      She also points out that when a child’s fight-or-flight response escalates, they may have a “meltdown”, which can leave them feeling humiliated afterward. (For more information on anxiety in young people, see the Anxiety B.C. website.)

      Miller says kids can benefit from medications that interrupt the onslaught of stress-elevating neurotransmitters and hormones. But she emphasizes that the Canadian Psychiatric Association and the Canadian Medical Association both advise that psychological help should be the first course of action.

      Cognitive behavioural therapy, which is often used to treat anxiety, focuses on the links between thoughts and actions. The goal is often to help kids stop applying negative meanings to certain events, like going to school. Unfortunately, sessions with psychologists and other types of counsellors who conduct CBT treatment aren’t covered by provincial medical insurance, but some private plans will pay for it. Some practitioners charge on a sliding scale.

      There are periods in young people’s lives when they’re at higher risk for developing anxiety, Miller says. Kindergarten can be a stressful time because it’s a child’s first exposure to a classroom setting. Grades 4 and 5 are also challenging, because the curriculum starts focusing on abstract as opposed to concrete thinking.

      “Then, the final explosion of symptoms would be around the entrance to puberty,” she adds.

      Younger children tend to demonstrate anxiety through their behaviour, perhaps by crying or refusing to engage in activities. Miller says that older kids are often better at articulating their anxiety, which sometimes manifests itself as perfectionism.

      According to Miller, adolescents with anxiety have higher rates of alcohol use, since alcohol is a depressant that calms them down. However, she says they “really hate marijuana” and mind-altering stimulants because these leave anxiety sufferers feeling less in control. Researchers have also linked teenage anxiety to a higher risk for suicide.

      “The number one predictor for adolescent suicide is untreated anxiety,” she says. “We used to think it was just depression. Actually, for kids who don’t get treatment for anxiety, about half of them will go on to develop depression.”

      Miller says that anxiety is probably the most treatable psychological problem. Several years ago, she played an instrumental role in B.C.’s Ministry of Children and Family Development becoming the first provincial ministry in Canada to adopt the Friends for Life anxiety-prevention program.

      It’s an evidence-based approach designed to help teachers, leaders of youth groups, and parents better understand how to help young people cope with this condition. B.C. offers free training to those who commit to implementing the program.

      It’s one reason Miller says that teachers are often the most adept at spotting anxiety problems in children—even more than parents are.

      “You can largely prevent an anxiety problem from turning into a disorder,” Miller says.




      Aug 16, 2013 at 1:51pm

      Probably because I would put myself in this category (highly anxious youth), I not only know that this hypothesis is fairly accurate, but I also know that childhood anxiety is virtually impossible alleviate and correct. Why, you ask??
      Without any research to site, it seems fair to say many cases of childhood anxiety are caused by anxiety in the child's home. Which means anxiety either created or allowed, in some way, by the child's parents. Parents who already demonstrate their willingness to shuffle their children off to the doctor for a label and prescription, rather than face and accept their own involvement.
      The next thing is, if those parents even notice their child's suffering, it's highly doubtful they notice out of concern for or of the child's suffering and much more likely they notice the way the child affects their life. This I'd argue as evidenced by the common misdiagnosis of ADHD. Who would report the child's nervousness to a doctor as hyper activity? Probably a person who is acutely annoyed.

      The solution - in simple terms - is caring, child centered parenting. Which is largely impossible. David Lynch's Transcendental Meditation organization has made profound differences in children and adults lives by creating school programs which teach mindful meditation. This could be thought of as coping. This is what may help. Forget any approach which asks the people who assisted in creating the problem to aid in owning their part and correcting it. It's not human nature, even loving parents can't face this fact easily.

      Karen C

      Aug 24, 2013 at 8:49am

      That's a pretty broad paintbrush you are using LisaAndSprinkles. There are many parents out there who do recognize the anxiety their child is experiencing and do actively seek assistance from others to help their child learn coping skills. Not all parents are out there to find a quick fix through a pill, some parents maybe, but certainly not all.

      There is a danger when we start assigning blame for a child's health concerns. It fractures relationships when everyone, and I do mean everyone, needs to work together to support a child in learning skills to cope with anxiety, depression, and yes, even ADHD.

      There are a great many possible factors that can make a difference for a child who has anxiety (and/or other mental health challenges). Yes, caring parenting is one. Being self aware as a parent is another, being mindful of how our own experiences affect our children, our viewpoints, and challenging those experiences and thoughts when we need to. Having positive connections with adults in the school community is another. Having positive connections and experiences in the community can have a tremendous impact for a child who is anxious. I have watched my highly anxious child flourish with the assistance of a mentor who takes my child out to do fun activities weekly. This connection build my child's confidence in his ability to thrive in his community, to be a part of his community.

      It is not, and never will be, only about inadequate parenting. Does parenting play a role? Absolutely. Can parents help or hinder their child's ability to develop coping skills? Absolutely. But are parents the only cause and contributing factor to continuing difficulties in their child? Not a chance.