Anxiety in Children & Adolescents

Anxiety disorders are more common than you might think! About 1 in 8 children are diagnosed with an anxiety disorder, and this number goes up to 1 in 4 for teenagers. That means in a class of 20 students, at least 2 or 3 might have an anxiety disorder. Both boys and girls can have anxiety disorders, but girls might be more likely to be diagnosed.

Everyone feels anxious sometimes, but there's a difference between "normal" anxiety and an anxiety disorder. Normal anxiety is when a child feels worried about something specific, like a test or a new activity. These feelings go away once the situation is over and don't stop the child from doing everyday things.

An anxiety disorder is different. It happens when anxiety is so strong and constant that it affects daily life, causing trouble at school, with friends, or at home. The child might avoid things they used to do or have meltdowns.

At MindWeal, our providers can tell the difference between normal anxiety and an anxiety disorder. They look at how often the anxiety happens and how much it affects the child's life. If anxiety causes distress and stops the child from doing things they should be able to do, it might be an anxiety disorder.

• Worrying: Kids with anxiety often have repetitive, uncontrollable thoughts about "what if" scenarios that may never happen. Avoidance: They might avoid situations that cause anxiety, steering clear of new or challenging activities.

• Behavioral Problems: If they can't avoid an anxiety-triggering situation, they might have meltdowns, refuse to participate, or have temper tantrums.
  
  
• Extreme Reactions and Hypervigilance: These children often display hypervigilance, constantly scanning their environment for anything new or different. They react to new or changing events with fear rather than curiosity, causing significant distress.
  
  
• Physical Symptoms: They often have physical symptoms like stomachaches, headaches, shortness of breath, nausea, or vomiting, and might worry excessively about their health.

Anxiety disorders can affect children and adolescents in various ways. Here are some of the most common types:

• Generalized Anxiety Disorder (GAD): Child worries about multiple areas like health, school, family, future events, and personal safety. These worries are persistent and not limited to one specific concern.
  
  
• Social Anxiety Disorder (SAD): Child has an intense fear of social situations, particularly of being judged or embarrassed in front of others. This fear can be related to performing in public or interacting with peers and adults.
  
  
• Separation Anxiety Disorder: Child has a fear of being separated from caregivers or loved ones. This includes worry about something bad happening to themselves or their caregivers when apart.
  
  
• Panic Disorder: Sudden and unexpected episodes of anxiety characterized by intense fear and physical symptoms like chest pain, shortness of breath, and dizziness. There is also a strong fear of having future attacks.
  
  
• Specific Phobia: Child has an intense, irrational fear of specific objects or situations, such as animals, heights, or certain activities. The fear is out of proportion to the actual danger posed by the object or situation.

Anxiety looks different in kids and teens compared to adults. Children with anxiety often can't say what they're worried about. Instead, they might have physical symptoms like stomach aches, headaches, and trouble sleeping. They might avoid things that make them anxious, leading to tantrums or meltdowns, especially when facing fears like going to school. Adults, on the other hand, are more likely to recognize and talk about their anxiety and can explain what they're worried about.

Sometimes, anxiety can improve on its own, especially if it’s caused by a specific situation. But if it happens too often, is too strong, or interferes with a child's daily life, it’s important to get help. Without treatment, anxiety can stick around or even get worse. Seeking support can make a big difference in helping your child manage their anxiety and thrive.

Anxiety in children and teens can be treated with therapy, medication, or both. After a careful evaluation, the MindWeal provider will recommend a treatment plan based on several factors: the type and severity of the symptoms, the child's treatment history, the urgency of the treatment, and how the child and family feel about therapy and medication. The goal is to find the best way to support the child's mental health and help them feel better.

Psychotherapy is often the first choice for treating anxiety disorders. At MindWeal, we recommend Cognitive Behavioral Therapy (CBT), a proven therapy for treating anxiety in children and teens. CBT helps kids recognize negative or unhelpful thoughts, feelings, and actions and replace them with positive, realistic ones. It also includes exposure therapy, which involves gradually facing the things that make them anxious until they become less scary. By learning these skills, children can better manage their anxiety and respond to challenging situations in healthier ways. Therapy can be used alone or with medication, depending on what’s best for your child.

Therapy can greatly help with anxiety, especially when the therapist is experienced and the individual attends regularly. However, it can be challenging. It requires regular sessions and a skilled therapist. Facing fears can be tough, and therapy might be less effective if anxiety symptoms are very severe or if there are additional mental health issues. In such cases, combining therapy with medication might be best.

Yes, medications can be very effective for treating anxiety in children and adolescents. Studies have found that kids who took medication for anxiety did better than those who took a placebo (a sugar pill). Research also shows that kids who take medication often see their anxiety improve faster than those who only go to therapy or do nothing. The best results usually come from combining medication with therapy.

The medications effective for treating Anxiety in kids and teens are:

1. Selective Serotonin Reuptake Inhibitors (SSRIs): These are usually the first choice.These include Sertraline (Zoloft), Fluoxetine (Prozac), and Escitalopram (Lexapro).
2. Selective Norepinephrine Reuptake Inhibitors (SNRIs): These are recommended if SSRIs were not helpful. Venlafaxine ER (Effexor XR) and Duloxetine (Cymbalta) are also effective for treating anxiety.
3. Atypical Anxiolytic: Buspar can be added to SSRIs & SNRIs boost their effectiveness.
4. Antihistamines: Hydroxyzine and Diphenhydramine (Benadryl) may be used for physical symptoms of anxiety and sleep problems related to anxiety.

These medications have been shown to help manage anxiety symptoms. Your child’s healthcare provider can help decide which medication is best suited for your child.

Choosing the right medication for your child's anxiety is a careful process. We only recommend medications that have been shown to work in research studies. Our choices are guided by practice guidelines from national organizations like the American Academy of Child & Adolescent Psychiatrists and the American Academy of Pediatrics.

The treatment guidelines tell us an SSRI should be chosen as the first-line medication for treatment. If it doesn’t work, we try another SSRI. After two unsuccessful attempts, we may switch to an SNRI (Selective Norepinephrine Reuptake Inhibitor). If these are partially effective, we might add Buspar to help.

Our providers look at your child's age, past medications and their effects, family history of medication responses, and the preferred form of medication (capsule, tablet, or liquid). By following these steps, we ensure your child gets the best possible care tailored to their needs.

To find the right dose for your child’s medication, we start with a low dose and gradually increase it. We continue this until we find the dose that effectively reduces symptoms without causing side effects. During treatment, you and your child will have regular check-ins with the clinician. These meetings allow us to see how well the medication is working and if there are any side effects. During these visits, the clinician will adjust the dose as needed to ensure your child gets the best results.

When your child starts taking medication for anxiety, you might see some improvement in 2 to 4 weeks, with more progress over 8 to 12 weeks. Some children feel better quickly with a low dose, while others might need a higher dose. We start with the lowest dose to help children get used to the medication and reduce side effects. Each dose is given about a month to work. If it doesn’t help, we increase the dose. Finding the best dose can take 8 to 12 weeks. Full benefits are usually seen after 6 to 9 months of treatment. It's important to be patient and trust the process. With time and the right support, your child can start to feel better.

Yes, your child may experience some side effects from the medication at first. Common side effects from SSRIs include headaches, trouble sleeping, changes in appetite, stomach pain, and diarrhea. Most of these side effects are mild and get better over time. We start medications at a low dose to help minimize these side effects. It's normal to worry about side effects, especially for children with anxiety disorders who might worry more than others. Side effects are important to consider when deciding if a dose needs to be adjusted. Sometimes, it can be hard to tell if a symptom is a side effect of the medication or anxiety about taking the medication, like a stomachache

The FDA has added a "boxed warning" to all antidepressant medications to alert doctors and patients about the need for special care when these medications are used in children, adolescents, and young adults. This warning states that antidepressants are linked to an increased risk of suicidal thoughts and behavior in a small number of children and teens, especially at the beginning of treatment.

Research shows a slight but notable increase in the risk of suicidal thoughts and behaviors among children and teens taking SSRIs. However, in research studies, this did not lead to actual suicide deaths. Studies also show that kids who are in therapy do not have this increased risk. While the current evidence does not definitively prove a clear link between antidepressants and these increased risks, the benefits of treating anxiety generally outweigh the potential risks.

It is crucial to monitor your child closely if they are on an antidepressant. Pay careful attention to any changes in mood, behavior, thoughts, or feelings, especially when starting a new medication or adjusting the dose. Watch for any sudden changes, as these can indicate increased risks and may need immediate action. By closely observing and reporting these changes, you can help ensure your child's treatment is safe and effective.

No, the medications prescribed by our providers are not habit-forming. Your child will not become physically or emotionally dependent on them. These medications help reduce anxiety symptoms, but they are just one part of the treatment. When medication, therapy, and positive thinking strategies are used together, they offer the maximum benefit

Medications can help shape your child's personality over time in a positive way. They reduce anxiety symptoms, which can lead to more positive feelings, thoughts, and behaviors. When your child feels less anxious, they can think more positively and start engaging in activities they might have previously avoided. Participating in positive activities helps boost their self-confidence, which in turn promotes even more positive behavior. This creates an upward cycle of improvement. These positive changes show that the medication helps your child feel and function better without changing who they are.

You will know that the medication is working if you notice these improvements in your child:

• Reduced Worrying: Your child isn't talking about or showing signs of worry as much.
• Increased Comfort and Relaxation: Your child feels more comfortable and relaxed in different situations.
• Improved Abilities: Your child can do things they couldn't do before, like going to school or public places.
• Decreased Physical Symptoms: Physical symptoms like headaches, stomachaches, and trouble swallowing due to anxiety are reducing or stopping.
• Overall Well-being: Your child's overall happiness and sense of self are better.

Once your child's anxiety symptoms have been gone for 12 months, the medication can be slowly reduced and eventually stopped. This process usually takes 3 to 6 months, depending on the dose. Higher doses might take longer to taper off. Any tapering and stopping should be done under the supervision of a licensed specialist to ensure safety and effectiveness.

Here are a few things to remember:

• Long-term use of these medications is safe if the medication is well-tolerated.
• There's a risk that anxiety symptoms could return even after your child has recovered if medications are discontinued.
• Children who have learned how to manage their anxiety in therapy are less likely to have symptoms come back once the medication is stopped.
• If anxiety symptoms return after stopping the medication, it may be necessary to continue the medication indefinitely.

Even with effective treatment using medication and counseling, children might still have intense anxiety in certain situations, like flying or visiting the dentist. For these rare, stressful moments, "as-needed" medications can help. These medications work quickly and don't last long. Common options are antihistamines like Hydroxyzine (Atarax or Vistaril) and Diphenhydramine (Benadryl). They can help manage anxiety during these times.

Children with anxiety often have trouble sleeping. They might worry about school, be scared to sleep alone, or fear the dark. Good sleep habits, known as sleep hygiene, can help all children with sleep issues. If these habits don't help, your provider may prescribe medications to help your child fall asleep and stay asleep.

Melatonin is often the first treatment used. Hydroxyzine (Atarax or Vistaril) and Benadryl can also be helpful. Clonidine can be effective, especially if your child also has ADHD. Some antidepressant medications like Trazodone and Mirtazapine can also help with sleep problems related to anxiety.

These medications should only be taken as prescribed by your provider to ensure they are safe and effective for your child.

Approach conversations with empathy and patience. Ask open-ended questions to encourage sharing. Listen actively, showing that you understand and care. Avoid being critical or dismissive. Let your child know it’s okay to feel the way they do and that you are there to support them.

Discuss their concerns openly and involve them in treatment decisions, understanding their fears to help address them. Emphasize the benefits of medication in managing anxiety and improving quality of life. Use the DESC technique to communicate effectively and foster cooperation—click here for a guide on implementing this method. If necessary, consult their healthcare provider to explore alternative treatment options. 

Maintain regular communication with your child, their teachers, and school counselors to understand how ADHD symptoms affect their school functioning. If ADHD is impacting your child, discuss with their provider and counselor whether school accommodations would be helpful. If recommended, work closely with school staff to develop an individualized education plan (IEP) or 504 plan. Ensure the school provides the necessary accommodations. Being proactive helps create a supportive school environment.

Consult with a healthcare provider to determine if homeschooling is appropriate. In most cases, homeschooling can make anxiety worse because avoiding anxiety triggers can increase anxiety over time. However, in some situations, homeschooling can be a temporary solution. If your child's provider recommends this and you choose this route, work towards gradually reintroducing your child to a school environment. Collaborate with your child's therapist and school staff to create a transition plan for when your child is ready to return.