Identifying Serious Anxiety in Your Child

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We're talking wellness at MemorialCare Health System. It's time for a weekly dose of wellness. Here's Deborah Howell.

Deborah Howell
And welcome to the show, I am, Deborah Howell and today we'll be talking about how to identify serious anxiety in your child. Our guest today is Dr. Ioana Pal. Dr. Pal is the clinical psychologist at the Stransky Children's Developmental Center, Memorial Care, Miller Children's and Women's Hospital Long Beach, where she supports the medical team through psychological assessments, appropriate referrals, treatment recommendations and support for patients and their families. Welcome, Dr. Pal.

Ioana Pal
Thank you so much for having me.

Deborah Howell
So nice to have you. Now, anxiety is treatable, but about 80% of kids with diagnosable anxiety disorder are not getting treatment. Dr. Pal, what is the difference between normal anxiety and anxiety disorders?

Ioana Pal
Sure. Typical healthy anxiety is sporadic and may be brought on by various events, experiences, people or places. But to stop, think about a child who's just afraid of Uncle Bob's dog, for example, there's an end without fear because that child is only scared about Uncle Bob Duck.

Deborah Howell
Mm-Hmm.

Ioana Pal
It is a rational reaction to a stable or dangerous situation. But when that anxiety or stress is severe or repetitious, it becomes unhealthy. Anxiety disorders include reaction to triggers that are disproportionate or irrational to specific events, experiences, people or places. So instead of a child being afraid of Uncle Bob's Dog, for example, that child may be afraid of all dogs, no matter what. Anxiety disorders include excessive fear, worry and other behaviors that continue over time. The operative word being excessive.

Ioana Pal
Okay, and what are some of the different types of anxiety disorders? Sure, there are a couple. Currently, the anxiety disorders are separation anxiety disorder, selective mutism, specific phobias, social anxiety, also known as social phobia, panic disorder, agoraphobia, generalized anxiety disorder, substance or medication induced anxiety and other anxieties that are not specific to a trigger.

Deborah Howell
Now that's a lot of different types. How common is social anxiety among adolescents and teens?

Ioana Pal
It is actually very common, and although it affects a significant portion of the twelve to 25 year old population, it is much more common and actually still on the rise in high school students. It is also more prevalent in girls. Anxiety is also significantly higher than depression in college students, so it's more prevalent than we actually know. And recent data suggest that about 6% of children are affected by social anxiety, which can start as early as age five and peaks around the age of twelve. So developmentally, it's important to remember that social anxiety affects friendship, quality, rejection experiences and intimacy. Therefore, untreated anxiety before the age of twelve, for example, and significantly affect future relationships.

Deborah Howell
Absolutely. So what are some of the symptoms of anxiety disorders that parents should look out for?

Ioana Pal
There are actually quite a few. So I'm just going to list them. But keep in mind that no two children are alike, and some children may experience only two or three of those. Others may experience a lot of them. But the parents should definitely look out for headaches, stomach problems, sleep difficulties, angry outbursts, constant worry, checking things, irritability, raising thoughts, poor concentration, even eating difficulties, changes in habits, just crying about missing school and generally just extreme reactions to typical situations. Specific signs that parents can also look for are their children being more quiet, keeping to themselves becoming more withdrawn if encouraged to talk, being passive, being overly concerned with negative evaluations, increased fear of embarrassment and humiliation. Even physical signs like crossing their arms and keeping their head down more often and showing limited facial expression. Poor school performance is another one. Not participating in class projects or group activities. Even being scared to speak up in class or not wanting to go to class if they're late that morning sitting alone more often at lunch. They may have fewer friends avoid going out or even avoiding eye contact. Some teens may also be self-medicating nowadays, and given everything that I said, it's also difficult. Or it could be more difficult for parents to notice these signs if they experience anxiety themselves.

Deborah Howell
And what are some of the common treatments for these anxiety disorders?

Ioana Pal
Treatment usually includes therapy, medication or a combination of both. The most successful form of therapy is based on cognitive behavioral therapy techniques. Trauma focused cognitive behavioral therapy can also be used depending on a child's history, exposure therapy or virtual reality aided exposure therapy are the most successful yet most uncomfortable forms of therapy. So if we go back to the dog example, exposure therapy would be gradually getting a child who's afraid of old dogs to be okay with small dogs, with a puppy, for example, and working gradually until that child does not fear old dogs and may have a good reason to fear Uncle Bob's Dog, for example. But it's not irrational.

Deborah Howell
Got it!

Ioana Pal
And a form of therapy could include equine or pet therapy and even yoga.

Deborah Howell
Really?

Ioana Pal
Yes!

Deborah Howell
That helps just calm the mind and reduce stress, huh?

Ioana Pal
Absolutely. It helps with breathing and regulating heartbeat. And it can be very, very helpful in helping children in the long run.

Deborah Howell
I can imagine that all the benefits of, you know, maybe doing yoga as a family might bring.

Ioana Pal
Absolutely.

Deborah Howell
What are some of the barriers that prevent people from seeking treatment.

Ioana Pal
Logistics and finances actually, most of the time, busy lives, shame, stigma, denial that there's a problem. Financial burdens on other members of the family having mental health problems or medical problems. Cultural, even religious beliefs about mental health. The other barrier is the belief that everyone has anxiety. Therefore, dismissing it as a problem. So people just assume it's normal, even though it can be debilitating so they don't do anything about it.

Deborah Howell
Absolutely. Now are there some factors that may increase a child's risk of developing an anxiety disorder?

Ioana Pal
Absolutely. In general, an overactive fight or flight response due to past or current trauma. So a child just panics or freezes, depending on what the situation may be. So, for example, with a dog for example, if a child just sees a dog, no matter how far away it is, they may just react instead of thinking, oh it's not anywhere close to me or it's on a leash and it can bite me. Struggling with social acceptance is another factor that can increase anxiety. Bullying actually perpetuates the cycle. And also high demand from school, from parents, from friends and even self-imposed children who are not ready or mature enough to deal with the aftermath of those fears tend to feel more out of control and experience anxiety like emotional chaos.

Ioana Pal
Right. So, Dr. Pal, what's the first step that parents should take if they're worried about their child? I would say listen, learn to accept, identify and verbalize feelings from a very early age. Like I mentioned before, this can start as early as five. So having open conversations with your child can definitely help taking judgment and failure out of the equation when talking about fear, providing understanding and being open to whatever the subject is, channeling feelings into something creative or positive, like yoga or art or sports, and monitoring social media actually, interestingly enough, the hashtag of self-harm three m's at the end has over 2.5 million mentions, so children actually communicate about their fears and express themselves over social media a lot more nowadays. So if parents can educate and provide boundaries for their children, it should definitely help stop. And in addition to that?

Deborah Howell
Yes, please go on.

Ioana Pal
I was just going to say, in addition to that, regardless of cultural or religious beliefs, parents should be open to having their children at least evaluated by a professional.

Deborah Howell
Got it. And we're can parents go to find out more about the Stramski Children's Developmental Center.

Ioana Pal
We have a website that parents can go through the Miller Children's Long Beach website as well, but our website is StramskiCenter.com, stramskicenter.com.

Deborah Howell
Thank you so much, Dr. Pal, for being on the show today. We really, really enjoyed having you and appreciate what you offered today.

Ioana Pal
Thank you so much, Deborah.

Deborah Howell
To learn more or to hear a podcast of this show, please go to MemorialCare.org. That's MemorialCare.org. That's all for this time. I'm Deborah Howell. Have yourself a terrific day.