Children & Adolescents - Anxiety Disorders - Assessment and Treatment

What is Anxiety? 

It is psycho-biological response generated from within in response to perceived stress or threat. The psychological component includes cognitive style of thinking the worse was likely to happen alongside the fear that makes up the emotional cog of this presentation. The biological response giving company to the thoughts and feelings includes a gush or chronically high levels of stress hormones and chemicals such as adrenaline which leads to the muscles feeling very tense, shaky limbs, sweats, dry mouth, changes in breathing pattern leading to alteration of blood gasses leading to dizziness and a compelling worry that the mind was going crazy. Butterflies in the tummy, pins and needles in limbs would also be experienced by some. 

What causes anxiety?   

Anxiety is an important, innate part of all animal kingdom. At the sight of danger the fear centre is invoked and safety behaviours follow. In the animal world this ensures survival! Anxiety is thus vital and has a significant role in our lives. Humans are bestowed with thinking abilities and rely (at least they should) less on experiencing fear to ensure survival - we can problem solve instead. People who find their fear centre mis-fire at the slightest thereby overriding the thinking faculties to a point they can't function would be said to have an anxiety disorder. 

Some people would be biologically more vulnerable, they may inherit genes that make them temperamentally anxious and sensitive. For others, the fear centre gets primed by early life experience - parents may role model maladaptive coping in the face of stress, early childhood life events such as trauma / separation / bullying / abuse can disrupt attachment and bonding leading to a very fragile insecure base.

Types of anxiety disorders

Anxiety is experienced on a spectrum and also varies in how it is felt. Some people feel it all the time, they worry about trivial matters, lack self confidence and esteem, they doubt themselves all the time and remain on the edge continuously. Such a person would be said to have GAD or Generalised Anxiety Disorder. 

All of us get irrational, bizarre thoughts which are absurd and impractical. Standing on a platform one may occasionally have thoughts or images randomly thrown up of falling over on the tracks. The thinking faculties normally check these cancel out the thoughts and emotions which are irrational. There is a reining in of a kind which is top down, when this malfunctions, we are left with irrational thoughts and feelings - sometimes these are unbearable blasphemous or unacceptable cognitions / images. Others may struggle with worry that some harm may befall them or loved ones or get engulfed by repeated worry if they had done something right (e.g. did they switch the gas off?). At times those affected may find doing something helps relive their anxiety, there is an irrational magical connection made between counting n number of time, praying, checking, ordering certain things.....as they produce relief, these behaviours become entrenched rituals. If you have read thus far, this para described OCD or obsessive compulsive disorder. 

There are those who come to find themselves getting fearful at the thought of being somewhere or doing something - being in a crowd, flying in a plane, going up elevators........the list can be a long one. Such specific anxiety is described as a phobia and usually accompanied by experience of severe short bursts of anxiety which people usually describe as panic. The latter however can be experienced alone as a panic disorder

Severe trauma can lead to symptom constellation of at times being numb or aroused (anxious) alongside re-experiencing the trauma through flashbacks. Such a syndrome is called PTSD or post traumatic stress disorder. 

Treatment of anxiety disorders in children and adolescents

This usually includes use of Cognitive Behaviour Therapy. Specific strategies would be taught alongside general understanding of how fear operates, the former include - relaxation techniques, breathing exercises, use of visualisation methods, positive self talk and cognitive rehearsal, exposure and response prevention. PTSD treatment involves some additional trauma work and specialised treatments such as EMDR (eye movement desensitisation and reprocessing). Moderate to severely affected or those who do not respond to psychological treatments would be candidates for medication. 

The best results in the longterm are known to be in those receiving a combination of psychological treatment with medication. 

© Dr A Joglekar