Dr. Rachel Agustines, left, and Alexsandra De Oliveria
Anxiety is a normal reaction to stress. A little anxiety is good, but when anxiety becomes excessive and starts affecting how your child functions at school, with friends and family life, you may need to seek help.
Anxiety-disorders affect one in eight children and it is the most common mental-health problem in children in the United States, according to statistics on the Anxiety and Depression Association of America’s website. Still there is a lack of awareness and a stigma associated with mental health that is leaving many who suffer from getting help.
There are a variety of different types of childhood anxiety disorders including: generalized anxiety disorder, panic disorder, separation anxiety disorder, post-traumatic stress disorder, obsessive-compulsive disorder and specific phobias. If left untreated anxiety can lead to depression, social isolation and even suicidal thinking. In the United States according to the latest statistics from the Centers for Disease Control in 2014, suicide is the second leading cause of death for 10-24 year olds.
Board certified psychiatrists like Dr. Rachel Agustines of The Costello Center and Florida Behavioral Medicine believes early intervention can help manage the symptoms and build the skills to cope with the stress of adolescence and adulthood.
Agustines has been in private practice for more than 13 years in both the hospital and outpatient settings. She is a double board certified psychiatrist in general psychiatry and neurology, as well as child and adolescent psychiatry.
According to Agustines, “Pediatric anxiety disorders can present with a variety of symptoms. This can be excessive worries, panic attacks, school refusal, or Obsessive Compulsive Disorder. The child might demonstrate their anxiety with physical manifestations such as nail biting, skin picking, hair pulling (trichotillomania), sleeplessness, enuresis (bed wetting), frequent stomach aches or headaches.”
As the new school year begins, Agustines sees a rise in school refusal from kids. “As parents we expect to see this when children first start school in preschool or kindergarten. But there is a second peak in the incidence for children aged 10-12. Perhaps this is due to the rise in hormones, and most of these students also have a family history of anxiety disorders,” she said. Nurse practitioner Alexsandra De Oliveria with Young Foundational Health Center also believes it is better to be diagnosed early and take actions that can prevent anxious kids from becoming chronically depressed adults.
“According to some epidemiological studies the onset of childhood anxiety is before age 12. I had this one patient that told me that she remembered at age of 9 years old being very anxious before activities in school. She would have stomach cramps and stay in the bathroom until she felt better. Her anxiety got worse over the years, leading to her adult depression at age of 30,” said De Oliveria. De Oliveria has been a nurse practitioner for more than 13 years and agrees genetics can be a factor in an anxiety disorder.
“There are environmental factors that can contribute to anxiety such as traumatic events and family stressors. But research has shown that anxiety can occur in families. Certain genes associated with anxiety disorders can be passed on by the parents to the child. Therefore the child is most likely to model the anxious behavior of the parent,” she said.
“Genetic testing can give a glimpse as to whether a person may have a biological predisposition to anxiety disorders. A specific gene Methylenetetrahydrofolate reductase (MTHFR), can have an inherited mutation that makes it difficult for an individual to absorb folate (folic acid), which is used in many biological processes and a deficiency can contribute to depression,” Agustines said.
Knowing a person’s genetic profile can be helpful, but there isn’t a blood test that can tell if a person has an anxiety disorder. “The diagnosis is made through a Psychologist or Psychiatrist. There are structured questions to be answered by the parent and the child aids in the diagnosis,” said Agustines.
Today there is a shortage of child psychiatrists in the United States, so it may be two to three months for a parent to secure an appointment for their child. This can be devastating to a parent who needs help right away. Agustines recommends starting treatment with a therapist or pediatrician in the mean time.
“A skilled therapist specializing in children can help the child in developing coping skills and strategies to work through the anxiety. In many cases this is enough to get improvement and the child can be back to their usual state of functioning,” said Agustines.
Licensed marriage and family therapist, Betsy O’Callaghan said there’s been an noticeable increase in the number of children and adolescents she’s seen in the last 2-3 years coming in with issues related to anxiety. “The reasons for this range from increase in testing/pressure in school to bullying and other relational issue,” she said.
O’Callaghan has been practicing in the Tampa Bay area for the past 12 years and is with the Network of Christian Counselors. O’Callaghan said she works with kids by listening to them and exploring their feelings, thoughts and beliefs behind them. “I try to find ways that they can overcome their fears. If they have faith in God, this is something we can often use to bring hope, comfort and peace. There are several cognitive behavior therapies I use as well as play therapy and Gestalt therapy to help each one gain back the feelings of power that may have been lost and to establish boundaries and set goals for future success.”
However, if the symptoms persist and continue to be disruptive, medication may be warranted. A board certified psychiatrist is the best to make this determination. When on medication it’s important to have regular visits with the psychiatrist to make sure the medication is doing what it is suppose to. “Whether or not medication is used, it is also important for the child to be eating a well balanced diet with limited sugars and no caffeine. Exercise can help manage the anxiety and channel the excess “nervous energy”. Relaxation techniques, meditation, deep breathing and yoga have also been shown to be particularly helpful,” said Agustines.
De Oliveria agrees with Agustines and also believes in exercise and taking the nutritional approach first before prescribing medication. “I prefer if my patients understand that we are all different and some of us need a little more focus on nutrition. Sometimes supplementation with specific nutrients for different DNAs variants are necessary. I also recommend that my patients also work with a counselor because I believe that we are what we think. And sometimes we need to be aware of our thoughts and create the ones that benefit us the most,” she said.
If your child has signs of anxiety or depression encourage them and support them. Anxiety disorders are treatable. “It is important that we as parents, teachers and the medical community recognize and assist these children in receiving treatment. We now know that anxiety is not a “character flaw” and forcing one through an anxiety-provoking situation only increases the distress. The child knows there is a problem; It is up to us to help them put words to the feelings and understand that it is not their problem alone, and there is not something wrong with them. To ignore these symptoms gives the child the message that they are not understood, not “fixable” or not worthy of treatment,” said Agustines.
Treatment can be transformative. As parents, knowing what to do for your child and where to turn if anxiety becomes an issue will make it easier to get your child back on track and live a healthy life.