Anxiety Disorders: Parents’ Medication Guide Anxiety Disorders: Parents' Medication Guide Work Group CO-CHAIRS: John T. Walkup, MD Jeffrey R. Strawn, MD MEMBERS: Kareem Ghalib, MD Kimberly A. Gordon, MD Tanya Murphy, MD, MS Daniel S. Pine, MD Adelaide S. Robb, MD Moira A. Rynn, MD Timothy E. Wilens, MD STAFF: Carmen J. Thornton, MPH, CHES, Director, Research, Development, & Workforce Sarah Hellwege, MEd, Assistant Director, Research, Training, & Education CONSULTANT: Esha Gupta, Medical Science Writer The American Academy of Child and Adolescent Psychiatry promotes the healthy development of children, adolescents, and families through advocacy, education, and research. Child and adolescent psychiatrists are the leading physician authority on children’s mental health. ©2020 American Academy of Child and Adolescent Psychiatry, all rights reserved. Table of Contents Introduction ....................................................................................................................................................4 The Anxiety Disorders ..........................................................................................................................6 Assessment and Treatment ............................................................................................................8 Medication as a Tool for Treating Anxiety ............................................................................9 Psychosocial Treatments for Anxiety ..................................................................................16 Resources .................................................................................................................................................... 17 Introduction he purpose of the Anxiety Disorders: experience an anxiety disorder, and 5.9% will Parents’ Medication Guide is to provide experience a severe anxiety disorder. Boys and T parents with an easy-to-read and easy- girls are equally affected in childhood, and after to-understand resource on treating anxiety puberty, girls appear to be more commonly disorders in children. In this Guide, we discuss affected than boys. the most common forms of anxiety and related disorders, including the following: Both genetics and the environment play a role in the anxiety disorders. A genetic family • Specific phobia history of anxiety disorder puts a young person • Separation anxiety disorder at risk for developing an anxiety disorder. In • Generalized anxiety disorder addition, caregivers or relatives can respond to an anxious child in such a way as to make • Social anxiety disorder the child’s anxiety even worse by unknowingly • Panic disorder supporting avoidance instead of engagement and unintentionally reinforce fear and worry • Obsessive-compulsive disorder instead of good coping. What is anxiety? Anxiety is a normal emotion that is critical What is the difference for our survival and functioning. It can help between “normal” anxiety and us avoid potentially dangerous situations an anxiety disorder? and prepare for challenges. Stressful life Anxiety disorders are different from regular or events, such as taking a test, starting a new typical anxiety, just like depression is different school, or speaking in front of a group can from everyday sadness or the way mania trigger normal forms of childhood anxiety (elevated and expansive mood) is different that are helpful in preparing a child for the from regular happiness and excitement. challenge ahead. That said, sometimes there can be problems in expressing emotions that Despite the different ways anxiety is can negatively affect day-to-day living. Fear, expressed among children from different anxiety, sadness, and even our capacity to backgrounds and ethnicities, symptoms of enjoy ourselves can be a problem if these anxiety disorders differ from those of normal emotions become extreme and impair one’s anxiety in a number of important ways. capacity to function. 1. Normal anxiety occurs at all time points in How common are the anxiety life. Yet, the anxiety disorders first affect children before puberty and can begin or disorders, and who is affected? get worse unexpectedly “out of the blue." Anxiety disorders are common in children and adolescents, and typically begin during 2. Typical and developmentally appropriate childhood and adolescence. In fact, some activities that most children enjoy are suggest that anxiety disorders may affect 1 in 8 not manageable for children with anxiety children. The National Institute of Mental Health disorders. For a child with an anxiety disorder, (NIMH) estimates that 25.1% of adolescents going to school, participating in sleepovers or between the ages of 13 and 18 years will going to camp, making new friends at a party, 4 Anxiety: Parents’ Medication Guide “showing off,” and participating in new leading to missed school days and even the symptom patterns of an anxiety and potentially rewarding experiences unnecessary medical procedures. disorder, in part because the types (amusement parks) can be very anxiety of symptoms are very similar among provoking. As a matter of fact, the child’s 4. The persistence and consistency of children with anxiety disorders. intense reaction is often surprising to the anxiety symptom picture over time their caregivers, as the triggering cause is key to diagnosing an anxiety disorder. Parents and caregivers often get into a That said, some anxious children can is often a routine and normal life event a pattern of anticipating a child’s anxious experience a sudden worsening of child of a certain age is expected to be behaviors and, in an effort to relieve their anxiety symptoms. For example, an able to do. child’s distress, will help their child avoid 8-year-old child who has been mildly a potential anxiety trigger. Unfortunately, 3. Children with anxiety disorders often anxious as a younger child but enjoyed although the parents and caregivers experience a number of unexplained school may now suffer from separation have the best intentions, their actions physical symptoms, such as anxiety and refuse to go to school. may actually make the anxiety worse stomachaches, headaches, shortness and prevent the child from coping with 5. Children with anxiety tend to cope by of breath, chest pain, worrying about and adapting to typical and important avoiding situations that make them choking, and gagging or vomiting. They developmental tasks. Avoidance, anxious. If the triggering experiences often worry about their overall health. meltdowns, or other behaviors that are routine and necessary tasks Anxious children may pay too much continually keep a child from doing age- of growing up, the child’s everyday attention to their body’s sensations appropriate activities result in “functional” functioning and home or school life and mistakenly believe that these can be disrupted. impairment. In addition, the physical sensations are symptoms of an illness. and emotional distress of anxiety is As a result, these children are likely to 6. Children with anxiety disorders can “psychological” impairment. When a child appear as physically ill to their parents, also have normal anxiety. Trained with anxiety is experiencing functional and to visit the school nurse and/or professionals, such as child and and psychological impairment, they are pediatrician more often, potentially adolescent psychiatrists, can recognize suffering from an anxiety disorder. Anxiety: Parents’ Medication Guide 5 The Anxiety Disorders nxiety disorders are categorized into • Physical complaints—headaches, fear of different forms depending on the gagging, choking or vomiting, chest pain, A symptoms children display. (Table 1) shortness of breathing, poor appetite, stomachache, urgent bathroom trips, Common Symptoms Across increased sweating, muscle tension, All the Anxiety Disorders jitteriness, and difficulty falling asleep. Although there are specific symptoms associated • Avoidance—the most common and easiest with each of the anxiety disorders listed in way for a child to cope with anxiety is to Table 1, there are common symptoms among avoid. Instead of approaching a new situation these disorders. with curiosity as most children do, children with anxiety disorders avoid their anxiety- • Hypervigilance—continuous scanning of the triggering situations. Avoidance of important environment for anything new and different. developmental tasks is a signal that the • Reactivity—whereas most children are child’s anxiety needs to be addressed. curious and interested in new things, • Behavioral issues—if the child cannot children with anxiety often feel threatened avoid an anxiety-triggering situation, by new or changing events or expectations he/she may demonstrate significant and react accordingly. behavioral issues, often described as “meltdowns,” such as refusing to participate, becoming oppositional, and having temper tantrums. Intense anxiety or meltdowns are very challenging for most caregivers and often leave them feeling powerless to help their child. 6 Anxiety: Parents’ Medication Guide Table 1. Anxiety and Related Disorders Specific • Irrational or extreme fearful reactions to an object or situation (e.g., animals, heights, costume characters, and type of transportation) Phobia • Results in avoiding the objects or situations or in demonstrating distress when exposed to them in normal everyday life • Often the first sign of an anxiety disorder and can be associated with other anxiety disorders Separation • Specific worry that something bad will happen to them or to their