{"id":149882,"date":"2022-01-07T14:53:08","date_gmt":"2022-01-07T14:53:08","guid":{"rendered":"https:\/\/effectsofanxiety.net\/archives\/149882"},"modified":"2022-01-20T18:14:33","modified_gmt":"2022-01-20T23:14:33","slug":"recognizing-and-treating-problematic-fear-anxiety-in-children-john-piacentini-phd-uclamdchat-2","status":"publish","type":"post","link":"https:\/\/effectsofanxiety.net\/archives\/149882","title":{"rendered":"Recognizing and Treating Problematic Fear & Anxiety in Children | John Piacentini, PhD | UCLAMDChat"},"content":{"rendered":"Hi, I’m John Piacentini. I am a Professor of Psychiatry and Biobehavioral Sciences at the Semel Institute at UCLA. I also direct the Cares Center at UCLA, which is the Center for Child Anxiety Resilience Education in Support, and this is the center where we work with the community to develop programs to prevent child anxiety and promote resilient children. Today, I’m going to be talking about how to recognize and treat problematic fear and anxiety in children.\r\n\r\nAnd you can ask questions on Twitter using the hashtag #UCLAMDChat, and I’ll be answering–have a few minutes at the end of the talk to answer questions for you, and it’s a pleasure to be here to be doing this for you today. So, what I’m going to talk about today is how to describe and distinguish between normal, mild, and clinically problematic fear and anxiety, to describe some of the signs and signals that your child might have an anxiety problem, and to describe effective strategies for helping your child to manage his or her fear and anxiety. So, first is, what is anxiety, and how do I know if my child has a problem? Well, anxiety is an expectation of something bad happening. So, children that are anxious look a lot like adults that are anxious, and anxiety is really worrying about things that might happen in the future. “Am I going to get sick? Am I going to get a bad grade on this test? Is something going to happen to mom or dad? Are kids going to tease me now?” This is a little different from fear, which–we think a lot about children being fearful and anxious– what fear is, fear is an immediate reaction to an actual threat or a perceived threat, so fear is really in the moment, I see a bee flying at me and I’m afraid I’m going to get stung, I hear a dog barking I’m afraid I’m going to get bitten.\r\n\r\nSo it really is something that’s more immediate. Anxiety is really worrying more about things that might happen in the future. When we think about anxiety or fears, we think about normal and developmental fears. So, anxiety and fear are really important aspects of us and of animals as well, and anxiety and fear are really nature’s early warning system, kind of our burglar alarm, or our alarm to let us know when something might be dangerous or harmful and to avoid it. So, when we think about different kinds of normal fears at different ages, we can think about infancy–so we know about infants, stranger anxiety or stranger fears–when the infant’s first able to differentiate between different people, they recognize that somebody is new or different from their parent, to their mother, and that will make them anxious–loud noises, also. Early childhood, you tend to see the normal fear is changing a little bit, and that becomes separation anxiety, becomes much more common.\r\n\r\nSo, children are really attached to their parents or other important figures in their life, and they can certainly be afraid about something bad happening to them or getting separated, and you can see that in little kids, 2, 3, 4, and even older, worrying, always wanting to be with mommy or know where mommy or daddy are. You also start seeing fears of things like monsters, things that kids really aren’t aware of or don’t understand that can also be scary. We’re going to talk a little bit more about what this means just in a minute. Middle childhood–as children are in school, they’re meeting other kids, they’re more broadly engaged with the world. The fears also morph a little bit or change to reflect that.\r\n\r\nSo they start worrying about real world dangers, kids start hearing about earthquakes or floods or droughts or fires, and they start getting worried about that or kidnappers, and new challenges that come up to them. They may start worrying more about school or how well they’re doing in school because all of a sudden school and academics are becoming more more difficult in adolescence. We all know adolescence is a time where children really–and adolescents and teens–focus their attention more on their peers and how they’re doing relative to other to other kids and others in their social group. So it’s not surprising that the most common normative fears or normal fears in adolescents relate to social status, social group performance to other people like me. “How well am I doing at these different kinds of activities?” These are all completely normal fears that people have kids have. What I want to talk about in just a second is how do you distinguish these typical fears, or these the normal developmental fears, from problematic fears and problematic anxiety? But first, let’s talk about a couple just general points about anxiety in general that characterize anxiety in children.\r\n\r\nAs I just said, mild fears are very common in children, everybody has fears or worries at different points, and again, these are quite typical. The number of fears tends to decline with age, so young children have a lot of worries about a lot of things. As you get older, you tend to have fewer specific fears, and some of this is because as we get older, we have a better understanding of how the world works, so one, you think about young kids that worry a lot about monsters, or there’s something under my bed at night, when kids are afraid to sleep, or there’s somebody outside my window, and for children, when they hear noises like floorboards creaking or a tree branch blowing against the window, they really want to understand what’s going on, what’s going on with that, so the logical explanation for a lot of kids is that there’s a monster under my bed, or there’s something under my bed, and that actually helps them try to understand what’s going on.\r\n\r\nAs we get older, we realize it’s not a monster under the bed, it may be the wood creaking, or it may be the wind blowing, so specific fears tend to reduce in frequency over the course of age. Overall, girls report a greater number of fears than boys, but this is age-related, so prior to puberty, boys and girls tend to report the same numbers of fears and have the same kind of the problem with anxiety. It’s pretty similar across boys and girls. Once adolescence occurs and into adulthood, the number of fears and the rates of anxiety disorder are higher in females than they are in males. The manner in which children express their fear, anxiety, and sadness–also which, oftentimes you do see sadness or depression associated with anxiety problems in children is really related to their level of cognitive and emotional development– so young children are more likely to express their fear or anxiety by clinging, by crying, maybe by tantruming, by stomachaches and headaches, a lot of physical symptoms. As you get older, the fear may be –children, they become more cognitively mature, they may be more likely to express their fears to worries and thoughts and things like that.\r\n\r\nAs I said earlier, fears often change as children grow older. For example, from concrete things like the monsters in the dark, fear of getting sick, to more abstract fears, will others like me, what about my future, what’s going to happen with the world? And again, this just really reflects children as they mature into teenagers and eventually into adults, just the ability to think more abstractly, to think about the future. They have a broader perspective on topics that are on their minds, and their anxieties are going to reflect these topics, and again, the focus of fears tends to change over time, as I said. So, more specific fears for younger children; typically more social anxiety or social fears as kids get older.\r\n\r\nThat’s not to say that social anxiety or shyness doesn’t occur in young children–it does quite a bit, and specific fears also occur in older kids, so you can have phobias or specific fears of dogs or the dark or things like that, but in general, if we look at the population as a whole, the specific fears tend to be more common in younger kids, and social fear is more common in older kids.\r\n\r\nSo, let’s start thinking a little bit about–so all these normal fears that kids have, and this is what fears look like in children at different ages, so when do we start talking about problematic anxiety or an anxiety disorder? Well, again, even short episodes of anxiety are pretty common in kids, so your child may have a meltdown or maybe be upset about the first day of school. Being nervous or anxious about that–again, the anxiety that your child expresses is going to be above average, it’s going to be typically more than he or she might express in other situations, but this, again, this is probably relatively normal, and when we think about these anxiety episodes that aren’t really problematic, we think that they’re typically associated with some kind of a circumscribed event, or a specific event. So, going to a new school for the first day, which can be stressful, loud thunder, or a thunder and lightning storm, having to give an oral report in school, maybe experience some teasing at school, or being in new situations where they have to go to their first, say, piano lesson or soccer practice–these kinds of situations are typically associated with some anxiety or some worry.\r\n\r\nAnd some kids may not want to go, or they may refuse to go, they may get upset, but in most children, these are relatively short-lasting, that once they get over these first day jitters, they feel more comfortable, and then the activities that they’re doing may be positive for them and the anxiety will go away. So a child that’s new in school and maybe nervous about going to a birthday party for a classmate because they don’t know anybody– that’s pretty common, but once the child gets to the party, if there’s other kids that are friendly and they’re having fun, their fear is quickly going to go away.\r\n\r\nSame thing with child going to their first soccer practice–could be pretty frightening for them, but once they are able to get more comfortable with the team and what’s to be expected of them, then they’ll do fine. So the short-term episodes of anxiety, there’s little outbursts that are predictable, that are related to specific events, again, are pretty normal, usually not something to worry about. So when do we need to start worrying about anxiety? What’s the difference between these normal episodes and more problematic anxiety? Well, there are a couple of things to look for. The first is the intensity of the fear.\r\n\r\nSo, is the child’s fear response or anxiety response within expected limits? For example, being nervous on the first day at a new school, or is it really out of proportion to the actual threat? Is the child expressing some nervousness, and saying, “Mommy, I don’t know, I’m scared, I don’t want to go to school.” Maybe a little extra clingy, maybe a little bit of crying, again, would probably be considered normal in most situations. But throwing a full-blown tantrum, screaming and yelling, trying to break things, trying to run out of the school, again, that’s a little bit of a greater intensity. A lot of children may be afraid of dogs, you know, walking in the park. If a big dog walks by, the child may cling a little closer to mommy or to somebody, the babysitter, or to somebody else–again, that’s not that unusual.\r\n\r\nHowever, if a little dog walks by and walks up and starts sniffing the child, if the child gets really upset or runs away or starts to cry again, that’s probably out of proportion to the potential threat of that dog. So we’re looking for intense fears that are surprising in, kind of, the degree or intensity of the response to the situation. The frequency of fears is another important thing to look for. So, again, the first day of school– even the first few days or the week or two of school might cause some nervousness in the child. If these fears or nervousness lasts longer than that, if it’s going on for several weeks or month or longer, again, that may indicate some kind of a problem.\r\n\r\nIf the child is starting to get upset about things, tantruming, clinging, crying multiple times a day or multiple times a week over the same situation–again, that may indicate that there’s some kind of a problem. Is the context of the fear focused on an innocuous situation? It’s one thing to be afraid of a bulldog that’s barking or snarling–that’s actually appropriate. It’s another thing to get really upset about a cartoon dog, cartoon that has a picture of a dog in it, or a picture of a dog in a book, or a small little dog. Or a child going to the birthday party of somebody that they know well, or a friend, or visiting cousins– again, if the situation–if you look at the situation and it’s hard to figure out why the child might be afraid in that situation, that might be an indicator of more problematic anxiety.\r\n\r\n
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