San Diego Experts On How Anxiety Affects Children
October 6, 2015 1:09 p.m.
How Anxiety Affects Children
Desiree Shapiro, psychiatrist, Rady Children's Hospital
David Peters, family therapist
Related Story: San Diego Experts On How Anxiety Affects Children
This is KPBS Midday Edition, I Maureen Cavanaugh. Stress about grades. Worry about fitting in. Nervousness about new situations. In moderation these worries can be seen as a normal part of growing up. The parents, teachers and healthcare workers are reporting a significant increase in the number of kids who are suffering from actual depression and anxiety disorders. The anxiety and depression's Association of America says anxiety disorders now affect about one in eight children. Today we will look at what is causing this increasing anxiety in children and how it's treated in new research to prevent it took
Join Amy Art Dr. Desiree Shapiro a psychiatrist at Rady Children's Hospital Dr. Shapiro welcome.
David Peters family practice in Mission Valley.
Always good to be with you Maureen.
Now in your own separate practices, let me share with you Dr. Shapiro, DC more chilling complain about being nervous or anxious or overwhelmed?
Yes. We see kids all the time complaining of anxiety. It's important to realize that all children experience anxiety. It can be helpful for them when they are studying for a test or when they're trying to get some runtime. When we start to eat -- get concerned is when it starts to impair the normal functioning. When they're having trouble school or at home or socially. That's when we want to evaluate them and make sure they talk to someone about it.
Have you been hearing more about this in your practice? I like to see is that actually know. Having experienced a change. In a single private practice it would be hard to register that. Other than if you're in a specialty arena working with children alone.
How do feelings like that show them in a chart that child's life quick
Children often don't know how to express it. They'll have stomachs headaches, nightmares, becoming to mom and dad more often. They can sometimes express that they don't feel good. But they don't know what it means to be edges. They will say they're anxious. They may have shorter tempers and scream and cry and that sort of stuff. Or they may be really shy at school and be hiding a school. You have to watch for behavioral symptoms with children.
Rather than a child coming in and saying I'm just nervous all the time.
They won't say that they won't know what that means.
Dr. Scheer Piro -- back Dr. Shapiro what are anxiety disorders.
We have social but generalized worry, panic disorder, obsessive-compulsive disorder concept dramatic stress disorder. These are a lot of terms we don't need to focus on but more encourage parents to recognize early signs of anxiety. Like David was saying, signs that kids can be experiencing anxiety is when they have headaches are stomachaches. But also kids can have more than internal focus of anxiety. I be quiet and you don't know. You want to definitely ask about it. The generalized worries. Kids can worry about the future or the help other families health. Other kids can be very socially anxious and I want to go out in public or not go to restaurants or raise their hands. Or speak up in class. When you start to Steve the things you want to ask your pediatrician or your healthcare provider about an evaluation.
David, how is depression related to anxiety? On a
On adept biochemical basis they can look similar. People who are vulnerable to depression sometimes have comorbid anxiety. The treatment can be very similar depending upon how you are doing it. You can do medication teaching. And education for anxious and depressed people under the same outcome. For anxious and depressed people who are grown-ups, I would say exercise is a really great way to charge you up and break free of some of the symptoms. That cognitive behavioral therapy with kids is quite often the case if you're going to attacking favor -- therapy. That would be used for depression. It still challenging perception of reality. And observing the symptoms you have and learning how to express those in a healthy way. So they're not the same, but there's certainly an overlap between depression and anxiety in the treatment of both.
And Dr. Shapiro, do we know how anxiety develops? Is it Frank Dasd genetic quick
Genetics are important, but they don't tell the whole story. It's really an interaction between developmental and environmental and genetic factors. We hope that by looking at prevention and early intervention and family involvement, were able to help the kids at risk for anxiety.
So there can be a genetic factor.
Absolutely. If mom has anxiety, there's a high likelihood his Dasher child will have it.
Are you marrying that behavior or is it something that is actually Dasher more vulnerable to?
Is both. It's how you raised in genetic and have what environment you're in.
If a child see a mom gets nervous up the store they might learn the behavior and model it. We want is to model healthy behavior. Teach parents to show their kids that they can overcome their fear and face their fears and lead healthy happy lives.
And David. If indeed this is not something that genetically that a child -- has been predisposed to. What are some of the reasons you think kids are displaying these anxious behaviors quick
We live in a world that is much faster pace. Where families are not able to sit together and be together and share an identity at the same time. Frequently parents are working opposite hours because they have to. Frequently kids don't get to have time to just relax and hang around. We've had discussions on this program before her kids are overscheduled. Their rental soccer and they have to run to guitar practice, then after in-school and the printer running back and forth. So with being brushed around and having less time to just relax and play, kids can have anxiety as a result. Because they just don't feel the world a stable around them. Basin -- they don't see their parents relaxed and calm around the. Received a stress.
Dr. Shapiro, just reading about this a little bit. I've been reading a lot about increase school presser. Kids are under a lot of pressure. There's a lot of anxiety associated with this. The important thing to pay attention to is what is causing the anxiety. Is it all about schooling grades? Is it possible parents can talk to teachers and reset expectations or provide little more assistance in class? Can you talk to a therapist to get coping skills? Is a contribution of bullying? Are so many factors. When you're going through an evaluation copy when a look at the whole life and see what is contributing. Perhaps something a situational where we can intervene early.
How do you go about Dr. superior making a diagnosis of anxiety in kids quick
Rady Children's Hospital were very comprehensive. We talked to kids and parents and caregivers. We observe the kids. We figure out what is going on with them and the how is it going at school. Hausa going with their peer group? Hausa going at home? Over time. Where able to see patterns of anxiety and talk about various treatments and therapy be number one for us.
Therapy is nonfree -- number one for you as well.
Dirt -- certainly. You can look at the age of the sky at the child and the skills of the child. For children traumatized, play therapy on the floor can be a great healing benefit. There are specialist to do play therapy that usually have small chairs and toys and things like that on the floor. And then also, you can do family therapy intervention if you see the parents can be a great tool in helping the child overcome the anxiety. You can teach the parents how to interact with their children in a different way. That is a different form of intervention. Frequently with kids these days, I will teach the meditation. And help them learn. There is something I do whenever I don't feel good. If I'm at school, and I don't feel good, I take five minutes and the other room and breathe a different way. And I call myself down. There's a variety of ways to work with it. You look at the strengths and weaknesses and the tools the kid Artie has. You look at the nature of the anxiety disorder to aim properly at the sort of intervention.
Want to talk a little bit more David about what you mentioned a moment ago and how parents might be contributing inadvertently to the increased anxiety in their kids.
Yes. There is a process that I see sometimes where it's uncomfortable to work with because people don't want to believe it about themselves. But sometimes a parents need to cling to their child, results in the parent looking for symptoms and their child. Looking for ways in which they need to specially treat their child. Which means their child can't go play because they have symptoms which cleave to -- keep them close to the mom. In that process, I see kids getting special treatment at school or being kept out of school, being homeschooled, or being even medicated or inappropriately in treatment. When really there is a parents need to have a kid with a problem. There's a dependency issue that is occurring there. It's much more difficult to diagnose. Is in the minority of cases. That is what we also see when we are looking at anxiety in children sometimes.
Dr. Shapiro, for anxiety to become a problem, it's not just the amount of stress and worry someone has, but how strong your abilities to cope with that. Our kids -- our kids being allowed to develop healthy coping mechanisms?
We want to focus on coping skills. Parents can be a great model for this. They can teach their kids how to stay calm and really handle stressful or anxiety provoking situations. I think they is really great. Encouraging more leisure activities for kids. When you're anxious how do you handle that? Will be carried through your whole life.
Play is good. Not just simply because it gets your mind off what you're anxious about Cobbett it also allows you time to process the kinds of things you're going through and how you might be able to handle them. Is that right quick
Absolutely. Play can be relaxing and creative. I encourage it for all active -- ages.
[laughter] spin we've been talking about meditation and play therapy. Are their medications for children who are experiencing some significant anxiety in their lives quick
Definitely. We tried it treat with therapies and family support first. We want to look at the etiology of anxiety and the complicating factors. Is there bullying going on, learning problems, issues at home, could there be a medical problem contributing to anxiety? What we want to do is talk about all of these things before we go right to medications. We are very judicious in the decision to start a child on medications. We do a comprehensive evaluation. It's very much a collaborative decision. We talk with everyone and make sure everyone understands the risks and benefits. If we do start a child on medication such as serotonin, we monitor them very closely. We tracked the response and the also continue to prioritize psychosocial interventions and therapies in addition to the medication. It's an option, but it's not the only option.
What are the outcomes you been seeing from this medications?
Medications can be very helpful for the treatment of anxiety especially with psychosocial therapy. If a child comes in with severe devout siding anxiety that is preventing them from going to school, or succeeding in their life, we are very helpful -- we have great data showing these treatments work
As I said before, the vast majority of medications are dispensed by general practitioners which is the problem. They are not getting the breath of treatment that Desiree is experienced -- describing here. Where they can try a variety of things to intervene with their child. But parents frequently say, I take my kid to the doctor. A doctors frequently trained only in medication. So go to his to a therapist or special -- at Rady Children's Hospital , you will get a group of people who understand a variety of ways this order -- disorder can be treated.
Seems to be a lack in the amount of treatment afforded to kids who are expressing signs of anxiety. In other words, this is a very underreported and undertreated kind of situation for children is that right Dr. Shapiro?
Up to 80% of youth with anxiety don't get the care they need. One main message I wanted across today, we need to fill comfortable talking about mental illness and teaches to our children. In order to get the care you need and to get well, you need to be able to comfortable talking about it. I want to encourage us to change our culture and make it easier to get care in a nonjudgmental way. Mental health care is an important part of healthcare. There's really no health without mental health.
Talking about society and changing their attitudes, I've heard anecdotally from parent after parent that it really is more difficult in a kid today. It took me a long time to believe that [laughter] but I think they have gotten to me. The pressure to get good grades and to get into a good college to be popular to be attractive is really a lot greater in years past. If that is the case, isn't this rising rate of anxiety and kids a societal problem as well as an individual family problem quick
Our society is breeding neurosis. A lot of it is in that media. We have a society that emphasizes competition. Losers are out.
I have young people in my office, teenagers who are obsessed with the idea that they must get into an Ivy League university. If they go to a state university, they are failure. That is obscene to think about it. To be under that much pressure. The alternative, if you don't care that much and you're not going to get into the good university, is to give up entirely. I see kids do this also with physical fitness. If they can be perfect, then they give it up entirely and eat junk food and say I don't really care about that. Because they can't tolerate the competition. The of session for perfection or giving up entirely is really in healthy.
And finally, Dr. Shapiro, how would you advise a family who are seeing the signs? Who are seeing the signs in their child? What is the first step quick
The first step is recognition. I think that is the key message. Try to recognize the signs and symptoms and talk to your pediatrician about them. Vista Hills smart Karen San Diego has a consultation program for patients and families and they can get a referral from their fifth -- pediatricians. They will talk about resources in the community and reaching out and connecting with the national -- on mental health websites. There's some great national websites. The anxiety and depression Association of America. Learn more and watch your kids as he got help from your pediatrician.
I've been speaking with Dr. Desiree Shapiro, a psychiatrist at Rady Children's Hospital. And David Peters with the practice in mission bound -- Mission Valley.
Thank you both very much.
Thank you so much Marine. Thank you.