Feeling anxious lately? Well, you’re in good company. With the economic freefall, and doom-and-gloom headlines about world events added to our own personal worries, many of us feel somewhat stressed and anxious.
A certain amount of anxiety as we go about our daily lives is normal. Most adults can navigate their way through the nagging concerns that dog their thoughts without getting derailed by them.
Children, however, have a much harder time handling anxiety. They often end up in the grip of fears and worries that are strong enough to affect their academic, social, and emotional development.
At a recent Boston University conference on childhood anxiety reported in the Boston Globe, one of the speakers presented startling statistics: one in eight children in the United States experiences anxiety symptoms that are so extreme, they cripple a child’s performance in school and social situations.
When this happens, the child may have an anxiety disorder.
The presence of anxiety – even at significant levels – does not itself indicate a disorder, experts explain. “It is only when the fears are out of proportion to the real-life danger and crushing anxiety persists nevertheless, that we suspect a disorder,” explained Dr. Donna Pincus of the Anxiety Treatment Center at Boston University.
Children develop certain anxiety disorders at different developmental stages. For example, separation anxiety, selective mutism (refusal to speak when away from home or family), and certain phobias usually occur in children under the age of nine.
Social anxiety, obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD) often emerge in children from ages 10 through adolescence as a result of biology, genetics and environmental conditions, as well as stressful home situations. These disorders tend to overlap, making life difficult indeed for the sufferer.
Generalized Anxiety Disorder
GAD, one of the most common anxiety disorders, is characterized by excessive, uncontrollable and often irrational worry about everyday matters. This extraordinary degree of worry often interferes with daily functioning, as children suffering GAD typically anticipate doom and disaster and lose the ability to concentrate on simple tasks.
Symptoms often escape identification by the child’s parents, who brush them off as nothing more than childish idiosyncrasies. Schoolteachers are often the first to identify signs of this disorder in children.
Consider the case of Racheli, M., an 11-year-old who lives with her mother and two siblings, aged 12 and 9. In financial straits following a divorce, Racheli’s mother was forced to relocate and to take a job with long hours to support the family.
A few weeks ago, Racheli’s teacher began to notice that she was behaving strangely. She seemed to have lost all spontaneity. At times she sat stiffly at her desk, all but motionless. When she did leave her seat for any reason, she would first perform an odd routine of hastily rising and sitting a number of times before actually getting up. Her schoolwork, once excellent, showed a marked decline, with excessive erasing and uncompleted tasks. At recess, she drifted off by herself, looking melancholy and preoccupied.
Racheli’s teacher called her over privately and gently probed for the source of the trouble. After much resistance, the fourth grader broke down crying. She admitted that she had “certain thoughts” that forced her to repeat various motions over and over. If she didn’t do so, uncontrollable fear rose in her that something bad would happen to her mother.
Slowly, the rest of the story began spilling out. Racheli confided that the frightening thoughts often got worse at home. She’d watch the clock anxiously as six o’clock approached, when her mother routinely arrived home by bus. If she happened to be late, the 11-year-old was seized with panic. Where was her mother? What if something happened to her?
Racheli described the heart pounding that overcame her as she strained to catch sight of her mother walking down the block from the bus stop. At a certain point, unable to bear the tension, she would hurry out of the house, circling the block repeatedly — two times, four times, eight times. Premonitions of tragedy assailed her. What if her mother never came home? What would happen to her and her siblings?
Filled with dread, Racheli would drag herself home. There was her mother busy in the kitchen cooking supper and chatting with the kids about their day! Limp with relief, Racheli would force herself to act casually, saying nothing of the panic and anguish she had just endured. But tomorrow, and the next day and the next, she would face the same rising dread as six o’clock approached.
When You Should Be Concerned
Anxiety is considered a disorder based not only on what a child is worrying about, but also on how that worry is impacting a child’s functioning. When deep anxiety become a child’s automatic response in ordinary situations such as a person’s lateness or minor illness; when the child feels constantly keyed up; when, as in Racheli’s case, anxiety exerts paralyzing control over a child’s academic and social performance, the evidence points to an anxiety disorder.
Racheli’s fears about her mother dying or disappearing — unsupported by any real-life danger – fall into the category of obsessive thinking. Her compulsive repetitive motions became her means of staving off terrifying thoughts and neutralizing what in her mind was an impending disaster.
OCD
Adults with OCD usually know they have a problem. They are able to separate their obsessive-compulsive thoughts and behaviors from normal, healthy ones, which is considered the first step on the road to recovery.
Children, however, generally do not have enough life experience or self-awareness to make this critical distinction. When they find themselves performing bizarre or repetitive rituals, they are ashamed and feel like they are going crazy.
Recognizing the Problem
Often, children are too embarrassed to tell their parents or an adult what is going on. They become experts at hiding their symptoms. This is why it is so important that adults are aware of OCD and knowledgeable enough about it to detect it in children.
What is OCD exactly? Tamar Chansky of the Children’s Center For OCD And Anxiety suggests we think of it as a “brain glitch,” in which the brain, activated by genetic and environmental factors, sends false messages — such as “the stove is still on,” or “there are harmful germs on the telephone” — and the affected person needs to perform rituals to shut off the voice delivering the message. The voice doesn’t get shut off — it becomes louder and more insistent.
Parents are advised to watch their children carefully for any of the following signs of OCD:
Obsessions
Contamination – excessive concern over germs, disease, illness, contagion.
Symmetry – needs to have possessions or surroundings arranged symmetrically or to move in symmetrical ways.
Doubting – becoming convinced that he’s done something wrong, or failed to do what was expected of him.
Numbers – fixation on a particular number or series of numbers; performing tasks a certain number of times regardless of how silly or inconvenient it is.
Religiosity – excessive preoccupation with religious concerns such as the afterlife, sin and death.
Hoarding – stockpiling of useless or meaningless objects such as old newspapers or food.
Compulsions
Washing and cleaning – washing hands until they are red and chapped; brushing teeth until gums bleed.
Checking – returning to check that the door is locked more than once.
Symmetry – need to have socks at same height on each leg; cuffs of exactly equal width.
Counting – counting steps while walking; insistence on performing a task a specific number of times.
Repeating/Redoing – performing a mindless task repeatedly until it “feels right,” even if the task has already been acceptably completed.
Hoarding – hiding food under the bed; refusing to throw away soda cans or gum wrappers.
Praying – excessive, time-consuming tefillah outside the normal range of time required.
Of course, many of us, at some point in time or consistently, get caught up in one or even a few of the above obsessions or compulsions. Many of the above manifestations affect non-OCD children for a variety of reasons. But if you notice your child engaged in several of these activities over a period of weeks, observe him or her very carefully for signs of the following, which may indicate the presence of OCD:
- stress
- difficulty sleeping
- depression or shame
- agitation
- crying jags, tantrums
- slowness in performing everyday tasks such as getting dressed in the morning or preparing for bed
- academic difficulties, including slowness to complete easy work
- angry outbursts when questioned about odd rituals or desires
- social difficulties or a desire to spend excessive time alone
What you are looking for are signs of obsessions and compulsions in a child who appears to be struggling emotionally, wrestling with internal burdens. Anxious children’s thinking is typically unrealistic, catastrophic and pessimistic. They may seek excessive reassurance and yet the benefit of that reassurance is fleeting. A perceptive adult will take note of these extreme behaviors.
Getting Help
Talk to your child if you think her idiosyncratic behavior masks something more serious. She may well be relieved you have noticed and could be eager to tell you what’s going on. However, children in the grip of obsessions and compulsions are often scared, confused, ashamed and defensive. They seldom open up on their own and often react belligerently when questioned about their bizarre practices.
Whatever the reaction from your child, it will very likely yield insight into what might be going on inside. If indications point to OCD or another anxiety disorder, it’s time to get help.
OCD and most anxiety disorders can be effectively treated with counseling, and certain dietary and/or lifestyle changes can also afford relief.
Cognitive-Behavioral Training
CBT involves retraining your thought patterns and routines so that compulsive behaviors are no longer necessary. One of the most effective CBT approaches is called exposure and response prevention. This therapy involves gradually exposing an OCD patient, under careful supervision, to a feared object or obsession, such as dirt – or in Racheli’s case, to the obsessive thought of her mother dying or otherwise abandoning the family. The child is then taught skills which help her neutralize her anxiety in a healthy way, as opposed to resorting to compulsions to expel the distressing thoughts.
With this kind of therapy, Racheli soon came to recognize that the panic about her mother dying or disappearing was an obsessive thought that had no basis in reality. She also began to understand that her fears were partly rooted in her grief at “losing” her father due to the divorce. After a great deal of practice and training, she learned to “re-label” her anxiety about her mother as an obsession – an unwelcome intruder who could be ousted – and to thereby reduce its suffocating control over her.
She learned to consciously restrain herself from practicing her counting rituals (response prevention) and to let the resulting rush of anxiety “peak” … and then slowly subside. Within weeks, improvement could be seen.
“From being socially isolated, fearful and miserable, she regained the ability to laugh and be lighthearted,” her teacher marveled. “Once, at the bottom of her test paper, she wrote me a note that brought tears to my eyes. It made me realize the resiliency of a child’s spirit and how an alert teacher can make a difference.
“‘Dear Morah,’ she wrote, ‘once it would have taken me almost a whole day and tons of extra paper and erasing to write these few words: Thank you!! I love you. Racheli.’”
