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Perspectives: Specialty Pediatrics
Perspectives: Specialty Pediatrics

Back to School Jitters — What’s Typical and What Suggests an Anxiety Disorder?

Posted on Aug 21, 2014 by Elvira Downs, MD , Section Chief - Psychiatry

Summer is winding down, and many children have back to school jitters. Starting a new school year can certainly be scary and overwhelming. But, some kids experience stress far beyond the typical feelings of nervousness. Approximately 13% of children and adolescents suffer from anxiety disorders, which can have a large impact on their academic and social functioning.

There are various potential causes of anxiety disorders, including:
• Genetic predisposition
• Environmental factors
• Temperament (shyness)

Fear and worry are common in children, especially at back to school time. But, it is important to distinguish normal, developmentally appropriate worries, fear, and shyness from anxiety disorders that significantly impair a child’s functioning.

The anxiety disorders commonly seen in children (DSM-5) and their associated symptoms are:

• Generalized anxiety disorder: Chronic, excessive worry in a number of areas such as schoolwork, social interactions, family, health/safety, world events and natural disaster, with at least one associated somatic symptom. These children are often perfectionists, seek reassurance, and may struggle with more internal distress than is evident to parents or teachers.

• Separation anxiety disorder: Distress in anticipation of separation from home or significant attachment figures. These children worry excessively about their own or their parents’ safety and health when separated, have difficulty sleeping alone, experience nightmares with themes of separation, frequently have somatic complaints, and may exhibit school refusal.

• Social anxiety disorder: Feeling scared or uncomfortable in one or more social settings, or performance anxiety. These children may have difficulty answering questions in class, reading aloud, initiating conversations, talking with unfamiliar people, and attending parties and social events.

Although anxiety disorders are the most common class of psychiatric illness affecting children and adolescents, they often go undetected or untreated (as opposed to externalized disorders such as ADHD, ODD, and bipolar). It can be difficult to make an accurate diagnosis. When assessing, one must look at factors such as duration, frequency and intensity of the symptoms within a developmental context; distinguish symptoms from medical conditions that can mimic anxiety; and rule out reactions to medication. Early identification and effective treatment may reduce the impact of anxiety on academic and social functioning and may reduce the persistence of anxiety disorders into adulthood. 

At Children’s Specialized Hospital, we evaluate and treat the spectrum of anxiety disorders. Our expert staff includes child psychiatrists, advance practice psychiatric nurse practitioners, psychologists, social workers, and licensed clinical therapists. We conduct full, comprehensive diagnostic assessments with the development of a multimodal treatment plan to address not only the diagnosed anxiety, but other co-morbid/associated conditions.

Our clinical approach depends on the age of the child, the severity of the symptoms, and the family's participation in treatment. Parent guidance is typically the first step.  This may be combined with cognitive behavioral therapy.  Medication is considered when symptoms are severe enough to interfere with the child’s ability to function in school and significantly disrupt family life. We work closely with and coordinate with schools, as well as with referring pediatricians and primary care providers. We also offer psychotherapy to provide a safe, accepting environment for the child to explore his or her feelings of beliefs about self worth and self-efficacy.

Have you noticed an increase in anxiety in your pediatric patients at back to school time?

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