We like to believe that childhood is a happy, carefree time, that little ones have nothing weightier on their cheerful minds than the next video game or trampoline leap. The sobering reality is that anxiety and depression are sometimes childhood companions, obviously uninvited and unwelcome.
As their parents’ lives grow more complex, the lives of children can easily become edgy and anxious, too.
Temple University’s Child And Adolescent Anxiety Disorders Clinic Happily, there’s a place in Philadelphia whose mission it is to diagnose and treat children with anxiety disorders. Eight therapists/clinicians are on the staff of Temple University’s Child and Adolescent Anxiety Disorders Clinic, where Dr. Philip Kendall is at the helm. Dr. Kendall is an expert in this highly specialized field and has developed a national profile for the pioneering work done at Temple over the last two decades. Dr. Kendall began working with children who suffer from anxiety disorders at the University of Minnesota.
“Anxiety disorders affect an estimated 10 to 12 percent of youngsters from 7 to 17 years of age,” noted Rinad Beidas, a master’s level clinician and doctoral candidate at the clinic, where pre-screened youngsters are treated free of charge. “While many children can go through periods of low self-esteem and emotional struggles,” explained Ms. Beidas, “the clinic is concerned with children who struggle with truly disabling anxiety and fears.”
A common challenge for kids is social anxiety, according to Ms. Beidas. “It’s the worry about being judged and accepted by others, but in some children this worry becomes impairing. They may be unwilling to join conversations or socialize in the most basic ways.”
Generalized anxiety disorder can be just as disabling. It involves worries about everything - the world, crime, terrorists, school and family. “These patients are often like ‘little adults,’ explained the Temple clinician. “They may start worrying about getting into college in third grade.”
Also treated at the Anxiety Disorders Clinic are children with separation anxiety, that is those who fear being apart from their parents or caregivers long after that anxiety is age-appropriate. Usually, it should end at about age 4.
The treatment approach at the Temple Clinic is based on cognitive-behavioral treatment (CBT) which teaches the youngsters to recognize the signs of anxiety, and then to implement the coping strategies they’ve learned. The therapist becomes the youngster’s “coach,” walking her through the situation and practicing how to handle it in real life.
Using grant money from the National Institutes of Health, the Temple Clinic also evaluated the treatment results when parents were actively involved in the therapeutic process, as compared to when they were not. Children tended to do slightly better in treatment with more parental involvement.
The good news: Treated anxiety in children resulted in a success rate of 72 percent. “It exists, and if untreated, it persists, emphasized Dr. Kendall. “But it IS treatable.”
Childhood Depression Demands Proper Treatment
The National Institutes of Mental Health estimates that 2.5 percent of all children and 8.3 percent of all adolescents will experience some form of clinical depression. Some estimates suggest as many as one in 11 children may experience some form of clinical depression before the age of 14.
The same Institutes’ research also reveals that without proper treatment, childhood depression tends to repeat into adolescence and adulthood, with each successive episode becoming more severe - not a sweet picture of childhood - and one that deserves our serious attention.
“Even very young children can describe feeling sad, but it becomes a concern when that sadness includes some of the very same characteristics adults mention when trying to explain their depression,” said Dr. C. Wayne Jones, Director of Bala Child and Family Associates in Bala Cynwyd.
Dr. Jones, a psychologist who also practiced at Children’s Hospital of Philadelphia’s Child Guidance Clinic, chose to work with children, he explained, “...because childhood is where everything starts, where our emotional lives begin.”
Children with depression come to Dr. Jones’ office because parents, schools or pediatricians recognize that something is wrong. “Sometimes, the child will be able to describe what’s happening. They may talk about other kids being mean to them, or say they feel worthless. But many times, there’s just a shift in behavior.”
Nightmares, stomachaches, sleeplessness and a noticeable “disengagement,” a sense that the child is simply going through the motions of daily life, are the major signals that a child may be struggling with depression.
“A good time to try to get a child talking is at bedtime, when you can have a quiet conversation and ask questions like, ‘Is there something bothering you? Are you worried about something?’” suggested Dr. Jones. “Kids may deny problems, but it’s important to at least try to get them talking.”
The Bala Cynwyd practitioner has treated children as young as two or three for depression, and notes that middle school age youngsters are often the most plagued by feelings of depression. “I almost always approach the child within the context of family - if the familial relationships can be opened up, there’s a greater chance of success. The art of therapy,” added Dr. Jones, “is to make sure that nobody feels blamed or judged.”
A proponent of therapy for any children who are facing a parental separation or divorce, the psychologist also believes in periodic “emotional check-ups” for families, especially those undergoing unusual stressors or changes.
Pharmaceuticals, he suggests, are never the place to start. “But the majority of issues can be resolved without medication.”
The exception may be the serious problem of bipolar disorder in children - and yes, it does exist.
Dr. Rosalie Greenberg, a board-certified child, adolescent and adult psychiatrist in Summit, N.J., is a national leader in bipolar disorder in children, and has served as president of the Juvenile Bipolar Research Foundation.
“One symptom doesn’t mean much,” said Dr. Greenberg, “but when we see a whole constellation of symptoms, we grow concerned.”
In bipolar disorder, she suggested, the level of pain can be intense. “The cardinal feature is the absence of pleasure. Bipolar is often genetic, and if there’s a family history on both mom’s and dad’s sides, it’s more genetically loaded.”
The “manic” phase of the illness causes children to have very high energy, to talk rapidly, express grandiosity or inflated feelings of great confidence. Temper outbursts also are common, in the “up” phase.
To complicate the picture, noted Dr. Greenberg, symptoms of bipolar disorder often overlap with symptoms of Attention Deficit/Hyperactivity Disorder (ADHD), and a diagnosis can be tricky. But it’s the mood variation element that can help with a diagnosis.
“Children with bipolar disorder are often painfully aware of their impact on others,” said Dr. Greenberg, whose book on the subject, Bipolar Kids: Helping Your Child Find Calm in the Mood Storm (DeCapo Press) has recently been published in paperback.
Those who doubt that bipolar disorder can affect the very young might be interested to know that one-third of adults with the diagnosis say they had the symptoms before they were 16. Fully 60 percent of bipolar grown-ups can recall experiencing symptoms before age 18.
By: Sally Friedman, For The Bulletin