Fear and worry are normal experiences during childhood.
However, between 3 and 30 percent of children and adolescents are affected by worries and anxiety disorders that significantly impair their lives.
Dr. Dhiman discusses common anxiety disorders, contributing family and social factors, diagnosis and treatment.
Selected Podcast
Anxiety Disorders in Children
Featured Speaker:
Namita Dhiman, MD
Namita Dhiman, MD, child and adolescent psychiatrist, sees patients at Centra Medical Group Piedmont Psychiatric Center and Centra Child and Adolescent Psychiatric. She received her medical degree from the Indira Gandhi Medical College in India. She completed her psychiatry residency at Creighton University in Nebraska and her child and adolescent psychiatry fellowship. Transcription:
Anxiety Disorders in Children
Bill Klaproth (Host): Fear and worry are normal experiences during childhood. However, between 3 and 30 percent of children and adolescents are affected by worries and anxiety disorders that impair their daily lives. Dr. Namita Dhiman is a child and adolescent psychiatrist and sees patients at Centra Medical Group Piedmont Psychiatric Center and Centra Child and Adolescent Psychiatric. Dr. Dhiman, thanks for your time today. Where does anxiety start? Is this something you’re born with, or do you learn this from your parents and upbringing?
Dr. Namita Dhiman (Guest): That’s a very good question. Thanks for having me here. Anxiety is something that kids have. There is something called normal fears, normal worries and apprehensions that kids have in every stage of life everybody has. It is very important for us to differentiate what is a normal transient developmentally appropriate anxiety and worry and what is not. If it’s anything that is interfering with daily functioning of children, that is what has to be intervened and has to be prevented.
Bill: Give us an example of something that would be out of the ordinary, outside of the normal fears of, “Gosh! Am I gonna pass the test?” or, “Am I gonna make this team?” or those normal, everyday kind of things.
Dr. Dhiman: Sure. Anxiety, as I was saying, that normal anxiety and common fear, if we take infants, they are having fears of loud noise. Toddlers, they have these imageries, imaginations, fears of monsters, and all. At the age of five to six, normal kids they are having these worries of injuries, getting kidnapped, storms, weather. But sometimes, we are seeing the excessive fears and anxiety beyond this age. Like from 8 to 13, if the kids are talking about thunderstorm fears and they are okay, they are accepting that fear and it’s not intervening or interfering with their daily functioning, that’s fine. If they are constantly worrying about it so much that they have stopped going to school, they have problems separating from the parents, they don’t want to do their homework, it’s like in different areas, what we expect them to do and function, they are not, they have stopped functioning because of this fear, that’s the time when we have to intervene.
Bill: What are some skills or strategies that a parent can use? You talked about the normal fears. Young child, the fear of sound, a loud noise or something, or the fear of monsters. What are some tips you can give parents, even at a very young age, to start doing right away with their children?
Dr. Dhiman: First of all, I would suggest to parents that they should be aware of these common fears. Because sometimes, as a physician, we see the genetic component of anxiety. Anxiety disorders run in the family. There are so many times when parents suffer from anxiety and these disorders. Sometimes they can’t take it, they can’t see the fears that kids are having. So it’s very important to educate the parents first of all about what are the common fears that’s okay, he’s going to overcome, and meanwhile, lower down the parents’ anxiety at the same time. That will automatically lower down the kid’s anxiety. Minimum what parents can do is open communication, like help the child to understand better what they are fearful about. That will help to reduce the level of anxiety. Any parent has to understand that, or anybody. In school, teachers have to understand that they are not completely saying that anxiety will go away. It will take some time. It’s a process. It will go away slowly provided the kids, they are getting cooperation from everywhere. It’s kind of a multi-system approach.
Bill: Absolutely. That makes sense. When I hear you talk about this, it almost seems like parents need to look at themselves, too, and research their own fears and troubles and issues that they may have before they can properly parent their children so they don’t pass their own anxieties and fears and worries to that child. Does that make sense?
Dr. Dhiman: Absolutely.
Bill: Let’s go back to the child now. How do you recognize then that something may be amiss here? This child might be suffering from anxiety or depression. Is there a timeframe, a couple of weeks? Or how do you know when something might be wrong?
Dr. Dhiman: Because there’s different types of anxiety disorders. Like generalized anxiety disorder, we are talking about separation anxiety disorder that sometimes we see at an early age up to 18 months. But if it’s more after five or six year old kids having separation anxiety, then -- there are different clusters of symptoms. Since this we have this new classification of DSM-IV and DSM-V, lots of changes have happened. Generalized anxiety disorder, if symptoms last for over six months, then we have to -- first and foremost, we evaluate the patients through the detailed evaluation, the interview, history and physical. The symptoms have to be clear whether they are falling in any of these categories. So interviewing the patient is first. Then there are different rating scales that we do. These scales, a child can themselves do the self-report or the parents can report called the SCARED scale and the MASC scale. So, different types of rating scales. The first and foremost when I see the patients, I ask different questions, but the questions have to be cognitively simple—in other words, in simple language what different kids cognitively can understand and express their fears. Because I don’t expect a five-year-old coming to me and saying, “I’m anxious.”
Bill: Right. And for a child then diagnosed with an anxiety disorder, what are the treatment options?
Dr. Dhiman: The treatment options are depending on what category their symptoms are in. I usually divide them into mild, moderate, and severe. If the mild symptoms, we usually start with psychotherapy. There are different types of psychotherapy called cognitive behavior therapy. That works extremely well if the patient just has mild symptoms. But moderate and severe category symptoms, when the kids can’t function in everyday life and they are interfering within different areas like school or at home, then we start with medications. Plus, at the same time, therapy, cognitive behavior therapy.
Bill: Then what’s the long-term outlook for a child with depression? Probably depends on the mild, moderate, or severe. I suppose somebody with a mild case can probably learn strategies that will help them throughout their life. But give me a best-case scenario for a child with severe depression.
Dr. Dhiman: Severe anxiety, you mean?
Bill: Correct.
Dr. Dhiman: Anxiety disorders always start with one type of anxiety, and there’s a rule of thumb that the most common comorbidity is that one anxiety disorder associated with another anxiety disorder. So depending on how much severity, mild, moderate, severe. If it’s a mild symptom and just one anxiety disorder we are talking about with therapy, we have to reevaluate in three to six months how the patients are doing and progressing. If moderate to severe symptoms and if we are talking about a cluster of anxiety disorders, like the patient has panic disorder, generalized anxiety disorder, and different clusters, the treatment will be longer. It will be six months to one year, but they can follow up, send the medication adherence, and the treatment follow-up adherence has been recommended.
Bill: All right, Dr. Dhiman. Thank you so much. Tell us, why should people choose Centra Health for their children’s health needs?
Dr. Dhiman: Centra, we have a very competent and very hardworking -- I can talk about my team here. We know what we are doing. Whatever I have talked to you right now, it’s all about evidence-based medicine, facts, and new research. It’s all about learning every day new things. We are practicing what is rarely working for the kid research-based or experience-based, and it’s a pretty effective, competent, excellent team, I can say.
Bill: Dr. Dhiman, thanks so much for your time today. We really appreciate it. For more information, please visit centrahealth.com. That’s centrahealth.com. I’m Bill Klaproth. This is Centra Healthy Radio. Thanks for listening.
Anxiety Disorders in Children
Bill Klaproth (Host): Fear and worry are normal experiences during childhood. However, between 3 and 30 percent of children and adolescents are affected by worries and anxiety disorders that impair their daily lives. Dr. Namita Dhiman is a child and adolescent psychiatrist and sees patients at Centra Medical Group Piedmont Psychiatric Center and Centra Child and Adolescent Psychiatric. Dr. Dhiman, thanks for your time today. Where does anxiety start? Is this something you’re born with, or do you learn this from your parents and upbringing?
Dr. Namita Dhiman (Guest): That’s a very good question. Thanks for having me here. Anxiety is something that kids have. There is something called normal fears, normal worries and apprehensions that kids have in every stage of life everybody has. It is very important for us to differentiate what is a normal transient developmentally appropriate anxiety and worry and what is not. If it’s anything that is interfering with daily functioning of children, that is what has to be intervened and has to be prevented.
Bill: Give us an example of something that would be out of the ordinary, outside of the normal fears of, “Gosh! Am I gonna pass the test?” or, “Am I gonna make this team?” or those normal, everyday kind of things.
Dr. Dhiman: Sure. Anxiety, as I was saying, that normal anxiety and common fear, if we take infants, they are having fears of loud noise. Toddlers, they have these imageries, imaginations, fears of monsters, and all. At the age of five to six, normal kids they are having these worries of injuries, getting kidnapped, storms, weather. But sometimes, we are seeing the excessive fears and anxiety beyond this age. Like from 8 to 13, if the kids are talking about thunderstorm fears and they are okay, they are accepting that fear and it’s not intervening or interfering with their daily functioning, that’s fine. If they are constantly worrying about it so much that they have stopped going to school, they have problems separating from the parents, they don’t want to do their homework, it’s like in different areas, what we expect them to do and function, they are not, they have stopped functioning because of this fear, that’s the time when we have to intervene.
Bill: What are some skills or strategies that a parent can use? You talked about the normal fears. Young child, the fear of sound, a loud noise or something, or the fear of monsters. What are some tips you can give parents, even at a very young age, to start doing right away with their children?
Dr. Dhiman: First of all, I would suggest to parents that they should be aware of these common fears. Because sometimes, as a physician, we see the genetic component of anxiety. Anxiety disorders run in the family. There are so many times when parents suffer from anxiety and these disorders. Sometimes they can’t take it, they can’t see the fears that kids are having. So it’s very important to educate the parents first of all about what are the common fears that’s okay, he’s going to overcome, and meanwhile, lower down the parents’ anxiety at the same time. That will automatically lower down the kid’s anxiety. Minimum what parents can do is open communication, like help the child to understand better what they are fearful about. That will help to reduce the level of anxiety. Any parent has to understand that, or anybody. In school, teachers have to understand that they are not completely saying that anxiety will go away. It will take some time. It’s a process. It will go away slowly provided the kids, they are getting cooperation from everywhere. It’s kind of a multi-system approach.
Bill: Absolutely. That makes sense. When I hear you talk about this, it almost seems like parents need to look at themselves, too, and research their own fears and troubles and issues that they may have before they can properly parent their children so they don’t pass their own anxieties and fears and worries to that child. Does that make sense?
Dr. Dhiman: Absolutely.
Bill: Let’s go back to the child now. How do you recognize then that something may be amiss here? This child might be suffering from anxiety or depression. Is there a timeframe, a couple of weeks? Or how do you know when something might be wrong?
Dr. Dhiman: Because there’s different types of anxiety disorders. Like generalized anxiety disorder, we are talking about separation anxiety disorder that sometimes we see at an early age up to 18 months. But if it’s more after five or six year old kids having separation anxiety, then -- there are different clusters of symptoms. Since this we have this new classification of DSM-IV and DSM-V, lots of changes have happened. Generalized anxiety disorder, if symptoms last for over six months, then we have to -- first and foremost, we evaluate the patients through the detailed evaluation, the interview, history and physical. The symptoms have to be clear whether they are falling in any of these categories. So interviewing the patient is first. Then there are different rating scales that we do. These scales, a child can themselves do the self-report or the parents can report called the SCARED scale and the MASC scale. So, different types of rating scales. The first and foremost when I see the patients, I ask different questions, but the questions have to be cognitively simple—in other words, in simple language what different kids cognitively can understand and express their fears. Because I don’t expect a five-year-old coming to me and saying, “I’m anxious.”
Bill: Right. And for a child then diagnosed with an anxiety disorder, what are the treatment options?
Dr. Dhiman: The treatment options are depending on what category their symptoms are in. I usually divide them into mild, moderate, and severe. If the mild symptoms, we usually start with psychotherapy. There are different types of psychotherapy called cognitive behavior therapy. That works extremely well if the patient just has mild symptoms. But moderate and severe category symptoms, when the kids can’t function in everyday life and they are interfering within different areas like school or at home, then we start with medications. Plus, at the same time, therapy, cognitive behavior therapy.
Bill: Then what’s the long-term outlook for a child with depression? Probably depends on the mild, moderate, or severe. I suppose somebody with a mild case can probably learn strategies that will help them throughout their life. But give me a best-case scenario for a child with severe depression.
Dr. Dhiman: Severe anxiety, you mean?
Bill: Correct.
Dr. Dhiman: Anxiety disorders always start with one type of anxiety, and there’s a rule of thumb that the most common comorbidity is that one anxiety disorder associated with another anxiety disorder. So depending on how much severity, mild, moderate, severe. If it’s a mild symptom and just one anxiety disorder we are talking about with therapy, we have to reevaluate in three to six months how the patients are doing and progressing. If moderate to severe symptoms and if we are talking about a cluster of anxiety disorders, like the patient has panic disorder, generalized anxiety disorder, and different clusters, the treatment will be longer. It will be six months to one year, but they can follow up, send the medication adherence, and the treatment follow-up adherence has been recommended.
Bill: All right, Dr. Dhiman. Thank you so much. Tell us, why should people choose Centra Health for their children’s health needs?
Dr. Dhiman: Centra, we have a very competent and very hardworking -- I can talk about my team here. We know what we are doing. Whatever I have talked to you right now, it’s all about evidence-based medicine, facts, and new research. It’s all about learning every day new things. We are practicing what is rarely working for the kid research-based or experience-based, and it’s a pretty effective, competent, excellent team, I can say.
Bill: Dr. Dhiman, thanks so much for your time today. We really appreciate it. For more information, please visit centrahealth.com. That’s centrahealth.com. I’m Bill Klaproth. This is Centra Healthy Radio. Thanks for listening.