Anxiety

(adapted from American Academy of Child & Adolescent Psychiatry)

Fears and worries in children can be common and developmentally appropriate. Infants, for example, are easily startled and, later on, develop a transient fear of strangers. Toddlers typically fear darkness, imaginary creatures, and being separated from their caretakers. School-age children tend to worry about injury, death, and natural events such as storms. Pre-adolescents and adolescents typically experience anxiety around school performance, social status, and health issues.  Some children may need extra support to manage their worries or anxiety, which could include behavior plans, adjusting the environment, providing visual schedules and practicing coping skills such as positive self-talk, mindfulness strategies and breathing techniques.

However, developmentally appropriate fears can become problematic if they do not subside with time, some of the above mentioned interventions, or if they are severe enough to impair a child’s day-to-day functioning. A clinician can help distinguish normal, developmentally appropriate anxiety or shyness from an anxiety disorder that requires further intervention and treatment.

Children and adolescents with anxiety generally voice a specific worry or fear, which they may not realize is excessive or unreasonable. They can also present with a physical complaint, such as stomachache or headache. Clinicians diagnose specific anxiety disorders by examining the context in which a child’s anxiety symptoms occur:

• Children with Generalized Anxiety Disorder experience chronic, excessive anxiety about multiple areas of their lives (e.g., family, school, social situations, health, natural disasters)

• Children with Separation Anxiety experience excessive fear of being separated from their home or caretakers. This can be developmentally appropriate up through 1st grade and can also be impacted by family and environmental situations such as an ill parent, loss of a loved one or as in the case of the Covid-19 pandemic, a re-adjustment to being in large groups away from family.

• Children with Specific Phobia fear a specific object or situation (e.g., spiders, needles, riding in elevators)

• Children with Social Phobia experience anxiety in social settings or performance situations

• Children with Panic Disorder experience unexpected, brief episodes of intense anxiety without an apparent trigger, characterized by multiple physical symptoms (e.g., shortness of breath, increased heart rate, sweating)

• Children with Obsessive-Compulsive Disorder perform repetitive mental acts or behaviors (“compulsions”) to alleviate anxiety caused by disturbing thoughts, impulses, or images (“obsessions”)

• Children with Post-Traumatic Stress Disorder experience anxiety symptoms (e.g. nightmares, feelings of detachment from others, increased startle) following exposure to a traumatic event.

There is no single cause of anxiety disorders. The development of an anxiety disorder typically results from an interaction between certain biological and environmental risk factors that are unique to each individual. Genetics play an important role in determining who will develop an anxiety disorder, as does a child’s temperament, or innate personality style. Studies show, for example, that children who are innately cautious, quiet, and shy are more likely to develop an anxiety disorder. Environmental risk factors, such as parenting style, combine with the biological risk factors of genetics and temperament to make a child more or less predisposed toward developing an anxiety disorder.

There is not one single treatment for children and adolescents with anxiety disorders. A clinician will formulate a treatment plan that is individualized to the needs of each child and family.  Some common interventions include calming strategies, cognitive behavioral therapies and exposure therapy, where the child is slowly and gradually taught to experience the situation that causes them to become anxious.

Psychotherapy is the first-line treatment for anxiety disorders of mild severity. One widely used, evidence-based form of psychotherapy for anxiety disorders is Cognitive Behavioral Therapy (CBT).

When a child’s anxiety symptoms are severe, or when a child has responded only partially to psychotherapy, adding medication may be helpful. Selective Serotonin Reuptake Inhibitors (SSRIs) are the first line medications used to treat children with anxiety disorders. Parents should discuss the risks and benefits of these medications with their child’s clinician.

For more information about psychotherapy see AACAP's Facts for Families - Psychotherapy for Children and Adolescents  

The American Academy of Child and Adolescent Psychiatry (AACAP) and the  American Psychiatric Association (APA) developed Anxiety Disorders: Parent's Medication Guide. This guide is designed to help individuals make informed decisions about treating anxiety disorders in children and adolescents.

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

ADHD:

(Adapted from healthychildren.org)

Almost all children have times when their behavior veers out of control. They may speed about in constant motion, make noise nonstop, refuse to wait their turn, and crash into everything around them. At other times they may drift as if in a daydream, unable to pay attention or finish what they start. 

 However, for some children, these kinds of behaviors are more than an occasional problem. Children with attention deficit hyperactivity disorder (ADHD) have behavior problems that are so frequent and severe that they interfere with their ability to live normal lives.  

According to national data, ADHD affects about 9.4% of U.S. children ages 2-17―including 2.4% of children ages 2-5 and 4%-12% of school-aged children. Boys are more than twice as likely as girls to be diagnosed with ADHD. Both boys and girls with the disorder typically show symptoms of an additional mental disorder and may also have learning and language problems.

The condition affects behavior in specific ways. For example, children with ADHD often have trouble getting along with siblings and other children at school, at home, and in other settings. Those who have trouble paying attention usually have trouble learning. An impulsive nature may put them in actual physical danger. Because children with ADHD have difficulty controlling this behavior, they may be labeled "bad kids" or "space cadets." 

Effective treatment is available. If your child has ADHD, your pedia­trician can offer a long-term treatment plan to help your child lead a happy and healthy life. As a parent, you have a very important role in this treatment.  

Left untreated, ADHD in some children will continue to cause ­serious, lifelong ­problems, such as poor grades in school, run-ins with the law, failed relationships, and the inability to keep a job. 

How a child with these symptoms may behave:

Inattention

• Often has a hard time paying attention, daydreams (Myth: Children with ADHD can't pay attention.  They CAN, if they are really interested in a topic or activity)

• Often does not seem to listen

• Is easily distracted from work or play

• Often does not notice details, makes careless mistakes

• Frequently does not follow through on instructions or finish tasks

• Is disorganized, loses things often

• Often forgets things

• Frequently avoids doing things that require ongoing mental effort (unless really interested)

Hyperactivity

• Is in constant motion, as if "driven by a motor"

• Cannot stay seated

• Frequently squirms and fidgets

• Talks too much

• Often runs, jumps, and climbs when this is not permitted

Impulsivity

• Frequently acts and speaks without thinking

• May run into the street without looking for traffic first

• Frequently has trouble taking turns

• Cannot wait for things

• Often calls out answers before the question is complete

• Frequently interrupts others

Children with ADHD may have one or more of the symptom groups listed in the table above. The symptoms are usually classified by the following types of ADHD: 

• Inattentive only (formerly known as attention-deficit disorder [ADD])—Children with this form of ADHD are not overly active. Because they do not disrupt the classroom or other activities, their symptoms may not be noticed. Among girls with ADHD, this form is more common.

• Hyperactive/impulsive—Children with this type of ADHD show both hyperactive and impulsive behavior, but they can pay attention. They are the least common group and are frequently younger.

• Combined inattentive/hyperactive/impulsive—Children with this type of ADHD show a number of symptoms in all 3 dimensions. It is the type that most people think of when they think of ADHD.

Realize, it is normal for all children to show some ADHD symptoms from time to time. Your child may be reacting to stress at school or home, bored, or just going through a difficult stage of life. It does not mean he or she has ADHD. 

Sometimes a teacher is the first to notice inattention, hyperactivity, and/or impulsivity and bring these symptoms to a parent's attention.  

• Causes of ADHD: What We Know Today

• Treatment & Target Outcomes for Children with ADHD

• Common ADHD Medications & Treatments for Children

• How Schools Can Help Children with ADHD

• Understanding ADHD  (Understood.org) 

• Parenting a Child with ADHD

• ADHD Fact Sheets

• National Institute of Mental Health or 866/615-6464

Source American Academy of Pediatrics (Copyright © 2019)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.

Autistim Spectrum Disorders:

(Adapted from the cdc.gov on autism)

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Autism spectrum disorder (ASD) is a developmental disability  that can cause significant social, communication and behavioral challenges. There is often nothing about how people with ASD look that sets them apart from other people, but people with ASD may communicate, interact, behave, and learn in ways that are different from most other people. The learning, thinking, and problem-solving abilities of people with ASD can range from gifted to severely challenged. Some people with ASD need a lot of help in their daily lives; others need less.

A diagnosis of ASD now includes several conditions that used to be diagnosed separately: autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. These conditions are now all called autism spectrum disorder.

People with ASD often have problems with social, emotional, and communication skills. They might repeat certain behaviors and might not want change in their daily activities. Many people with ASD also have different ways of learning, paying attention, or reacting to things. Signs of ASD begin during early childhood and typically last throughout a person’s life. Below is a list of some common traits, however many may not apply to all students on the spectrum.  Each child with autism is unique, with their own set of strengths and challenges.

Children or adults with ASD might:

• not point at objects to show interest (for example, not point at an airplane flying over)

• not look at objects when another person points at them

• have trouble relating to others or not have an interest in other people at all

• sometimes may avoid eye contact and want to be alone

• have trouble understanding other people’s feelings or talking about their own feelings

• prefer not to be held or cuddled, or might cuddle only when they want to

• appear to be unaware when people talk to them, but respond to other sounds

• be very interested in people, but not know how to talk, play, or relate to them

• repeat or echo words or phrases said to them, or repeat words or phrases in place of normal language

• have trouble expressing their needs using typical words or motions

• not play “pretend” games (for example, not pretend to “feed” a doll)

• repeat actions over and over again

• have trouble adapting when a routine changes

• have unusual reactions to the way things smell, taste, look, feel, or sound

• lose skills they once had (for example, stop saying words they were using)

Learn more about symptoms »

Learn about developmental milestones that young children should reach »

Diagnosing ASD can be difficult since there is no medical test, like a blood test, to diagnose the disorders. Doctors look at the child’s behavior and development to make a diagnosis.

ASD can sometimes be detected at 18 months or younger. By age 2, a diagnosis by an experienced professional can be considered very reliable.1 However, many children do not receive a final diagnosis until much older. This delay means that children with ASD might not get the early help they need.

Learn more about diagnosis »

There is currently no cure for ASD. However, research shows that early intervention treatment services can improve a child’s development.2, 3 Early intervention services help children from birth to 3 years old (36 months) learn important skills. Services can include therapy to help the child talk, walk, and interact with others. Therefore, it is important to talk to your child’s doctor as soon as possible if you think your child has ASD or other developmental problem.

Even if your child has not been diagnosed with an ASD, he or she may be eligible for early intervention treatment services. The Individuals with Disabilities Education Act (IDEA) says that children under the age of 3 years (36 months) who are at risk of having developmental delays may be eligible for services. These services are provided through an early intervention system in your state. Through this system, you can ask for an evaluation.

In addition, treatment for particular symptoms, such as speech therapy for language delays, often does not need to wait for a formal ASD diagnosis.

Learn about types of treatments »

We do not know all of the causes of ASD. However, we have learned that there are likely many causes for multiple types of ASD. There may be many different factors that make a child more likely to have an ASD, including environmental, biologic and genetic factors.

• Most scientists agree that genes are one of the risk factors that can make a person more likely to develop ASD.

• Children who have a sibling with ASD are at a higher risk of also having ASD.

• Individuals with certain genetic or chromosomal conditions, such as fragile X syndrome or tuberous sclerosis, can have a greater chance of having ASD. 

• When taken during pregnancy, the prescription drugs valproic acid and thalidomide have been linked with a higher risk of ASD.

• There is some evidence that the critical period for developing ASD occurs before, during, and immediately after birth.

• Children born to older parents are at greater risk for having ASD.

Click the link below for more information on autism:

Parent's Guide to Autism - (pdf - Scroll down to see text)

The information contained on this Web site should not be used as a substitute for the medical care and advice of your pediatrician. There may be variations in treatment that your pediatrician may recommend based on individual facts and circumstances.