What does the child who can’t say goodbye to a parent without breaking down have in common with the child who is terrified of dogs and the one who gets stomach ache on Monday mornings?
Anxieties and worries of all kinds are common in children and a necessary part of healthy development - until they interfere with the child’s functioning.
From separation anxiety and phobias to generalised anxiety disorder, many children’s lives are at some point touched by anxiety that gets out of hand.
“I often tell parents that anxiety and fears are a normal and healthy part of growing up,” said Dr Sabrina Fernandez, an assistant professor of paediatrics at the University of California, San Francisco, who has written about strategies for doctors to use in dealing with anxiety disorders.
“I worry that it’s becoming something more when it interferes with the child’s ability to learn in school and to make friends.”
Children whose lives are being derailed by anxiety often receive psychotherapy or medication, or both.
And a meta-analysis published in November looked at the two best-studied treatments for anxiety disorders: cognitive behavioural therapy and psychotropic medication.
The technique of a meta-analysis allows scientists to examine research and then consider the data gleaned from the multiple investigations.
“We included panic disorder, social anxiety disorder, specific phobias, generalised anxiety disorder and separation anxiety,” said the lead author, Zhen Wang, an associate professor of health services research at the Mayo Clinic College of Medicine and Science (they did not include children with post-traumatic stress disorder or obsessive-compulsive disorder).
The study looked at the effectiveness of treatments in reducing anxiety, and at ending the anxiety disorder state. They also looked at any reports of adverse events associated with the treatments, from sleep disturbances to suicide.
The authors examined 115 studies for 7719 patients, and concluded that certain kinds of antidepressant medications - especially the selective serotonin reuptake inhibitors, or SSRIs - were effective in reducing anxiety among the children in the five to 16 age range.
Only a few studies compared them, but they suggest cognitive behavioural therapy might be more effective at reducing symptoms and resolving the disorders, and that the combination of medication and CBT might be best.
The drugs were associated with adverse events, though they did not find the association with suicide attempts that has led to a black-box warning on SSRIs. Still, they have not ruled out the dangers: “The difference may be due to under-reporting and monitoring of suicide attempts in clinical trials,” Wang said.
Which of those children - the parent-clinger, the dog-fearer, the school-avoider - needs psychotherapy or psychopharmacology?
“Anxiety happens in kids,” said Dr Christopher K Varley, a professor in the department of psychiatry at the University of Washington School of Medicine in Seattle. “It does not always need treatment.”
And it does not always look like what adults think of as anxiety, he added. Kids can have physical symptoms, or become disruptive; headaches and stomach aches and tantrums.
“The important questions to me are: Is this a problem? Is it getting in the way of functioning? Is it creating stress for the child and the family? Is it causing pain and suffering?” he said.