Fear and anxiety are a normal part of childhood development. Fear of strangers, for example, peaks at 8-12 months old. It is common for younger children to be afraid of, for example, monsters hiding under the bed. In the adolescent years, fear of negative evaluation and rejection by peers often play a big role.
But there are times when children get stuck and need to be evaluated for anxiety disorders and treated, psychiatrist Sheree Krigsman explained during a recent SWBOCES Special Education PTA event. “Childhood anxiety disorders are among the most common mental health problems in children and adolescents,” said Dr. Krigsman, who works with the Tappan Hill and Pocantico Hills programs.
“If left untreated, the pediatric anxiety disorders tend to persist into adulthood and can be associated with depression, substance abuse, occupational impairments and suicidal behavior,” she added.
During the Nov. 19 workshop, Dr. Krigsman provided information on identifying and treating the disorders. She also emphasized the importance of preventive measures – maintaining good physical health, getting enough sleep, eating well, having positive social interactions, teaching children how to identify and regulate emotions and behavior, and doing activities like yoga and mindfulness.
Parents can help children by adding structure into the day, setting clear expectations and goals, providing motivation, and giving incentives and praise for effort, she said.
Positive social interactions “foster a sense of joy, well-being and community,” Dr. Krigsman said. “What we are trying to do with all these preventative measures is really access the circuitry of the brain that really does slow and calm us down, and give us the positive results and successes that we want in our lives and in our children’s lives.”
Tappan Hill School social worker Yolette Levy began the workshop by explaining mindfulness and leading a breathing activity. Mindfulness is a type of meditation in which people take a step back, acknowledge their feelings and recenter themselves. They relax their body and mind through breathing, guided imagery, listening and other practices.
Mindfulness can relieve stress, improve mental and physical health, increase brain function and lower blood pressure, she said. The technique can be especially useful in times like we are living in now, with the COVID-19 pandemic and political unrest.
“It’s the basic human ability to be present in the moment, being intensely aware of the emotions that you’re feeling and allowing them to come and go without judgment, not overreacting or feeling or becoming overwhelmed,” Ms. Levy said.
Dr. Krigsman explained some primary types of pediatric anxiety, including social anxiety disorder/social phobia, separation anxiety, panic disorder and generalized anxiety disorder. Social anxiety disorder is the most common, but most co-occur with other disorders, such as ADHD, conduct disorder and major depressive disorder. Medical conditions must always be ruled out first before reaching a diagnosis, she said.
Dr. Krigsman discussed specifics of a few disorders, which she noted must be persistent and cause significant distress or impairment for a diagnosis to be made. With social anxiety, children are fearful of social situations in which others may evaluate them negatively. They may express it through crying, tantrums, freezing or clinging, shrinking or failing to speak in social situations. The more people avoid something, the more likely they are to continue avoiding it and to fear it.
A number of factors can play a role in the development of childhood anxiety disorders, such as genetics, heredity, temperament (behavioral inhibition and anxiety sensitivity) and environment (stressful life events, overprotective or overcontrolling parents, lack of social support), Dr. Krigsman said.
She illustrated the interplay of the factors with slides depicting a suspension bridge. Each vertical suspension symbolized individual genetic components. When someone does not have any risk genes, the bridge can sustain severe stressors and still function normally. With multiple risk genes, that is not the case. “We can see the compromised integrity combined with the environmental stress may ultimately end in the collapse of the bridge or metaphorically, the overtaking by disease,” she said.
People can change environmental stressors by making sure they are not under chronic stress and are doing relaxation techniques, she added.
Dr. Krigsman explained various treatments, such as cognitive behavioral therapy (CBT) and medications. Social effectiveness therapy is CBT for children and adolescents that involves psychoeducation, social skills training and exposure exercises. It is designed to modify behaviors, thoughts and beliefs and replace them with positive ones that lead to behavioral changes. Studies have found that therapy and medication combined can have the most impact, she said.
Providers and parents weigh the risks versus benefits of medications for the child and start with the lowest possible dose. Side effects can include worsening of behaviors, agitation, a potential for increased risk of suicidality and others.
“Treating children and adolescents with these anti-depressants is one of the most controversial topics in psychopharmacology. We always take it very seriously,” Dr. Krigsman said. “We try to do what we can without medication first. Some people will benefit and get better without the medication, but others may only improve when medication is added.”
Dr. Krigsman also answered questions from parents and teachers, such as whether anxiety has increased among special needs students during the pandemic.
Anxiety has increased. “It’s challenging, I know, for the parents and I know it’s challenging for the children,” she said. “And community is so important. Knowing that this will pass is so important.”
There are resources for managing stress and coping with COVID-19 anxiety available on the websites of the Anxiety and Depression Society of America, the World Health Organization, the Child Mind Institute and others, according to Dr. Krigsman.
Tappan Hill Principal Phyllis Rizzi said SWBOCES is lucky to have providers like Dr. Krigsman and Ms. Levy on staff. “Please know that at each one of your sites, there are clinicians, social workers who are really there to support you, Ms. Rizzi said.
Anne Marie Cellante, SEPTA executive board member, asked parents to email the SEPTA board with any ideas for future presentations. “We hope to add more as the year goes on,” she said.