Separation Anxiety Disorder in Children

Anxiety is a condition which is not only seen in the adults but also in the children. If you observe the behavior of the kids you will realize that they too at some stage suffer anxiety disorder. If the children are not taught to cope up with this anxiety then in late childhood they may develop performance anxiety and in adolescence may have social phobia.

Anxiety can often be noticed in kids right from the time they are 4 months old to 24 months old. Infants can easily be noticed to get terrified when they happen to hear some loud noise all of a sudden. It is also quite normal for the child to cry if separated from his care-giver. The crying of a child when his parent is not near him is a way to show his anxiety. A child cries when his parents are away or at least one of the parent to whom he is more attached is not near him. The crying of the child exhibits his fear of going away from his parents or the fear that his parents may not return and would be lost for ever. It is this anxious feeling that makes the child cry.

The parents should never bribe a child to get rid of the child’s crying. Instead the parents should teach the child to learn to adjust to the new surroundings. The child should be made to understand gently. In no way should a child be scolded to quit his behavior forcibly. Toddlers who start going to preschool may also display at times such anxiety when they move out of the cozy and protective environment of their homes and reach amidst such people whom they are not familiar with. At this time the teachers should take care of the child. Make the child believe that he is quite safe just like the other children. If the child becomes extremely anxious and starts panicking then the parent should be allowed to see off the child till his class room but should not sneak back again into the class.

Some children seem to be more irritable or clingy while they are in their infancy. Such children find it exceedingly difficult to adjust to their transitions or their daily schedule.

Such children are more likely to develop anxiety when they grow up. Hence children with such kind of temperament are more easily to develop anxiety when they grow up further. There are several factors which are responsible for the anxiety in children. The factors can be tiredness, major or minor illness, any change or transition in the house hold, birth of a sibling, family changes like somebody’s death or illness etc.

There are certain treatments available for such children who are suffering from anxiety disorder. Behavioral therapy is often beneficial for both the child and his parents. Counseling proves to be of immense help for the child and his parents. In few cases where the counseling or the behavioral therapy fails, medication can be combined with it but for children, medications should be given only when the alternative methods fail. But medication is needed for a minority of children who have persistent symptoms, resistant to behavior modification and psychotherapy.

How Old is the Disease of Anxiety Disorder

Anxiety Disorder does not need much of an introduction to the people these days. Thanks to the ever mounting pressure in our daily life, be it lifestyle pressure or professional pressure, anxiety disorder is no alien disease to us. But interestingly anxiety disorder was first recognized only in 1980, by the American Psychiatric Association. Before this, even if people went to a physician received the general diagnosis of just simply ‘stress’ or ‘nerves’. This was one of the main reasons that people hardly cared for this condition thinking that it would soon pass. More over the physicians also had the least knowledge of the disease and that was also one of the reasons that the people never received any effective treatment. It was only after 1980 that people began to recognize the possible threat to a person’s personality and severe disabilities that could be associated with anxiety disorder, like agoraphobia, drug abuse, etc.

Often people used to think that anxiety or stress is basically a ‘woman’s problem’ but in reality it does not spare even the men. In fact the current researches show that anxiety disorder can inflict even the children and the elderly. The awareness that the people have today about anxiety disorder is basically because of the exposure of the researches in front of the media.

History of the Treatment of Anxiety Disorder

Media has been instrumental in spreading the awareness about anxiety disorder and hence more and more people are showing interest now to visit the physician and get them selves examined for their condition. Men, who otherwise considered the disease troubling only for women, now realize that this is not true and hence like to take a doctor’s advice to treat their condition even if it is just the onset of the disease.

In olden days when the disease of anxiety disorder was not much recognized, people used to employ some strange, humorous and sometimes even painful methods to treat themselves of their condition of anxiety. Sometimes the methods of treatment involved were really very dangerous. Many people used herbal medicines or balms to treat their anxiety disorder. Some people tried to give extreme hot and cold temperatures to the body. Some people used to bathe in extreme cold water of the rivers and the streams, used health spas etc. but there were even some crazy people who inflicted deliberate pain to their bodies, like blood-letting using the leeches to suck the blood. With the emergence of psycho-analysis and Freud’s psycho theories, people gradually began to understand the psychological basis of the disease and started visiting a therapist in order to consult about their disease. With the entry of pharmaceuticals in curing the condition people slowly started relying on medicines, although it was not yet known by the name of ‘Anxiety Disorder’.

Statistics reveal that more than 19 million adult Americans in the age-group of 18-54 year suffer from anxiety. Often we see that in a particular situation some people stay very cool and relaxed while in a similar situation there are some persons who lose their nerve and become over anxious about the situation.

The difference in the behavior of people in similar situations can be best understood if we take a look at the mechanism of the brain. It has been found that the body’s fear response is coordinated by a small structure deep inside the brain, called the amygdala. Neuroscientists have shown that when confronted with danger, the body’s senses launch two sets of signals to different parts of the brain. One set of signals, which takes a longer route, relays information to the cerebral cortex, the cognitive part of the brain that explains in detail the threatening object or situation such as a big blue bus coming towards you as you cross the street. The other signal reaches the amygdala causing the fear factor to rise and hence protect oneself even before the cognitive part of the brain can describe that what actually the threat is. Although the amygdala is a very small part of the brain yet its function is very complicated. A recent research with animals suggests that different anxiety disorders may be associated with activation in different parts of the amygdala.

One or more fearful experience makes a person extra cautious and he responds with fear in similar situations, reacting in a much different way from other persons in a similar situation. But sometimes similar fearful situations become so much embedded in a person’s mind that whenever a slightly similar situation occurs then the same fear comes to the fore front and the person behaves in a hyper manner. For people who are suffering from ‘post traumatic stress disorder’ (PTSD) even a small reminder of the incident brings shivers down the spine for that person. This is because even the slight reminder of the incident can make a person recollect the fear embedded in his mind associated with the incident. Research evidence proves that genetics is also one of the factors which can spark the anxiety disorder in a person. Researches on mice have shown that there is a specific gene (SLC6A4) which is responsible for the birth of anxiety disorder in a person.

There are various ways which can treat these kinds of anxiety disorders. There are various therapies like cognitive therapy, psychotherapy and finally medication. Generally, a mild anxiety disorder can be effectively treated by using psychotherapy or cognitive behavior therapy. It is only when the anxiety disorder does not get treated by psychotherapy or cognitive behavior alone that medicines are required to treat a person. There are quite a number of anti-depressants prescribed for the treatment but Xanax is one such medicine that is widely popular among the physicians, as far as the treatment of anxiety disorder is concerned. Xanax belongs to a class of drugs known as benzodiazepines.

If you find symptoms of anxiety disorder in any of your near and dear ones then the best way is to visit your physician as soon as possible. Only your Physician can detect that whether these symptoms are due to anxiety or any other medical condition. The symptoms of Anxiety Disorder like restlessness, loss of sleep, loss of hunger, over-impulsive nature, losing temper easily, etc. are some of the symptoms which can detect the mental disease of anxiety disorder. After you come to know for sure from your physician that you are really suffering from anxiety then the next important step is to visit a mental health care professional.

Apart from the general physician there are people like psychologists, counselors, and at times even the psychiatrists. These professionals implement various methods and techniques to treat a person suffering from anxiety disorder. There are methods like hypnotism, verbal counseling, and finally medication if the situation worsens immensely then there is no way apart from medicines like Xanax. At first the effort of every physician or counselor is to treat you without putting on medication. They try various other alternative therapies to make you free from anxiety. Sometimes there are social workers and psychologists who work in close connection with the psychiatrists.

Sometimes a group therapy or group counseling is equally effective for some patients to get rid of their anxiety. When you are deciding to settle upon the idea of visiting a mental health care professional then you should also try to find out that what kind of therapy is that doctor using and whether he relies on medicines as well or not. In case you are already taking some medication to treat your condition then it is strictly advisable not to increase your dosages on your own. You should always consult your doctor before tampering in any way with the dosages you are taking. It’s only your doctor who can give you the right dose required. Once you are satisfied with the possible treatment applied by the physician you should give in completely to that physician’s way of treatment. You must though have faith on your physician completely on whatever method he applies. Sometimes it can be cognitive therapy and sometimes it can be behavioral therapy or may be a combination of both the methods that your physician may apply to treat you. Treatments for anxiety disorders, however, may not start working instantly. Your doctor or therapist may ask you to follow a specific treatment plan for several weeks to determine whether it’s working or not.

While anxiety disorders occur throughout the life time but the anxiety occurring in older people is quite different.

Interestingly, most anxiety disorders are somewhat less common and often less severe in persons over 65 years of age; for example social phobia, agoraphobia, panic disorder, post-traumatic stress disorder and the more severe forms of obsessive compulsive disorder.

Nonetheless, about 20% of all elderly persons report some symptoms of anxiety. In addition, anxiety symptoms arising from physical problems or medication side effects are more frequent among the elderly. For example breathing problems, irregular heart beats and tremors can give rise to the symptoms of anxiety. Anxiety can occur along with other psychiatric problems too; over half of elderly persons with severe depression also can be said to be suffering from generalized anxiety disorder.

As an increasing section of our population ages, mental health problems among older adults are getting more and more attention.  Unfortunately, much of the existing research so far has focused predominantly on young or middle aged adults. Studies have shown that among older adults, anxiety disorders occur two to seven times more often than depression problems such as major depressive disorder.  This suggests that anxiety disorders are a very real and relatively common problem among older adults experiencing mental health problems.

There are many reasons which result in the anxiety for the senior people. The everyday activities of the people put stress on their minds giving rise to their anxiety. Many elderly people must deal with significant changes, with threats to their independent functioning and with major losses at a time in their lives when they are often least equipped to deal with them. All this definitely leads to anxiety. Among the elderly, anxiety symptoms can also be associated with real problems such as physical health problems, medical problems, challenges to living independently, and cognitive impairment. An anxiety disorder is only diagnosed if the anxiety symptoms are excessive, uncontrollable, create significant distress to the individual and/or interfere with daily living.

The high degree of overlap between anxiety and medical problems can make correct diagnosis and treatment of anxiety disorders particularly challenging among older or elderly adults. For example, muscle tension, sleep disturbance, and feeling agitated can be symptoms of both anxiety disorders and medical conditions. In addition, some medical problems (e.g., cardiovascular disease, hyperthyroidism) can lead to symptoms that feel like symptoms of anxiety. For this reason it is important that both mental and physical health symptoms are reviewed thoroughly with older or elderly individuals who have anxiety-like symptoms.

Fortunately, there are many good treatments for anxiety disorders. These may include the use of relaxation techniques, psychotherapy and medications. Frequently with effective treatment, the person can then handle the challenges of his life.

Caroline’s high school result is going to be declared tomorrow and here she is lying awake with wide eyes at 1:00 A.M. in the night desperately worried, what if she doesn’t perform well, what if she doesn’t get admission in the course of her choice, what if she is forced to stay away at an alien college away from her friends. For you and me, it is a pretty ordinary situation but for Caroline it may mean the end of the world to her.

Anxiety must be a very harmless looking condition to a person who has never experienced it ever in his life. It is well said that only the wearer knows where the shoe pinches. Just ask a person who has been suffering from anxiety for past several years. The endless sleepless nights spent, the frequent bouts of anxiety experienced, the constant fear nagging him etc. can be well understood only by a person who has ever experienced the condition of anxiety in his life or has come across somebody close to him with a similar condition.

It is a general perception among the common public that anxiety is something which is always attached with the grown ups or the elderly. But they are gravely wrong in their perception. Anxiety can be experienced just by any person, be it a child, a teenager, a girl, a boy, an adult or an elderly.

What we are going to discuss here is the anxiety suffered by the teenagers, or teenage-anxiety. A 13 year old child may be staying awake till 2:00 a.m. in the night worrying for his English or Math test. He might be worrying over a fight with a dear friend of his. Might even worry himself to death thinking about what if the constant fights of his parents lead them to a divorce. A teenager may also start worrying unnecessarily if he is going on his first date or for that matter attending the Prom night with his fellow buddies. For an ordinary person situations like these can be pretty harmless but for a teenager who is suffering from anxiety, situations like these can trigger bouts of anxiety which can often become troublesome if not checked or monitored. Thus it is wrong to assume that only the grown ups have reasons to worry. Anxiety is a mental disorder which depends on many factors.

A teenager may be suffering from anxiety more than a fellow teenager of his age due to many factors such as personal factors, genetic factors, the brain chemistry of that teenager etc. A teenager who has a parent suffering from anxiety has a high chance of developing anxiety disorder as compared to the other teenagers. Sometimes the constant problems in one’s life start troubling a tender mind which is more sensitive than the others. Some teenagers are more susceptible to anxiety because of the chemical imbalance in their brain. Anxious teenagers are more likely to indulge in smoking, drinking alcohol etc. and there are even instances of drug-abuse in an anxious teenager.

A brain has neurotransmitters. Neurotransmitters are in fact the chemical messengers which communicate with the neurons of the brain. There are basically two kinds of chemicals in the brain, dopamine and norepinephrine which are responsible for a person’s ‘feeling low’. In the face of any danger our brain is accustomed to act in a way where we can either fight the danger or can defend ourselves by running. People who are sensitive create an artificial danger like situation for the brain due to which the brain reacts,

thinking that the body is in danger, and hence starts getting anxious for the fear of a possible attack. Every fearful situation in the brain is recorded so that whenever any similar situation occurs the brain may be all set to send caution signal to the body. An oversensitive person sends signals to the brain that the body is in danger and hence the brain acts accordingly causing an imbalance in the neurotransmitters- dopamine and norepinephrine. This causes the person to become over anxious and feel overtly worried and concerned in a specific situation although in reality the situation may not be really that bad.

There are possible ways to check anxiety in teenagers. At first a teenager should be taken to a physician who can examine and monitor the particular person and suggest a possible treatment method for him or her. Initially they should be made to go for non-medicinal therapies like cognitive behavior therapy, meditation etc. In cognitive behavior therapy, the teenagers should be told how to remove the cause of their anxiety, that is, their worrisome thoughts by changing their way of thinking. Alternative therapies like meditation can also do wonders in maintaining the inner calm of the person. All this goes a long way in the removal of the ‘what if’ fear syndrome in the teenagers which in fact is one of the prime factors for giving rise to the unnecessary anxiety in them. If the situation is beyond any control then the physician may be likely to prescribe CNS depressants like Xanax which calm down the brain activity.

Xanax (alprazolam) is approved by the FDA as the most effective drug for the treatment of anxiety and other panic disorders. A large scale placebo controlled study of the action of Xanax on anxiety disorder patients support the efficacy of the drug. Alprazolam is highly recommended for the treatment of different types of anxiety disorders like generalized anxiety disorder, chronic anxiety disorder etc. The drug can also provide relief in a short time.

But the use of Xanax is highly debated due to its potential side effects. Though Xanax is recognized as a benzodiazepine with very few side effects, it can still develop tolerance and withdrawal symptoms. It can cause dizziness, sedation, postural hypotension, confusion, headache, insomnia and other physiological and psychological problems. A methodical use of Xanax can help in minimizing all these side effects.

One should start with a small dose of the drug during the initial period of medication. 0.25 mg to 0.5 mg of Xanax twice or thrice a day would be an effective start as it will negate the sedative effects that usually set in during the first week of the treatment. And taking the drug after meals will help in overcoming drowsiness and help in the therapeutic effect of Xanax to act for a longer period in the system.

After the first week, the dosage can be gradually increased, say adding 0.5 mg to one of the three daily doses. The maximum dosage at a time should not go beyond 2 mg. One should also try to restrict the dosage between 1mg to 10mg per day. It is also advised to take a dose of Xanax after every four hours or so. This will keep the anxiety attacks that keep recurring after certain intervals under control. But it is always best to maintain the dose after consulting a physician.

The tapering process of the drug also plays a significant role in avoiding the harmful effects of Xanax. An efficient tapering of the drug should be done under the guidance of an experienced physician. Generally, it is recommended to reduce 0.25mg of Xanax after every three days. Withdrawal as well as rebound symptoms are likely to occur during tapering. Long time users of alprazolam may need around two to three months for successful withdrawal of the drug from their system.

Well, if the above schedule doesn’t help at all, alternative methods or other long acting benzodiazepines should be used. Longer acting benzodiazepine like clonazepam can be a suitable optional drug. The barbiturate called Phenobarbital may also be tried out. Adding another medication like carbamazepine, propranolol or clonidine to Xanax can also be effective in reducing the troublesome problems that occur during the withdrawal period.