Kids and Anxiety: Diagnosing kids' anxiety not so cut and dried, experts say

By KARA YORIO STAFF WRITER | The Record

Parents watch their children and know something is wrong, but many North Jersey families find it can take a long time and many doctors' appointments to be told the issue is anxiety.

Even though anxiety disorders are the most prevalent psychiatric illness among children and adolescents — affecting as many as one in four — diagnosing it can be difficult.

"It's often difficult to accurately assess anxiety disorders because anxious children and adolescents may be reluctant to disclose the fearful thoughts and experiences they have, and they have less observable (physical) signs of distress than say, impulsive or distractible problems," psychologist Brian Chu, who runs the Youth Anxiety and Depression Clinic at Rutgers, wrote in an email. "There may also be some additional stigma to labeling boys as anxious, and so, we may see more girls willing to express their anxiety than boys."

A child can have more than one condition at a time (co-morbidity), symptoms can mimic other disorders, school personnel and pediatricians might think the parents are overreacting or specialists disagree for a variety of reasons, experts say.

Several years ago, a preschool psychologist observed a 3-year-old Tenafly boy who was prone to fits and disruptive behavior. Her take? The child was just being manipulative, using the tantrums to get what he wanted.

In kindergarten through second grade, that same boy began seeing a therapist for his behavior issues. He was given no official diagnosis but the therapist told his parents the issues were anxiety-driven. The summer before third grade, a psychiatrist evaluated for and diagnosed him with attention deficit hyperactivity disorder (ADHD). He was put on and still takes medication, but two years later, the boy continues to struggle and his school work, family life and friendships are suffering.

Recently, after reaching out to a new therapist, his parents were told it might not be ADHD at all.

"As we've been going to different psychiatrists and psychologists, there's been a debate on how much of his behavior issues are anxiety versus ADHD," said the frustrated Bergen County mother who is now trying to figure out which therapist has the right plan for her son, who is now in fifth grade. "A lot of them think it really stems more from anxiety."

A mother of a 9-year-old Bergen County girl tells a similar story. Told early on that her daughter would grow out of the behavior causing the mother concern, when it didn't happen, she was eventually tested and diagnosed with ADHD. Now they are not so sure.

"We realized that what most of her ADHD is anxiety," she said. "She has nothing else. She's not hyperactive."

Another mom took her kindergartner for many different screenings, which found nothing. A year later, she was diagnosed with anxiety and got treatment.

Multiple mental health professionals offering different opinions and diagnoses is a common source of confusion and frustration for parents. It can be because of the expert's specialty — perhaps not someone familiar with anxiety in children, for example — or it can simply be a product of timing.

"In mental health, so much depends on the parents-and-child report," said Cresskill child psychologist Matthew Goldfine. "That is to say, what if I see your family on Monday and it's been an awful weekend and you're saying, 'This is terrible, this is awful, the worst ever.' Then you see someone else on Friday after the week and your daughter is picking up and doing better and you're feeling good and maybe the report you give isn't exactly the same as the report you give to me. Because of those variables, I think it's so easily shifted from one direction to another."

Within the broad diagnosis of anxiety, the semantics of what kind of anxiety it is may become less important than the plan going forward. There are many types of anxiety disorders; pinpointing all of them in a patient might not be as vital as reacting to the symptoms and impairment. One of Goldfine's patients has been diagnosed with obsessive compulsive disorder but shows symptoms that seem to fall into the category of other disorders as well. His father, a school psychologist, has asked about the possibility of other conditions as well.

"They give it a very diplomatic answer: 'It doesn't matter what we call it, it's what we see,' " he said. " 'Call it spaghetti, if it's the same symptoms, we're going to treat the symptoms not the label.' "