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Kids and Anxiety: Many theories exist as to why some kids are anxious and others aren't


Frustrated parents want to know, "Why?"

One in four children suffers from an anxiety disorder during childhood and adolescence, according to experts, but why is this particular child in that 25 percent? Why him instead of his classmate? Why her and not her twin sister? What happened? Why won't it just go away?

There are a lot of theories and continuing research as to why some children develop anxiety disorders while others — even those raised in the same environment by the same parents — do not.

One study by researchers at Stanford showed that children with anxiety disorders had larger amygdalae — the parts of the brain that processes a fight-or-flight response — and stronger connections between the amygdalae and other regions of the brain responsible for perception and the regulation of emotion.

Scientists are also looking into a genetic link.

"There's very exciting research lately looking at kids, identifying genes," said psychologist Donna Pincus, director of the Child and Adolescent Fear and Anxiety Treatment Program at Boston University. "We do know it runs in families in some ways. But interestingly, you don't inherit specific anxiety disorders. If your mom had social anxiety disorder, it doesn't mean you'll inherit that specifically. But you might have more of a tendency to experience negative emotion, and it might come out as depression, or it might come out as anxiety.

"Now that they're able to scan brains of kids or look at genetics," she continued, "the field is moving forward really rapidly — the whole area of neuroscience — trying to identify earlier kids who might be at risk for these kinds of problems."

Children can be born with a more anxious temperament, said psychologist Brian Chu, who runs the Youth Anxiety and Depression Clinic at Rutgers.

"That temperament might mean you're more sensitive to things going on in the world," Chu said. "Might mean you are more jittery, might mean you have an elevated baseline of hyper arousal, so you react more sensitively to things.

"At the same time," he continued, "what then happens over the course of your life, if because of that anxiety, that temperament, you start to avoid things, that collective learning of avoidance … will foster more and more anxiety."

Coming Sunday: A family’s struggle with health insurance and paying for their daughter’s treatment.

Anxiety disorders afflict more girls than boys, while attention, behavioral problems and oppositional defiant disorder occur more in boys, according to Pincus. But those numbers might be skewed by an inherent bias.

"There was one study where they had the exact same behaviors for a boy and a girl, and parents had to label what the behavior was," she said. "People were more likely to label the boy's behavior as oppositional and the girl's as anxious. It's interesting that it might be the way we see boys and girls differently, but there might be some true gender differences."

There could also be a difference in the way parents treat girls versus boys. It could be that it's more socially acceptable for girls to admit they are feeling scared or worried, but boys are "not coddled quite as much," Pincus said.

Parents who get help for their children are often bogged down trying to figure out the reason their children are suffering.

"A big part of what I do is try to get people away from the why, particularly with anxiety," said psychiatrist Lisa Kotler, medical director of the New York University Child Study Center in Hackensack. "With depression, what I always say about depression is it makes sense – something happened, there's a loss, a stress, people get depressed. It makes sense. Anxiety does not make sense. This is why it's so frustrating for parents. They're like, 'Why won't this kid just go to school? Why won't this kid just eat this? Why won't this kid just go to a birthday party? What's the big deal?' "

Answering the why has to be the first step in solving the problem, right? Not necessarily, say the experts.

"I ask family history, anything stressful happen, was there a trauma," Kotler said. "We're always digging for that just because that's what we're trained to do. But we don't' always find it. … Sitting around digging and digging — dynamic therapy, what your mother did and your father did — that's not been shown to be helpful. What's been shown to be helpful is the here-and-now treatment."

Herb and Andrea Ouida's son Todd couldn't go to school for more than two years in the mid-1980s because of an anxiety disorder. They got him help, and he went on to live a productive and successful life until he was killed at the World Trade Center on 9/11.

The Ouida's never knew why Todd was suddenly stricken with such severe anxiety, and they still don't, though they can't keep themselves from continuing to wonder.

"I still, to this day, I have my own theory about what caused it," said Herb. "My wife and I don't agree about it. … The truth is who cares anymore? The truth is, if you can get past all that energy trying to figure it out, you can put that energy toward going forward."

Tips on dealing with siblings of anxious kids

The siblings of children with anxiety are greatly affected as well. Parents must pay extra attention to the child with the anxiety disorder, and family plans are often changed or canceled to accommodate the anxious child. Siblings can become angry and resentful. Cresskill child psychologist Matthew Goldfine, who specializes in helping children with anxiety disorders, offers these tips to parents on helping siblings:

1. Give them a brief education in mental health. Helping your other children understand what anxiety is and how it is affecting their siblings can help dispel feelings that the afflicted child is "faking it" or acting worried just to get attention. Who knows, this may even help them down the road when a friend, spouse or child of their own is struggling.

2. Make sure they don't take on too much responsibility in helping the anxious child get better. The job of your other children is to support and understand the sibling with anxiety, not be a makeshift therapist or third parent.

3. Have at least five minutes of special time that you spend each day with your other children. One of the top complaints from parents is that because of one child's anxiety, the parents' energy and attention are stretched too thin. The other children almost become an afterthought and may even start acting out or becoming resentful of the attention paid to the anxious sibling. This daily one-on-one time can give your other children what they need — your undivided attention — and may make them behave better in general, which is very helpful when you are on your last nerve.

4. Help them vocalize their feelings. Being able to communicate effectively and respectfully — both to you and their anxious sibling — can help create a dialogue about any negative emotions that having an anxious sibling can bring.

5. Don't forget to include siblings in the fun parts of treatment.. Keep in mind that when children are treated for anxiety, there is often a reward component built in for achieving certain goals. That is, if the child successfully completes an anxiety-exposure challenge, he or she earns a reward. As siblings can often become jealous of these rewards and wonder why they aren't receiving any, including them in the fun can help. It doesn't necessarily have to be an anxiety-related challenge (for example, it can be a reward for setting the table), but it includes them and gives them a goal and, more important, a reward to strive for.