Kids and Anxiety: Questions parents might have about professionals who treat anxiety

By KARA YORIO STAFF WRITER | The Record

Parents who are concerned their child has an anxiety disorder often hesitate before reaching out for help. The child is struggling, but they do not know what will happen once they take their personal crisis to professionals. Could they somehow make the situation worse? Is there more they could do on their own? Will they subject their child to derogatory labels or stigmas? Are they setting them up for a lifetime of weekly therapy sessions or medication?

These parents are not alone. One in four children and adolescents suffers from an anxiety issue in their lifetime. Here are some questions parents might have about what they can expect when they reach out for help.

Q. Does going for an assessment mean there will be diagnosis of an anxiety disorder?

No. There are times, the pediatrician, counselor or therapist do not think there is a serious issue. Therapists will talk to parents and the child and make an assessment. Sometimes, though, it only takes a phone call for Cresskill psychologist Matthew Goldfine and pediatrician Josh Menasha to reassure parents that the behavior causing them concern sounds developmentally appropriate.

The first conversation for many, though, is in the pediatrician’s office. These visits are typically initiated by parents, but the discussion can be started when a child comes in with chronic headaches or stomach pain.

“When they can’t express themselves, it can manifest physically,” said Menasha of Tenafly Pediatrics.

Those symptoms can provide a clue to the pediatrician and serve asan opening to start a dialogue about anxiety with the child and parents.

“Sometimes it’s an issue of just good communication between a parent and a child,” Menasha said. “Sometimes, if you’re able to open those doors of communication, just even addressing it or just telling a child, ‘I understand that you’re nervous about something’ or ‘I know there’s a lot going on in the house right now.’ … Just addressing that can really allay the fears.”

Q. If it’s not anxiety, what might it be?

Sometimes a child’s behavior is just a product of personality. There are kids who are naturally shy, not risk-takers or overly social. It’s not a mental health condition, it’s just who they are.

Words like withdrawn, inhibited, tentative and reluctant are often used to describe anxious children.

“All those words can sound like a typically shy kid and that’s OK,” said psychologist Brian Chu, who runs the Youth Anxiety and Depression Clinic at Rutgers. “We don’t want to take every shy kid and say, ‘Oh you have to be bold and adventurous.’”

Experts know the difference.

“We’re trained to look at the continuum because shy, introverted can also mean alert, sensitive and extra-caring,” said John Lestino, a member of the board of the New Jersey Association of School Psychologists. “We don’t want to diagnose that as a disability or diminish it.”

Deciding if there is a bigger issue always comes down to the impact on the child’s life.

“It really depends on the functioning,” Lestino said. “We always come back to the functioning. Does it reduce a major life function that we would normally expect a youngster at that age grade or developmental or cognitive level to perform?”

Q. What kind of recommendations are made?

If the anxiety is not deemed to be severely disruptive to the child’s life, pediatricians or school counselors might suggest a few options to help before trying therapy. Depending on the source of the anxiety, being more consistent at home and school can help.

“For me, I like checklists,” said Debbie Keeney, president of the NJASP. “You can give a parent a checklist, and they can check off every week. Are the books in the book bag? Is the homework done? Are the papers signed that need to be returned from the Friday folder? If you have specifics, rather than general question — ‘Are you ready?’ You have to be explicit and really specific. If you leave it open-ended, it gives the child an out.”

Engaging in stress-reducing activities like yoga or sports can help as well.

“There’s no question that physical activity, things like sports and making sure the child has a great support system through friends and at school, can make a big difference just to find a way to relieve the stress and the anxiety,” Menasha said.

Q. If necessary, how can parents find a therapist?

Pediatrician offices often have a list of recommendations, and mental health organizations and clinics have referral services.

Q. How do you choose a therapist?

Parents can struggle selecting from the different kinds of therapists and knowing whether someone is properly qualified.

“There are a large number of therapists out there, but the question is finding the best one for this situation,” said Menasha, who provides his patients a list of local therapists. “Some therapists specialize in play therapy, some use art therapy. It depends on the child’s age, how well they’re able to communicate.”

It can be confusing, Goldfine said.

“How do you navigate through all the therapy types?” he said. “I’m more of a cognitive behavioral therapist. You’re going to have play therapists. You have psychodynamic therapists. Parents aren’t up to speed on all of the research. They’re not reading medical journals. They don’t know all the terms.”

Taking the recommendation of a trusted source is the best route, experts say, but parents need to know the first choice doesn’t always work out.

“This is where it gets a little difficult,” Menasha said. “It doesn’t always match the first person that a child sees or a parent meets with. That can also lead to additional frustration because it’s time being spent on a situation that isn’t working out for anybody.”

There is also a dearth of mental health professionals, particularly child specialists. The result is long waiting lists for the most qualified therapists. For those in the most need, the waiting time can be shortened, according to Menasha.

“A lot of times in extreme situations or extreme cases, therapists will make time, especially if it’s significantly impacting daily activities, quality of life,” he said.

Q. Will the pediatrician or therapist recommend medication?

Not necessarily. It depends on the doctor and the child’s level of impairment.

The most common practice guidelines recommend talk therapy first, according to Chu.

“If we were to find someone who would benefit from medication, we would refer them to one of our colleagues,” he said.

When there is severe impairment, prescribing medication right away may be necessary in conjunction with therapy, according to Dr. Lisa Kotler, a psychiatrist at NYU Child Study Center at Hackensack University Medical Center.

Q. Does seeking help through the school mean children will be given a label that will follow them throughout their academic career?

No. Many times counselors will investigate the situation, talk with the parents and child and come back with a plan that includes employing the options discussed above, joining a group session at school or engaging with peers in activities the counselors think will help.

Asking for help does not mean automatically setting up a so-called individualized education program, a written education plan designed around the child’s specific needs. A counselor must assess whether the issue is affecting academic work and requires intervention — and therefore an official diagnosis or special needs classification.

“Not every child who has anxiety needs to go through a child-study team for special education services but there are many who do,” said Keeney of the NJASP. “Maybe the child’s education is being impacted then you have to go through the child-study process. But there are kids who I see are both special ed and regular ed that just need a little assistance, whether it’s dealing with a situation that occurred in a lunchroom or class or something outside of school. It doesn’t matter if they’re classified or not, I’m here as a mental health professional.”

Q. What should parents do if they really believe there is a problem but a pediatrician or school says it’s a passing phase or not enough of an issue for intervention?

There is no right answer to this, but anecdotally, North Jersey parents whose kids have received treatment for anxiety often tell the same story of trying to get help early on, only to be told to relax, their child’s behavior isn’t a big deal.

Sometimes that is true, but when a parent’s concerns persist or symptomatic behavior continues over a long period, they should seek another opinion. Often kids with anxiety go unnoticed for years, experts say.

“Anxiety is really one of the lesser-known secrets,” Chu said. “You think about ADHD — attention deficit hyperactivity disorder — or conduct problems’ having all the attention and needing all the services. That’s true. Those are important problems. But anxiety disorders, we call them the silent sufferers because they’re so under the radar. They could be sitting there in class suffering just as much as the kids with ADHD or who are impulsive, but they just don’t cause as much attention.”

By the time children are referred to Chu’s clinic, they have often spent years suppressing their anxiety, and it is now coming out in the form of avoidance or school refusal.

“It’s not until the kids start to act out, until they start to misbehave, that a lot of the school professionals, personnel, teachers and the parents start to pay attention,” he said. “That’s when we get the call.”