More than 400 parents, teachers and educators gathered at the West Red Oak Lane Campus of The Windward School for the Fall Community Lecture of the 2014-2015 school year. Dr. Harold S. Koplewicz, M.D., one of the nation’s leading innovators in the field of child and adolescent psychiatry and the president and founder of the Child Mind Institute, addressed the importance of recognizing common symptoms of anxiety in children and adolescents and when to intervene if it causes dysfunction.
In his outline of normative anxieties, Dr. Koplewicz cited the fears that children commonly experience at different developmental levels. Infants are often fearful of sudden loud noises, heights, strangers and separation. Preschool children may fear animals, the dark, storms and imaginary creatures, and they may begin to experience anticipatory anxiety (fear that they will encounter something that causes them anxiety). In the early school age years, children begin to experience specific realistic fears such as social acceptance and school achievement. By adolescence, children have developed the ability to think abstractly about fears that may include the pressure to achieve academically, get into a good college or conform to new social demands.
As Dr. Koplewicz profiled normal age-appropriate fears, he further explained that school can be the biggest stressor for some students. Along with the academic challenge of homework, schedules, organization, and performance assessments, there are such social factors as navigating friendships and managing social activities. Parental limits and expectations also contribute to the challenge of finding a comfortable social and emotional balance in a child’s life.
Dr. Koplewicz reminded the audience that, in most cases, anxiety is a common, predictable, basic emotion. Ongoing excessive worry, nervousness or anxiety that is felt intensely and interferes with daily life, however, is considered a disorder. He also noted that an astounding 13% of American children and adolescents are affected by anxiety disorders, which are the greatest predictors of mood disorders and substance abuse in adulthood. More than 40 million adults in the U.S. (18%) have reported that disabling anxiety has negatively impacted their lives. For this reason, he emphasized the importance of early intervention.
In discussing the transition from common anxieties and fears to concerning behaviors, Dr. Koplewicz stated the importance of awareness of the following symptoms:
- Physical complaints, such as headaches, stomach aches, dramatic presentations of pain
- Problems falling asleep and chronic middle-of-thenight awakening
- Eating problems
- Avoidance of outside and interpersonal activities, such as school, parties, camp or sleepovers
- Inattention and poor performance at school
- Explosive outbursts
Because anxiety disorders are so common, it is easy to minimize them. However, ongoing untreated anxiety creates a neurochemical condition that primes the brain for increased risk of depression at puberty. Lack of treatment also leads to higher risk for doing poorly in school, which may have social consequences, increase the risk of substance abuse, and contribute to the development of a mood disorder.
In addition, childhood anxiety disorders often co-occur with other disorders. As with adults, about half of children presenting clinically with an anxiety disorder also meet criteria for at least one additional condition, which may include eating disorders, substance abuse, ADHD and behavioral problems. Untreated anxiety can further lead to more serious concerns such as school avoidance, lower self-esteem, academic dysfunction, impaired peer relations and potential problems adjusting to work situations.
Dr. Koplewicz encouraged the audience with his message of optimism that cognitive behavioral therapy can be a highly effective treatment for anxiety disorders. With this approach, the therapist gradually exposes the child, in a safe, controlled setting to the situation that triggers their fear in order to help them learn to tolerate the anxiety until it diminishes. As the Windward Community Lecture came to conclusion, Dr. Koplewicz summarized his theory that the best and most long-term solution for anxiety disorders is responsible, early intervention. Parents, teachers and educators came away from the lecture knowing when not to worry about their child’s worries and how to identify the signs and symptoms of children in need of more support.