Fear and worry are common and transient emotions and therefore represent a normal part of childhood and adolescence. In contrast, a child with an anxiety disorder typically experiences intense fear, worry, and/or feelings of discomfort for extended periods and to a degree that these feelings impact his or her life. Such feelings can get to the point that they prove immobilizing and, as such, may begin to impair the child's school performance, relationships with peers or family, and his or her willingness to participate in certain activities in and outside of the home. While your child's fears may seem irrational at times, they are very real to the child and require gentle, confidence-inspiring therapeutic intervention in order to help the child move past his or her anxiety and resume a normal life. Anxiety disorders are among the most common difficulties experienced by children and adolescents, affecting an estimated 4 to 13%, with figures increasing with age. Anxiety is frequently accompanied by behavior problems such as oppositional and noncompliant behaviors. If not treated early on, an anxiety disorders may lead to depression, school disruption, impaired social functioning, low self-esteem, substance use in adolescence, and anxiety disorders in adulthood.

Cognitive-Behavior Therapy (CBT) is a systematic and goal-oriented approach to psychotherapy in which thoughts, emotions, and behaviors are viewed as interrelated. Working together with the child to replace less constructive thoughts and behaviors with those that are more adaptive is typically the goal of this type of therapy (as they are considered the most tangible), in order to ultimately impact the child's emotional state. CBT is often a time-limited therapy with a primary focus on the "here and now" rather than the past. Symptom removal is of utmost importance. Goals are concrete and identified collaboratively with the client. When working with children, parents are often involved in the treatment process, in order to ensure that gains made in the therapy office transfer to the home (and, if appropriate, school) setting. CBT has been identified as the "treatment of choice" for many emotional and behavioral difficulties common to children, especially the anxiety disorders.

The range of difficulties for which I have had specialized training include pediatric Obsessive-Compulsive Disorder (OCD), Social Anxiety Disorder, Separation Anxiety Disorder, Specific Phobias (e.g., dogs, needles, water), Panic disorder, and Generalized Anxiety Disorder (GAD).

What is pediatric Obsessive-Compulsive Disorder (OCD)?

Children and adolescents with Obsessive-Compulsive Disorder experience repeated upsetting thoughts ("obsessions") and/or behaviors ("compulsions") that they feel compelled to do (e.g., hand washing, arranging socks in a very particular way). Although the child may wish to stop these thoughts or behaviors from happening, it becomes very difficult to resist compulsive urges and control or stop obsessive thoughts on his or her own. The most common obsessions in pediatric populations include fears of contamination, fear of harm to the self or others with whom the child is close, and an intense need for symmetry or exactness. The most common compulsive behaviors include excessive washing and cleaning, checking, counting, repeating, touching, and straightening. OCD is estimated to affect between 1 and 3% of children and adolescents. Among younger children, it is more common in boys than girls but the gender ratio is more equal in adolescence. The latest research indicates that OCD is caused by neurological abnormalities and it is thought to be the result of heredity.

What is Social Anxiety Disorder?

Children and adolescents with social anxiety disorder tend to be excessively fearful of criticism or embarrassment in front of other people, especially those that the child does not know. These children will spend exorbitant amounts of time worrying about social situations. Upcoming situations in which social evaluation is common (e.g., public speaking) are either intensely feared or altogether avoided. These fears and avoidant reactions can greatly impair the child's daily life, social and otherwise. Social Anxiety Disorder is thought to arise as a result of genetics and environmental factors.

What is Separation Anxiety Disorder?

Separation Anxiety Disorder is indicated by extreme stress, worry, and/or physical symptoms (e.g., headache, stomachache) when a child is separated from the people to whom he or she is most attached (i.e., typically parents or the primary caregiver). These children often have trouble leaving their parents to go to school or camp. They may be able to go shopping with friends or attend birthday parties but will avoid sleeping over a friend's home. Intense fear that harm will befall the parent or caregiver while not in the presence of the child is most common. Typical symptoms include clingy behavior with parents and frequent attempts to sleep in parents' beds instead of their own. Separation Anxiety Disorder most commonly develops after the child experiences a traumatic event although this is not always the case.

What is a Specific Phobia?

Many of us have fears about certain things, and we would rather avoid them than have to deal with them - this is normal. A child with a phobia, however, has excessive and unrealistic fears of a particular object or situation. Phobias typically focus on animals, storms, water, needles, or heights. Children with phobias tend to go to great lengths to try and avoid the feared object or situation, which can greatly restrict their lives. Young children with phobias may outgrow them while adolescents may develop panic attacks in response to the feared object or situation.

What is Panic Disorder?

Children who experience repeated and often unexpected attacks of intense fear accompanied by physical symptoms are suffering from "panic attacks." Panic attacks come on very suddenly and can last anywhere from a few minutes to several hours. They are typically in "full swing" within about 10 to 15 minutes, such that physical symptoms like a fast heartbeat, dizziness, sweating, and fears of imminent death become quite intense. This experience is understandably so scary and confusing to children that they often become worried and preoccupied with thoughts of when the next attack will be between attacks. They may even go to great lengths to avoid situations that they feel may bring on another attack. Panic Disorder is relatively rare in young children but it is more likely to affect adolescents. A combination of heredity and stressful life experiences are thought to play a role in developing this disorder.

What is Generalized Anxiety Disorder (GAD)?

Children with GAD have extreme, often seemingly unrealistic worries about a number of different things, such as their school performance, an upcoming sporting event, or being on time. They are often very self-conscious and have a seemingly excessive need for reassurance from parents, teachers, and coaches. Sleep problems, feelings of restlessness, muscle tension, and physical complaints including frequent headaches and stomachaches are common for these children. GAD tends to run in families and can become worse in stressful situations (e.g., during the school year).