Anxiety is a normal human emotion that helps us move forward in our lives, be aware of our surroundings, learn, solve problems and cope with everyday challenges.
However, millions of children and adolescents suffer from one of the group of anxiety disorders, in which they experience overwhelming and uncontrollable feelings that interfere with their daily lives, whether at school, home or in relationships. AD covers a broad range of diagnoses, which include separation anxiety disorder, generalized anxiety disorder, social anxiety disorder, phobias, panic disorder, PTSD and OCD.
As nurses, we often work with young patients and students who are anxious. In our roles as nurse educators in many settings, we know it is a real and significant barrier to learning. But how do we know when young patients or students suffer from an anxiety disorder and need professional help in dealing with it? What do we need to know to identify the disorder and appropriately refer young people who have AD for help?
At the NewYork-Presbyterian Hospital and Weill Cornell Medicine 33rd Women’s Health Symposium, Gail Saltz, MD, and John Walkup, MD, offered some practical information about AD that can help us better understand the disorder. Saltz is clinical associate professor of psychiatry, Weill Cornell Medicine, and associate attending psychiatrist at New York-Presbyterian Hospital. Walkup is vice chairman and professor of psychiatry, and director, division of child and adolescent psychiatry and DeWitt Wallace senior scholar, Weill Cornell Medicine, along with an attending psychiatrist at New York-Presbyterian.
• Signs and symptoms: Parents may describe their child with AD as fearful, shy, apprehensive, homesick or worried. As early as ages 6-12, these children will display hypervigilance to their surroundings, overreaction to new situations, coping avoidance, difficulty with sleeping or eating, excessive need for reassurance, and explosive outbursts. In an attempt to protect and help their child cope, parents try to remove all triggers and create an imaginary bubble around him or her. As children move to adolescence and young adulthood, it becomes even more difficult for them to deal with life’s challenges if AD is left untreated. These adolescents may develop poor adaptive and coping skills, such as alcohol and drug use, and may even appear as marginally functional and depressed.
• Treatment modalities: Evidence-based treatment for AD has been in existence since 2009. In that short time, it has been shown that about 80% of children and adolescents respond well to a combination of cognitive behavior therapy and medication. In CBT, key motivating principles include empowering themes: Take the challenge, overcome adversity, be brave. However, medications should not be viewed as a last resort in treatment. The first priority always is to help patients get rid of inappropriate symptoms and then enable them to learn to live life fearlessly.
• Everyday practices: It has been demonstrated that lowering caffeine intake, exercising regularly, practicing mindfulness and thought acceptance, and decreasing screen time (decreasing blue light) are ways to help with everyday anxiety and perhaps offer support to those with AD.
• Early diagnosis and treatment: It is important to diagnose AD as early as possible, because it is treatable. There is a genetic component to the disorder, and the stigma associated with it often prevents patients and their families from seeking assistance. The earlier families seek professional advice, the better off their children will be in coping with life, taking on new challenges and learning and growing into healthy, functioning adults.
As nurse educators, we are in an excellent position to be case finders and patient advocates for children and adolescents with AD and their families. Our role is an important one.
What clues have helped you identify children or adolescents with AD who needed professional help?