When it’s More Than Just Worry: Changing Life Trajectories for Children with Anxiety

Identifying the Causes

Two 7th graders plan to study the night before a math test. Both are nervous, especially because their parents have repeatedly reminded them that they need to do well on the test if they want to be accepted into one of Chicago’s elite high schools.

One student studies for several hours, and is able to marshal her anxiety to prepare for the test. Afterwards she feels relatively comfortable that she understands the material, and leaves for school the next morning still feeling a bit nervous, but ready.

The second student tries to study, but can’t concentrate. Deep down, he knows he’s smart enough to do well on the test, but he tends to become anxious and “freeze up” under even minimal pressure. Sure enough, while studying he feels sick to his stomach. He worries about what might be on the test, and fixates on what will happen if he doesn’t get an “A.” He puts the textbook aside and tries to sleep, but he tosses and turns all night. The next morning he has no appetite, and feels exhausted and overwhelmed during the test. He “shuts down” during the test and doesn’t finish it on time.

Proportional vs. Disproportional Anxiety

The first student displayed what John T. Walkup, MD, Head of the Pritzker Department of Psychiatry and Behavioral Health at Lurie Children’s, calls “predictable and proportional anxiety” — the form of anxiety all of us experience from time to time. The second student is a “worrier.” On a day-to-day basis, he worries about performing even straightforward, developmentally appropriate tasks — ordering food at a restaurant, meeting new people or dealing with what Dr. Walkup calls “predictable uncertainties,” like school tests.

“Normal anxiety is a healthy human emotion and is ‘expected and proportional’ to the triggering event,” says Dr. Walkup, a nationally- known expert in anxiety treatment and research. “On the other hand, the type of anxiety associated with an anxiety disorder serves no practical purpose and seems to come out of the blue. It is ‘unexpected and disproportional.’”

Not All Kids “Grow Out of It”

Anxiety disorders are the most common mental health disorder in the U.S., affecting 18 percent of adults and more than 12 percent of children and adolescents. It can have a strong genetic component, and symptoms are typically first experienced in children between the ages of 6 and 12. Left untreated, children with anxiety disorders can experience increasing impairment over time, and often struggle to take on independent functioning in adolescence and adulthood.

“We used to think of anxiety as normal, or just a phase kids will grow out of,” says Dr. Walkup. “Well, not all kids grow out of it, and it can be devastating across development. A lot of adults with anxiety disorders are successful, but they pay a price for it in their inability to lead full lives.”

Lurie Children’s was recently awarded $7 million by the Patient-Centered Outcomes Research Institute to compare the effectiveness of the two approaches most commonly used to treat pediatric anxiety disorders: cognitive behavioral therapy (CBT), and CBT combined with antidepressant medication. Dr. Walkup is principal investigator of the study, whose results he hopes will help families make more informed decisions on the treatment of children and adolescents with anxiety disorders.

Educating Caregivers

Dr. Walkup says that even though anxiety disorders are common, they are often under-diagnosed and under-treated. He strongly believes that educating pediatric primary care providers to recognize the symptoms of anxiety disorders early is key to getting the best outcomes.

Under his leadership, Lurie Children’s is expanding access to its Mood and Anxiety Program, which provides a comprehensive diagnostic evaluation and input from parents and teachers. Upon completion of the diagnostic evaluation, a multidisciplinary team of clinicians reviews each case and provides treatment recommendations.

“Incorporating behavioral health into all of pediatrics is an exciting transformation of our practice at Lurie Children’s, and will clearly benefit patients and families,” says Dr. Walkup.