HJAR Jan/Feb 2023

18 JAN / FEB 2023 I  HEALTHCARE JOURNAL OF ARKANSAS  Anxiety is a normal emotion that all people, including children, experience at one time or another. Anxiety is defined as an emotional response to the anticipa- tion of future threats. 1 According to Mona Potter, MD, former medical director of the McLeanAnxiety Mastery Program and Child and Adolescent Outpatient Clinic, anxiety can be beneficial since it can motivate us, help us think ahead to avoid danger/prob- lem behaviors, and learn ways to cope as we mature. Developmental research shows us that anxiety disorders can develop in childhood (e.g., separation anxiety, selec- tive mutism, and specific phobias). When anxiety becomes overwhelming and inter- feres with school, home, or play activities, the child may be at risk for receiving one of the DSM-5 anxiety disorder diagnoses. 1 Anxiety symptoms appear similar to those experienced by adults but may also present as oppositional or depressive behaviors. Typical symptoms include a racing heart rate, sweating, or trembling. Other children may “shut down” and not express their worries aloud, resulting in a missed opportunity for treatment. Children with limited verbal capability or language expression may have difficulty communi- cating thoughts and feelings to caregivers. Additional behaviors include: • Verbal and/or nonverbal expression of sadness or fear. • Irritability. • Loss of interest in fun activities. • Changes in eating, sleeping, energy lev- els, and social interaction. • Difficulty paying attention. • Self-injury or destruction. • Physical symptoms, such as vomit- ing, crying, shaking, trouble catching breath, and headaches. • Excessive emotional reactions to sep- aration from familiar individuals and environment. Data shows rates of anxiety in children are rising. The Centers for Disease Con- trol and Prevention show that diagnoses of anxiety increased over time from 5.5% in 2007 to 6.5% in 2012 in children ages 6-17. 2 Since the COVID-19 pandemic began, the rise in anxiety (and depression) in children and adolescents has risen at an even more alarming rate. A meta-analysis of peer- reviewed publications in a JAMA Pediat- rics 2021 article found children’s depression and anxiety before the pandemic was 8.5 to 11.6%. Since the pandemic, one in five (25%) children are reporting symptoms of anxiety. 3 Research has shown that several factors can contribute to a child having a diagno- sis of anxiety. Biological factors or genetic predisposition, temperament, adverse child- hood experiences, difficulties with coping, and emotional regulation can all play a role in a child having anxiety symptoms. The JAMA article hypothesizes that during COVID-19, factors such as social isolation, family financial stressors, school disrup- tions, and missed milestones have contrib- uted to childhood anxiety. For children with special needs, Lund and Gabrielli identified decreased access to special education sup- port, decreased healthcare, therapy and mental health support, and exposure to trauma as contributing to anxiety in chil- dren and adolescents with special needs. 4 To identify children with anxiety, the U.S. Preventative Services Task Force recom- mends screening children starting at ages 8 to 18 years. The authors did not recommend Editor’s Note: Last spring, I was sitting at a national conference of healthcare journalists; there were about 200 of us in the room. The speaker, Julie Kaplow, PhD, ABPP board-certified in clinical child and adolescent psychology, said something along the lines that every child in America has PTSD right now. Every? It felt like a startling claim to me. As you might expect from a room full of reporters, questions flew. The majority were focused on the lack of behavioral health experts to handle this crisis. There are simply not enough, and no matter how we try to ramp up for it, there will not be enough. Something needs to change in our culture. We are simply not doing something right if we are giving all of, or even the majority of, our children PTSD; it seems vastly unfair to them. We reached out to the folks at Arkansas Children’s and asked them what we should put in the Journal about this — in the hopes that we, as adults and today’s leaders, can be more considerate of the collective and individual psyche of the generation below us. The following is their response. “Biological factors or genetic predisposition, temperament, adverse childhood experiences, difficulties with coping, and emotional regulation can all play a role in a child having anxiety symptoms.”