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HEALTHCARE JOURNAL OF ARKANSAS I  JAN / FEB 2023 19 a specific screening tool. 5 An editorial in the same JAMA issue suggests that ask- ing directly about anxiety/depression symptoms, stress for the child in their pri- mary environments (home and school), and family history of anxiety symptoms are good places to start. 6 Parents and caregivers may be able to access resources in the media to help their child cope with anxiety. TheAmerican Psychological Association publishing house, Magination Press, has an array of children’s books that address emotional/ behavioral topics, including anxiety ( www.apa.org/pubs/magination ). Another resource is the Psych Central website, https://psychcentral.com/health/books- about-anxiety-for-kids-and-parents. General recommendations include eating a healthy diet consisting of fruits, vegetables, and lean protein. Children may also benefit frommindfulness and relaxation activities. These include diaphragmatic breathing, progressive muscle relaxation, and listening to calming music. 2 Children may continue to have difficulty managing symptoms of anxiety, which interferes with daily activities. In these situations, parents may consider additional support. This support can come through psychotherapy or medication manage- ment. Talking to their child’s primary care physician (PCP) is always a good place to start with this process. Parents may also want to discuss anxious behaviors with the child’s teacher to develop a plan to support development in school. Researchers consider anxiety and depression in children a global health crisis. 3 Parents, teachers, and PCPs must intervene to support and promote optimal devel- opment. When looking at longitudinal studies, the importance of identification and treatment for children/adolescents with anxiety becomes paramount. Astudy published by Woodward and Fergusson found a significant association between anxiety diagnoses in adolescents and later risks of anxiety disorders, depressive disorders, substance use/abuse, and educational underachievement as adults for these individuals. 7 By communicating openly and accessing prevention and intervention services, children and adolescents can acquire the necessary tools to overcome, manage and decrease long-term negative outcomes. n REFERENCES 1 American Psychiatric Association Task Force. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 2013. https://doi.org/10.1176/appi.books.9780890425596 2 Centers for Disease Control and Prevention. “Anxiety and Depression in Children.” Last reviewed April 19, 2022. https://www.cdc.gov/childrensmentalhealth/depression.html 3 Racine, N.; McArthur, B.A.; Cooke, J.E.; et al. “Global Prevalence of Depressive and Anxi- ety Symptoms in Children and Adolescents During Covid-19: A Meta-analysis.” Journal of the American Medical Association Pediatrics 75, no. 11(Aug. 9, 2021): 1142-1150. doi:10.1001/ jamapediatrics.2021.2482 4 Lund, E.; Gabrielli, J. “The role of pediatric psychologists in mitigating disability-specific barriers among youth during the Covid-19 pandemic.” Clinical Practice in Pediatric Psychol- ogy 9, issue 1 (2021): 12-23. https://doi.org/10.1037/cpp0000387 5 Viswanathan, M.; Wallace, I.; Middleton, J.; et al. “Screening for Anxiety in Children and Adolescents: Evidence Report and Systematic Review for the US Preventive Services Task Force.” Journal of the American Medical Association 328, no. 14 (Oct. 11, 2022): 1445-1455. DOI: 10.1001/jama.2022.16303 6 Walkup, J.T.; Green, C.M.; Strawn, J.R. “Screening for Pediatric Anxiety Disorders. Jour- nal of the American Medical Association 328, no. 14(Oct. 11, 2022): 1399-1401. doi:10.1001/ jama.2022.15224 7 Woodward, L.J.; Fergusson, D.M. “Life course outcomes of young people with anxiety dis- orders in adolescents.” Journal of the American Academy of Child and Adolescent Psy- chiatry 40, no. 9(September 2001): 1086-1093. DOI: 10.1097/00004583-200109000-00018 Anxiety manifests itself differently in young children, school-age adolescents, and teenagers. “One of the challenges for adults is we forget what it’s like to be a child. So we may expect a child to come to us and say, ‘I’m feeling anxious. I’m feeling upset,’ and being able to talk about it,” said Jayne Bellando, PhD, a pediatric psychologist who has worked in the Dennis Developmental Center at Ar- kansas Children’s Hospital (DDC) for 16 years and is a professor in the department of pediatrics at the University of Arkansas for Medical Sciences (UAMS). “Many times for children, we see changes in their behavior rather than them being able to tell us with their words.” Some examples of anxiety in young children include: • Being more fearful. • Excessive crying or fear of separation. • Consistently wanting to avoid school or extra- curricular activities. • Reverting to bedwetting. • Nightmares. • Changes in sleeping and eating patterns. • Stomachache. • Headache. • Having no interest in favorite activities. Some signs of anxiety can be more challenging to pinpoint. They include increased anger, being pouty, behavior problems, and fussiness. School-age chil- dren might also say they feel “sad” or begin drawing sad pictures. In teenagers, anxiety is often related to school or friends, particularly bullying and cyberbullying. In her sessions, Bellando said she tries to normal- ize anxiety so her young patients know everyone has worries. She also asks a child in what ways they are currently coping. “We always want to start in a place of strength. For most of us, we’re not melting down all the time. We’ve figured out some ways that help us feel better. Whether it’s talking to our good friend, taking a walk, petting your dog, listening to music, playing video games — there’s something that we do,” Bellando said. “I also ask them, ‘Tell me about a time that was really stressful for you that you made it through?’ Be- cause what helps us is when we realize that we have the coping skills, and we can learn those coping skills to help us feel better. The psychological term for that is self-efficacy. So knowing, ‘I can do this.’” A primary care provider (PCP) can refer a patient to a licensed therapist. Bellando said it’s easier to begin treatment when the anxiety issues are limited rather than waiting for the anxiety to increase. BREAKDOWN OF ANXIETY BY AGE