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Hal Pickett: Childhood anxiety disorders are treatable with common-sense therapies

Hal Pickett: "Today anxiety is the most commonly diagnosed mental illness in children — and adults."

A child’s life is a bed of roses — or at least that’s how might seem to an adult burdened with the cares of the grownup world.

But most children carry their own share of worries, some passing and developmentally appropriate, but others as heavy and overwhelming as any adult’s.

Hal Pickett, Psy.D, LP, ABPP, director, client services at Headway Emotional Health Services, a Twin Cities-based mental health support program for families, has been treating children with anxiety disorder for more than two decades. In his clinical psychology practice, Pickett works closely with children and their parents to understand the difference between normal and clinical anxiety, and to provide tools for overcoming these sometimes-crippling obstacles. 

Last week, Pickett had an opportunity to share his expertise with an audience of parents, educators and mental health professionals when he took part in a panel discussion titled “Self Care and Parenting the Anxious Child” at a community meeting sponsored by Headway at PrairieCare Institute in Minneapolis. Alisha Perkins, mental health activist and wife of Minnesota Twins Pitcher Glen Perkins, was keynote speaker.

In his practice, Pickett emphasizes self-care for children and parents. When we spoke late last week, he told me that he believes knowledge is power when it comes to mental health, and with education and common-sense solutions, children and their families can find healthy ways to stop anxiety from limiting their lives.

“Anxiety is something that can be treated,” Pickett said. “When a child learns techniques that help them put a damper on their anxieties and even control or manage them, they learn that they are free to engage in a broader range of activities and live a happier life.”

MinnPost: How commonly are children diagnosed with anxiety?

Hal Pickett: For the longest time, people thought depression was the most common mental illness in children. Today anxiety is the most commonly diagnosed mental illness in children — and adults. Therapists who work in schools overwhelmingly report that anxiety is their No. 1 referral.

MP: But children are often anxious and fearful about many things. Isn’t that normal?

HP: Some kinds of anxiety are normal and healthy in childhood. Take separation anxiety, for instance: That behavior is developmentally appropriate between the ages of 18 months and 3 years. Most children naturally grow out of this anxiety. But when that anxiety extends well past that developmental stage, then it can become more of a problem.

And other common childhood anxieties, like a fear of the dark or a fear of monsters, are all normal anxieties that children experience. As a child’s brain develops, they tend to grow out of them.

MP: So these are all anxieties that fall under the definition of “normal.” How do you determine if a child’s anxiety has reached the level of a disorder?

HP: Sometimes it is difficult to understand the difference between normal anxiety and disordered anxiety. When you are looking at a behavior from the perspective of a disorder, the factors that you want to look for are, “Does the anxiety interfere with normal functioning?” “Does this anxiety make it difficult for the child or adult to participate in work, school, socializing or to take part in community functions?”

To get a diagnosis of anxiety disorder, a person’s anxiety has to regularly interfere with their daily functioning.

MP: When a child is anxious, it must feel easy for parents to write off their worries for years, thinking, “This is just a developmental phase. They’ll grow out of it.” How do parents and children eventually get to a point where they seek help?

Hal Pickett
Hal Pickett

HP: This is very common behavior. Usually a child’s anxieties get to a point where it becomes rather evident that they have been going on for a long time, that these anxieties are not something that the child is going to grow out of.

Parents want to protect their children from their fears. That’s appropriate. But as a child gets older and starts going out into the world, the harder it is to protect them from the things that make them anxious. Little kids are at home with Mom and Dad. But older kids want to start venturing into the world by themselves or with their peers. When children and parents realize that a child is too anxious to start trying new things, when they realize that a kid’s anxieties are preventing them from developing the skills they need to live in the outside world, families tend to come looking for people like me.

MP: Do families take longer to seek treatment with anxiety than they do with other mental illnesses? Anxiety seems easier to hide than serious depression, for instance.

HP: That’s true. Anxiety is easier to mask: A lot of people with anxiety just struggle through life without asking for help. Unlike depression, many people with anxiety can continue to live their life by simply avoiding the situations that make them anxious.

MP: What are some of the approaches you suggest for treating anxiety?

HP: The good news is that anxiety disorders in children and adults respond to good self-care. Anxiety is probably is best reduced by very common-sense techniques like getting enough sleep, watching what you eat, getting enough exercise and getting out into the sunshine.

I also think that yoga is an amazing tool for treating anxiety in adults and children. And other practices like mindfulness meditation and creating self-care rituals have been shown to successfully treat anxiety.

Anxiety is a big problem for children in school. With this in mind, Goldie Hawn’s Hawn Foundation has created a curriculum called Mind Up. Starting with preschoolers and moving into elementary and middle-school age, this curriculum provides teachers and students with ways to take breaks in the day for centering mindfulness exercises. Some schools on the East Coast have incorporated the Mind Up exercises into the school day. Several times a day, the class stops whatever they are doing and tries a mindfulness exercise to get their brains centered and restore calm. These exercises are designed to teach children how their brains work and what may be causing them to worry.

MP: Are there other techniques you use with the children in your practice?

HP: If a child is old enough, I like to work with them on creating a “toolbox” of techniques that they can use to calm and reassure themselves when they feel anxious. When a child is on the younger end of things, our work tends to be parent guided. When I work with younger children I see that the things that work best with them tend to be more active and less cognitive.

With some of the really young children, because I was also trained as a physical therapist, I’m also a stong supporter of sensory integration therapy, where I work with children to reorganize their nervous system. In some children, severe anxiety can cause their nervous system to be so disordered that they respond to anxiety by behaving like a cornered dog. They exhibit anger and uncontrollable behavior. In these cases, I work with parents to understand where the anxiety is coming from and what we can do to get to the root of the problem.

MP: I was often anxious as a child. I remember especially the sinking feeling I’d get on Sunday nights. I’d start worrying about going to school the next day, and I’d get an awful stomachache.

HP: That “Sunday-night” anxiety is really common. When kids have that concern, I try to work with parents around building in some fun ritual for Sunday nights, some distraction that keeps children from obsessing over what’s going to happen the next day. 

MP: Is anxiety genetic? Are anxious parents more likely to have anxious children? Or does being raised by an anxious parent make a child more likely to be anxious themeselves?

HP: Anxiety begets anxiety. If you are around someone who is anxious about something you can start to feel anxious yourself. But there is also a genetic component to anxiety. If a child is living in an anxious environment they may be more likely to grow up to be anxious themselves. Sometimes it is hard to determine if it is nature or nurture.

It is interesting to watch children with anxiety whose parents aren’t anxious. In those cases, the parents tend not to personalize their children’s anxieties as much. A nonanxious parent may be more likely to expose their children to things that a fearful parent could potentially avoid. So they may say to their children, “You’ll have to work through this anxiety to go to this party, to see this event.”

MP: So far, you’ve talked about a lot of alternative treatments for anxiety. Are their any pharmaceutical options that work?

HP: I tend to fall in the middle camp on this issue. The truth is we don’t have any great anxiety medications that aren’t addictive. The most effective drugs for treating anxiety, like Xanax and Ativan, can be very addictive. So physicians are hesitant to give them to kids.

Back when antidepressants like Prozac first came out, doctors started using them to decrease anxiety. Some psychiatrists still believe in treating anxiety with SSRIs like Zoloft and feel they get a lot of positive response from their patients.

I’ve worked with depressed people who take medications and their depression is fine. I’ve never worked with an anxious person who can control or get rid of their anxiety just by using medication. But the good news is that anxiety is very responsive to alternative treatment.

MP: What’s the best piece of advice you would give to parents of anxious children?

HP: If I could say one thing to parents, it would be this: If your child is anxious, you are not a bad parent. Parents get mired in the concern that if their child is struggling with anxiety it must be something that they did wrong. You can always be a better parent, but don’t avoid seeking help just because you think someone is going to shame you for how you raised your kids. If a therapist does that, leave that that therapist and find another who knows what they are doing. A child’s anxiety is not a bad thing or something you did wrong. It is just how they are wired, and it is something you both can work on and fix.

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Comments (1)

  1. Submitted by howard miller on 05/24/2017 - 08:43 am.

    This is so overdue

    Thanks, Andy and Dr. Pickett. Anxiety has become the plague of our era, I’m afraid. Identifying it as an illness (along with all the other new illnesses which parade across our TV’s nightly) is the first error we make.

    Anxiety and stress are usually adaptive mechanisms our body uses to guide us; that is, we are uncomfortable for some reason, we seek the source of the discomfort, judge the validity of the source and then address it. Yoga, exercise, reading and many other guided responses are the way to handle anxiety.

    Medication carries us in the opposite direction. Even if it provides temporary belief, as side effects increase, as they inevitably must, our anxiety begins to increase geometrically.

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