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With over 13 % of 16 year olds having an anxiety disorder and prevalence rates on the increase, in this blog Dr Sabina Dosani – Child and Adolescent Psychiatrist and Clinical Partner, looks at what you can expect for your child or teenager if you come for an assessment with a Psychiatrist. She also discusses some practical tips for helping your child and how they can manage a panic attack.
I work with families every day who are understandably nervous about what to expect from their appointment with a Psychiatrist. We might all be used to going to the GP, but many people have not needed to see a Psychiatrist. You and your child may not know what to expect and in this blog I hope to be able to answer some of your questions.
You and your child will be asked a lot of questions and we may go into quite some depth. That’s because in order to be able to get a clear diagnosis, we need to understand some of the complex issues around your child’s symptoms. You may have been asked to complete some questionnaires before attending the appointment as well – these are used to understand in more detail what your child is experiencing.
When I do assessments, it is helpful for me to think about physical and psychological symptoms of anxiety separately. This is known as doing a systemic enquiry, when we ask about:
When diagnosing anxiety disorders in children, it often helps to have information from schools, as well as from you and your child. This helps us both confirm the presence of any disorder and establish the current level of severity and gauge how much it gets in the way of learning and friendships. It will also help us to identify appropriate interventions.
We divide symptoms under these headings, even though they are experienced together, as several physical disorders may mimic an anxiety disorder. Psychiatrists are looking for signs things like of complex partial seizure disorder, substance misuse and withdrawal. These might sound scary, but the role of the Psychiatric assessment appointment it to make sure the right diagnosis is given and that there are no other reasons for the symptoms.
We know that anxiety is often experienced by children and teenagers along with something else – in medicine this is called ‘comorbidity’.
In medicine, comorbidity is the presence of one or more additional diseases or disorders co-occurring with a primary disease or disorder.
Anxiety can be either the primary (i.e. the main disorder) or the secondary disorder and an important part of the psychiatric assessment is looking for any other illnesses / disorders that your child may be experiencing. It can affect the way that we think about treatment and the options that are right for your child and family.
Looking at the whole picture of the child’s life, what their early experiences were and how things have changed for them are all part of formulating the diagnosis.
Q. What causes anxiety?
A. Anxiety is caused when your primeval fight or flight mechanism gets activated. We think that this evolved long ago, when we lived in caves and had to fight or flee when confronted by a sabre tooth tiger. It kicks in when you feel under threat.
We haven’t evolved out of anxiety as, at low levels, increased anxiety leads to better performances. Those pre-exam nerves help you do better than you would without them. Low level stress is essential for survival, enabling you to produce work to high standards. But adding extra stress when you’ve already reached your peak, can have catastrophic results. Typically, tiredness is the first sign. Exhaustion and illness follow if stress continues unchecked.
Q. What can I do when I have a panic attack?
A. Panic attacks last about ten minutes, but when you’re having one it can feel a lot longer. The first thing to remember is that all of these strange symptoms are completely harmless. They can’t make you have a heart attack or stroke, and you’re not going crazy. They all happen because your body has had a sort of false alarm, kicking you into sabre tooth tiger fighting mode. Panic attacks are a case of right feelings, but wrong place, wrong time. Breathing deeply and slowly counteracts the effects of this fight or flight reaction. It calms down your nervous system and helps you get back to feeling calm again.
Panic attacks feel dreadful because your mind misinterprets the signals your body is giving you. Tell yourself those palpitations and rapid, shallow breaths are just your body’s way of preparing you to fight the tiger.
When you are feeling calm again, a good way to cope with future anxiety is to take a scientific approach. This is the sort of thing I mean.
Make a list of all the feelings you have during a panic attack and what you think they mean. Next do some research into anxiety and find out what’s really going on. Draw up a table like this one and keep it in your bag or pocket. Next time you feel anxious, get it out to remind yourself of what’s really going on.
Parents often ask, ‘what can we do to help our child with anxiety?’
Seek help from mental health professionals who are trained in working with young people, offer evidence based therapies such as cognitive behaviour therapy and use medication judiciously.
Children are influenced by our behaviour and emotions as parents and a big part of helping anxious children is to demonstrate good coping mechanisms. Anxiety often runs in families and having a child with an anxiety disorder can be anxiety provoking in itself, so this might be really hard. Some parents may need treatment for anxiety themselves by a specialist clinician who is skilled in working with adults. You might want to consider family therapy which can be really helpful for the whole family as we are all affected when someone in the family is experiencing something like an anxiety disorder.
Clinical Partners is the UK’s largest private mental health partnership, helping children, adults, families and organisations nationwide.
1 Green et al 2004 Mental health of children and young people in Great Britain