Your child with ADHD is scared

Ms. Walitza, how do you recognize child fears?

Child and adolescent psychiatrist Susanne Walitza says that children usually don't talk about their fears. She explains, how to recognize child fears - and what distinguishes them from adult fears.

Interview: Sarah King
Image: Stephan Rappo / 13 Photo

Ms. Walitza, anxiety is one of the most common mental disorders in children and adolescents. Do you notice this in everyday clinical practice?

Interestingly, we are more likely to treat children and adolescents with ADHD, even though twice as many children have an anxiety disorder that needs treatment. We know from surveys of school health services that, for example 30 percent of the students have fears, around 10 percent of them require clinical treatment.

How does this discrepancy come about?

In the past, fears and compulsions were combined diagnostically. When it comes to anxiety and obsessive-compulsive disorders, we know that those affected often wait up to eight years before receiving treatment for the first time. Children don't talk about their fear. In addition, a child with an anxiety disorder is less noticeable in school. It is in contrast to a child with ADHD calm and adjusted. Fear is an invisible disease. This leads to this gap between those affected and those who are being treated.

How do children hide their fear so that they don't attract attention?

Let's take that Social phobiawhich is common among adolescents: 70 percent of fearful situations take place in school. Mostly it is about what others think of the young person. So he develops Security strategiesTo avoid fear: For example, he only holds out his hand when the teacher has already started to call someone. He speaks softly and ponders for a long time how to put an answer in a short sentence. So that he doesn't have to spend breaks with others, he pretends to have to hand in homework, for example. These and other strategies are extremely exhausting for the adolescent.

Can fears grow?

What grows out by itself is Development fears. They occur in parallel with cognitive development. In the first year of life, for example, this is the Xenophobia - if the child suddenly notices: This is not my caregiver who is carrying me around. From the fourth to the sixth year of life, for example, they are Monsters in the basement. Such fears come and go. However, if the fear is excessive compared to peers and it affects everyday life, then professional help is appropriate. If children cannot carry out their everyday tasks, they may miss important developmental steps. If left untreated, anxiety affects a child much more than it does an adult.

Is there a difference between children's anxiety disorder and adults?

Children usually have unspecific symptoms. They complain of abdominal pain, are lethargic or aggressive. The form also differs: Generalized anxiety disorder is less common in children. Panic attacks are also less common. Separation anxiety is the most common fear in childhood.

The child's fear of being separated from their parents?

Yes, but the most important thing is the fear for the parents. If they are not home, something could happen to them. Some children become aggressive in the separation situation, also towards themselves: They cling to their mother, pull their hair, scream. Once I had a child who was about to hit his head against the wall when the mother was about to leave the room. You have to be able to endure it when you see this, and you have to help mother and child with the separation. The aggression can also mask the fearwhich boys quickly perceive as oppositional behavior. There is a huge fear behind it.

And what do you do when a child wants to hit his head against the wall?

First I separate mother and child. It is important to convey to the mother beforehand that the child will calm down as soon as she is outside. I've never seen it any other way. You can also send the mother a cell phone photo so that she can see that her child is happy again. If the separation takes place at home, we advise the parents or make house calls in an emergency. We treat in all variations, always individually. Sometimes parenting advice is enough.

And if not?

If the situation goes wrong - for example, if the child has been refused school for a long time and there are multiple fears or even a depression - the child may need an inpatient stay. We have a school where lessons are given according to the curriculum. The child is then gradually returned to their home school.

Are there children who are more susceptible to an anxiety disorder than others by their character?

There are several factors that contribute to an anxiety disorder. When it comes to character, the whole family is sometimes characterized by restraint and fearfulness. There is also a biological vulnerability or susceptibility. It expresses itself in rather fearful behavior and reluctance when it comes to getting to know yourself and trying out new things.

How big is the healing success for anxiety disorders?

The prognoses are good. We complete therapy as soon as the anxiety is reduced enough that the child can perform everyday tasks and is stable. This refers to treatment with behavior therapy. If only medication is used, the child will probably no longer be stable after stopping the medication. Psychotherapy is always the first choice and medication always takes place as part of a multimodal treatment.

How long does therapy last?

That varies depending on the child and the form of fear. On average, therapy lasts around 20 hours. With the specific phobia, it goes faster if the fearful situation can be easily practiced. However, if the child is afraid of vomiting, for example, it is difficult to establish an exercise situation. In principle, the following applies: The earlier those affected can be treated, the better the healing success. But: It's never too late for therapy.

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The Child fears theme is the big dossier topic of our May 2019 edition. Order our magazine now.