The Anxious child

Rivky Cohen, a 9 year old, attending the local Bais Yaakov school, is a lovely girl and a conscientious student, but for the last month, she has been difficult when it came to going to school. Every school day morning, she wakes up complaining of a stomach ache, which are noticeably absent on weekend. Her mother has been driving her to school almost daily, but Rivky seems to be arriving later and later. When questioned by her mom, she denies that anything has happened to her in school. A visit to her pediatrician fails to find anything physically wrong. Eventually, Rivky refuses to attend school at all. When Mrs. Cohen tries to force her to go to school, Rivky becomes aggressive and throws a tantrum.

We have all experienced anxiety. All living, breathing creatures have been created with an early warning system hard wired into the brain. This system warns us when we are in potential danger, and prepares our body to run or fight. When this system goes awry, an anxiety disorder may result. It is not that uncommon, and can affect individuals at any stage in life.

While some anxiety symptoms can be easily rationalized, others are harder to trace and understand. For instance, a child bitten by a dog will appropriately fear dogs, but sometimes a child will be phobic of dogs without ever really ever having had a bad experience with one, or any encounter with a dog whatsoever.

Unexplained physical symptoms, both in children and in adults, may be signs of an anxiety or mood disorder. Before physical symptoms can be explained away in this fashion, they need to be thoroughly evaluated by a qualified medical professional. This might mean a referral to a specialist, like in Rivky's case, a referral to a pediatric gastroenterologist.

At the suggestion of the school and the pediatrician, Rabbi and Mrs. Cohen seek professional psychiatric help, and Rivky is referred to a local child psychiatrist for evaluation. The psychiatrist carefully reviews the history of the problem, as well as Rivky's developmental, medical, family and social histories. The results revealed that in fact Rivky was always an anxious child, and had a more difficult time separating from her parents. She was also late with her toilet training, and still has occasional accidents at night. The family history uncovered that her mom has always been anxious, and this has become worse over the past 4 months because of the illness of a close friend and financial problems. Mrs. Cohen's father has also always been a 'worrier.' Rabbi Cohen's family has its share of both anxiety disorders and depression as well. Rabbi Cohen explained that his mother was never able to fly to visit relatives in Eretz Yisroel, and could never be without her Xanax.

Anxiety disorders, like many other conditions, tend to run in families. Not only do the genetics play a role here, but the environment is likely playing a role as well. The worsening anxiety that Mrs. Cohen feels is likely having an effect on her daughter. Mrs. Cohen would probably protest claiming that, despite feeling more worried, the house runs as it should, but this does not shield Rivky from 'feeling' the anxiety and worry that her mother experiences and reflecting it in her own behavior.

Dr. Ronen Hizami is a child, adolescent and adult psychiatrist practicing in Brooklyn and New City, NY and can be reached at 718-645-5138.