Two Types of Anxiety

Two Types of Anxiety

I would like to follow up on my previous email concerning the importance of trying to be specific about the anxious expressions in your child. For the sake of discussion, I think it is helpful to draw a distinction between classic expressions of anxiety and what I would call more derivative expressions. In the more classic forms of anxiety, it is usually easier to identify what the child is anxious about with statements along the lines of, “I am scared” or “I am afraid that …” accompanied by an apprehensive facial expression or tense posture. The more classic forms of anxiety can be thought of as an overactive alarm system, in which there are either a high number of false alarms or simply too many alarms altogether. Treatment will involve helping the child face his fear and in doing so reprograming the “alarm system” to more appropriate settings.

But anxiety can manifest itself in a more general form where it is not so much a problem of an overactive alarm system as it is a by-product of a system that has trouble regulating itself. This is what I mean by a derivative expression of anxiety. Some part of the system is not working efficiently and the anxiety is a reflection of this problem. The engine isn’t running efficiently, the machinery used to deal with unexpected/changes in plans is not working efficiently. The glitches will show up when there are transitions. This is different from just an overactive alarm system. This is more like negotiating a dark passageway with a flashlight and never knowing what might jump out at you. If the world is filled with a lot of unwanted surprises, you will be more anxious. Some examples:

1. A      10-year-old girl with ADHD gets anxious at her summer camp because there      are a lot of field trips pertaining to their nature studies. She has      always had trouble with directions and even as a young adult can get      confused about right versus left. She is anxious because she does not      really understand where she is going and she wonders to herself, “What if      I get lost?”
2. A boy      with very significant ADHD and dyslexia is very athletic but reluctant to      try new activities. In part he is sensitive to the noise that occurs with      indoor sports and is also unsure of what to expect. He is impulsive and      often gets corrected in school and since he is nonresponsive, voices get      raised.
3. Children      who struggle with unstable moods will be vulnerable to anxiety. They can’t      count on how they will feel from one moment to the next and this creates a      baseline state of ongoing tension. Not being able to count on some      internal stability will lead to anxiety. So you will see children who are      afraid to be upstairs by themselves or go outside by themselves. Tracy      Anglada has written a book on children with bipolar disorder and she      quotes one child as follows “I      remember being quite anxious as a child. I would describe it as an      unexpected event, where something normal would cause me to panic, my chest      would tighten, my heart would beat rapidly and I would sometimes just      break down and cry” (p 87). And certainly nighttime is a time of      heightened anxieties and with someone with bipolar these fears can be      especially intense where dreams can be quite vivid and disturbing.
4. Perhaps      it is not as common in children, but the experience of having a major      depression where you can’t focus or concentrate on anything can be a      frightening experience.
5. A high      school student has experienced significant help from being diagnosed with      ADHD and receiving medication, but complains about being socially isolated      and would like to make more friends. In talking with her, one can see that      maintaining eye contact is a struggle and she does not understand jokes or      any nuances in conversation. She seems to be someone with difficulties in      processing nonverbal information.
6. Children      with Aspergers or other conditions in which there is a strong detail      orientation and corresponding difficulty in seeing the big picture are      going to be more vulnerable to surprises.
7. If you      are someone with pronounced sensory sensitivities, you depend on a certain      continuity in order to maintain a sense of well-being. Anything that      upsets that precarious balance will lead to more avoidance behavior. So      one of those children whom the parents had a impossible time calming down      as an infant and had a variety of sensory sensitivities is going to have a      much harder time adjusting to the school environment and may show a lot of      separation anxiety.

Although the distinctions between classic anxiety and derivative expressions in real life may be fuzzy, it is important in making a plan of action to determine whether the primary problem at the moment is the “overactive alarm system” or a larger problem in self-regulation.