Don’t let anxiety disorders derail your child.

One typical spring morning, 10-year-old Amanda awoke at the usual time in her usual room with a sudden, unshakable dread that her mother was going to die.

“It was totally random,” said Amanda,* a likeable student from a supportive family. “I mean, I knew my mom was healthy and I could hear her making breakfast down the hall. But no matter how crazy they seemed, I just couldn’t make the thoughts go away.”

Amanda found a few things that helped calm her fears. Some made sense—like insisting her mom avoid certain activities and staying free from germs. But other “solutions” seemed bizarre, like counting backwards and getting out of bed in exactly the same way every morning.

“I knew it didn’t make sense,” said Amanda, “but I got desperate to make the bad feelings go away.”

Her family was mystified. It seemed that overnight their daughter’s bright, easygoing charm was replaced with tantrums, worry and weirdly obsessive thoughts.

“We thought it was just a stage,” said Amanda’s mother. “We thought if she would just try harder, or if we could just tell her the right things, she could stop all these crazy behaviors.”

At first the family went along with Amanda’s rituals, trying to ease her anxiety. But over time, compulsive behaviors began to rob them of time and energy previously devoted to schoolwork, play and sleep. They agreed they needed professional help.

Getting Answers
After several misdiagnoses, Amanda’s family eventually found a psychologist who diagnosed Amanda with a form of Obsessive Compulsive Disorder (OCD) known as PANDAS: Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococccal Infections. This type of OCD attacks children and teens suddenly and severely following a bout with scarlet fever or strep throat.

“When I first heard about the strep connection, I thought it sounded impossible,” said Amanda’s father. “But then it clicked. We remembered Amanda had just recovered from a bad case of strep just before we started noticing her irritable behavior and constant demands.”

Treatment Is Available
With a diagnosis finally in hand, the doctors and family were able to begin a course of cognitive-behavior therapy (CBT), a type of counseling that helps patients recognize, understand, and restructure negative thoughts into more positive ones. For children whose anxiety levels are especially high, doctors sometimes combine CBT with medications such as selective serotonin reuptake inhibitors (SSRIs), which can reduce the impulse to engage in the ritualistic behavior.

Amanda overcame her first bout with OCD, only to be thrown back into it again when she developed another strep infection. While most children with OCD—which affects roughly 1-2 percent of the pediatric population—have symptoms that are stable over time, children affected by PANDAS have symptoms that come and go. So her doctors and parents started checking for strep at the first sign of sore throat or fever.

Families Play Key Role In Healing
No one knows for sure why PANDAS occurs. One theory is that strep infections trigger an antibody response in some children that causes changes in the basal ganglia, a part of the brain that has been implicated in OCD. It’s important for adults to understand that OCD—or any anxiety disorder—is never the child’s fault.

“Some days we were late for school,” said Amanda’s brother, “and a lot of times we ran out of time for fun things we used to do. She kept telling us, ‘It’s not me, it’s the OCD.’”

Experts say families are key to success when it comes to beating anxiety disorders. It’s worth the time to get informed, get expert help, modify expectations, and stay supportive. They urge families to recognize and praise any small improvements, and keep routines as normal as possible.

“It’s scary and confusing and lonely and embarrassing to live with OCD,” remembers Amanda, who now at 17 is almost too old to be threatened by PANDAS. “I’ve learned that not everything you feel is real. I know how to fight and win.”

• Not her real name.

  Anxiety Disorders
  All children have worries and doubts; but for approximately one-in-10 children and teens with anxiety disorders, those worries won’t stop, no matter how much they want them to go away. Some childhood fears are normal and expected—being left alone at preschool for the first time, sleeping in the dark, or getting hurt playing sports, for example.
  Some not-so-normal anxiety disorders include the following:

• Generalized Anxiety Disorder
• Panic Disorder
• Separation Anxiety Disorder
• Specific Phobias
• Selective Mutism
• Social Phobia
• Obsessive Compulsive Disorder

• Post Traumatic Stress Disorder

  If your child experiences a fear that interferes with normal activities, it’s time to seek help. Very often, successful short-term therapy can help ease a child’s fears and get things back to normal.