Child & Adolescent Anxiety Disorder: Recovering with Functional Medicine

Watch our video: Amber Ratcliffe and Dr. Zendi Moldenhauer discuss Child & Adolescent Anxiety and how Functional Medicine can help your child recover from the inside out and get them back to feeling their best.

Is your child irritable, quick to anger, or have frequent emotional outbursts? Do they avoid age appropriate activities? Do they have trouble sleeping? Have frequent stomach or head aches? Do they bite their nails? Do they trend towards perfectionism, excessive planning, or negative self-talk?

If so, they might be suffering from anxiety...

If you think your child or teen is suffering from anxiety or depression, you aren’t alone. At least one in five children report experiencing anxiety. Studies confirm what you can tell just by talking to other parents and teachers - child and adolescent anxiety is on the rise.

While medication and talk therapy can be helpful, often they just help make the symptoms more manageable. The good news is that there are new Functional Medicine approaches to uncover and treat the root cause of the anxiety so your child can recover once and for all.

At our functional medicine and psychiatry practice, we see anxiety as a symptom of a deeper root cause - something is out of balance in the body, such as critical nutrients, the gut microbiome, hormones or even the immune system. Once the imbalances are identified, we address those root causes of anxiety so the body can come into balance and the symptoms can resolve naturally from the inside out.

Did you know?

The median age of onset for anxiety is age 6
It is estimated that worldwide prevalence of anxiety and depression has doubled since the start of the Covid-19 pandemic
In 2020, the percentage of emergency room visits for mental health emergencies rose by 24% for children between the ages of 5 and 11 and 31% for those 12 to 17, compared with 2019.
According to a survey from The Mental Health Institution, levels of depression among members of Gen Z went up about 4% or 5% between pre- and post-pandemic

Most kids experience some level of temporary anxiety in reaction to stressful situations – such as feeling nervous before a test or getting “butterflies” in the stomach before a performance. But others suffer from anxiety with an intensity or duration that interferes with daily life or makes them avoid things that are developmentally appropriate for their age.

If this resonates with you, request a free 20-minute consultation to see if Functional Medicine might be right for you.

What are the Symptoms of Child & Adolescent Anxiety Disorder?

Physical symptoms of anxiety include:

Insomnia
Fatigue
Nail biting
Rapid heart rate, shaking or dizziness
Other physical symptoms such as headaches, stomachaches or nausea

Emotional symptoms of anxiety include:

Anger or irritability
Trouble concentrating/lack of focus
Defiance
Avoidance or apathy
Overplanning
Negativity
Emotional outbursts
Perfectionism

How Does Teen Anxiety Differ?

Younger kids worry about all sorts of things - the dark, spiders, being away from their parents, and so on. Teen anxiety is more likely to be pointed inward; they worry about themselves. A teen might worry about their changing body or about school or sports performance. Teens often compare themselves to others and feel they don't measure up, particularly once they enter the world of social media.

Teen anxiety can be harder for adults to differentiate from other adolescent emotional changes. Stereotypes about teen behavior confuse caregivers about what is normal vs. cause for concern. Is your teen avoiding situations or lashing out due to anxiety or because they are being a "typical moody teenager?" As they gain some freedom, teens might be prone to more lifestyle factors that contribute to mental health issues, such as less sleep, less movement and more processed food.

While it might be harder to recognize, monitoring symptoms and seeking a professional consultation can help you identify an anxiety disorder and support your teen to recover.

What are the Different Types of Child and Adolescent Anxiety?

According to the Child Mind Institute, “Anxiety is a very general term used to describe a feeling of extreme worry or unease. Feeling anxious is natural after something upsetting happens. But when a child feels anxiety that lasts a long time and prevents them from doing things like going to school or seeing friends, then it becomes an anxiety disorder.” Child & teen anxiety might fall into one of these categories:

Generalized anxiety disorder is characterized by an ongoing state of tension and nervousness without a specific cause.
Separation anxiety is the fear of being separated from caregivers. While many children go through a phase of separation anxiety, if it manifests suddenly and/or continues for several weeks this could be separation anxiety disorder.
Social anxiety disorder blocks connection with others due to irrational fears of social interactions, e.g. phone calls, public speaking, even ordering at a restaurant.
Panic disorder is when a person experiences episodes of intense mental and physical symptoms (such as rapid heartbeat, chest pain, nausea, sweating, numbness and more). These panic attacks can be triggered by stress, anxiety or even the fear of having panic attacks.
Obsessive compulsive disorder (OCD) involves thoughts and worries (obsessions) that make the child very anxious. Some children create rules for themselves, or repetitive actions (compulsions) that they feel must be followed to relieve the anxiety.
Specific phobias involve intense fears of specific things such as objects, situations, animals, illness, etc.

How are Child and Adolescent Anxiety and Depression related?

According to 2019 statistics from the Centers for Disease Control and Prevention, more than 1 in 3 U.S. high school students reported they had experienced persistent feelings of sadness or hopelessness in the past year, a 40 percent increase from a decade earlier.

Unfortunately, anxiety and depression can become a continuous cycle. For example, anxiety about social situations can result in isolation and loneliness which leads to depression. The stress of chronic anxiety is exhausting to the body and that fatigue might lead to avoidance of activities that could combat depression, such as exercise, seeking connection and eating healthy foods.

There is a physiological component to the anxiety and depression spiral as well. Chronic stress reduces the stomach acid and digestive enzymes necessary to properly assimilate the protein and nutrients required to produce feel-good chemicals (dopamine, serotonin) in the brain. An imbalance in the gut microbiome can also result in yeast overgrowth, which can cause symptoms of anxiety and even panic attacks. Bringing the digestive system back into balance can address those psychological effects.

When Anxiety Isn't Anxiety: PANS/PANDAS

As mentioned, anxiety is a symptom that things are not functioning properly in the body. When we get a call from a concerned parent, we frequently discover that a child or teen with anxiety actually has Pediatric Acute-Onset Neuropsychiatric Syndrome (PANS). PANS is an autoimmune condition in response to an infectious trigger where the immune system inadvertantly attacks the brain instead of just attacking the infection, causing inflammation and myriad symptoms often mis-diagnosed as psychological conditions such as anxiety, ADHD, OCD, behavioral regression and more. In this case, unless the root-causes are uncovered and treated, anxiety is unlikely to resolve using anxiety medication and/or therapy alone. PANS triggers can be complex, layered and can include:

Mycoplasma
Strep (this is called PANDAS, or Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infections)
Coxsackie virus
Epstein-Barr virus
Herpes simplex virus
Lyme disease, or coinfections such as Bartonella or Babesia
Mold toxicity
Gut Dysbiosis

In many cases PANS/PANDAS triggers are layered. Even if a child or teen does not appear sick, lab work may show the presence of multiple infections. Exposure to toxins such as mold or heavy metals can further complicate PANS/PANDAS. Our treatment plans are phased over several months and address critical nutrients, gut health, immune function, detox, and other areas as needed. Plans typically include prescription medications, nutrition guidance, nutraceuticals, lifestyle modifications, stress management, and other complementary therapies.

Complete this assessment to determine if PANS/PANDAS could be behind your child's anxiety.

What is the Functional Medicine Approach for Child and Adolescent Anxiety?

First, we always start with a very thorough medical history using questionnaires, symptom surveys, and a 90-minute initial consultation. We want to understand the child’s personality, and social and family dynamics. Then we conduct comprehensive medical testing.

As Functional Medicine experts, we are specially trained to perform advanced biomarker testing to uncover how your body's systems are performing. Using the latest evidence-based research in nutrition, toxins, inflammation, chronic infection, stress, and functional brain testing called a QEEG Brainmap, we seek to uncover the root cause of your child’s symptoms through their unique biomarker profile. With that profile in hand, we use conventional and holistic medicine techniques to get their systems back on track so that symptoms resolve from within.

Nutrient Deficiencies

We assess nutrients such as zinc, copper, iron, vitamin D, B vitamins, and protein. Are these deficient or out of balance? A treatment plan could include supplements, recommendations for specific foods, and/or digestive support to ensure the body is absorbing the nutrient building blocks of dopamine, serotonin and other neurotransmitters.

Gut Dysbiosis

Hippocrates, the "father" of natural medicine, stated "all disease begins in the gut." For example, an overgrowth of yeast can contribute to intense feelings of anxiety and even panic attacks. SIBO, or small intestinal bacterial overgrowth can cause excess hydrogen or methane to seep into the blood and can negatively impact brain function. Gut health is one of the first things we assess in addressing child and adolescent anxiety and depression.

Biochemical Abnormalities

We conduct testing to confirm or rule out imbalances in neurotransmitters and hormones. An adrenal system that is weakened by stress, for example, can lead to burnout and anxiety. A treatment plan could include lifestyle modifications and supplements to support healthy adrenal function.

Hormone Issues

Is the adrenal system under strain due to prolonged stress? Is a adolescent on hormonal birth control? If so, side-effects are common and can impact other hormones that drive energy and mood. Specialized testing can help us assess whether hormonal support is necessary to treat child and adolescent anxiety symptoms.

Immune System Dysfunction or Underlying Infections

We test for the presence of bacterial or viral infections to rule out the possibility of the autoimmune condition described above (PANS/PANDAS).

Toxins

Does the body need support in detoxing from mold or heavy metals? A body overburdened by toxins will exhibit a myriad of symptoms, which can include anxiety and/or depression.

Dysregulated Brain Waves

QEEG Brainmaps and Neurofeedback can be incredibly useful tools to help understand the root cause of anxiety and can change stuck, dysfunctional brainwave patterns in the brain. Just like people, brains can develop bad habits over the years. The great news is that neurofeedback can be an effective method for retraining brainwaves into a healthy pattern. Neurofeedback has had good success resolving anxiety naturally and permanently without medication as long as there isn’t another serious underlying medical condition that would need to be resolved first (see above possible root causes).

Functional Medicine Treatment Plans for Child & Adolescent Anxiety

After our root cause investigation, functional medicine pulls from a vast menu of treatment options for child anxiety and depression. We work with parents/caregivers to establish a holistic plan that may include prescriptions, nutraceuticals, nutrition, stress-management techniques and other complementary therapies such as neurofeedback or psychotherapy.

We look at lifestyle and might suggest implementing changes for sleep, modifications to digital screen time, exercise and more. We trust your instincts and collaborate with you to determine the best path for your child and family. Our goal is to help you build a toolkit that helps address your child’s anxiety and maintain healthy living lifelong.

What if the Root Cause of Child and Adolescent Anxiety Disorder is not Addressed?

According to the Child Mind Institute, 80% of kids with a diagnosable anxiety disorder and 60% of kids with diagnosable depression are not getting treatment. Even those who do seek treatment can get trapped in a long-term cycle of chasing symptoms and dependency on psych meds and therapy if they do not identify and treat the root cause of the condition.

At Arbor Health, we frequently see a young adults who have spent years on various medications without success. Our testing uncovers the presence of infections, toxins and nutrient deficiencies. This is a case where psychiatric prescriptions alone fall short of a comprehensive treatment. This young person could need antibiotics, immune-supporting supplements, dietary modifications and detox support instead of or in addition to psychotropic medication.

Ignoring child and adolescent anxiety and depression can put kids at risk for behaviors such as substance use and other forms of self-harm. Anxiety and depression can become a relentless cycle as stress taps the body of its ability to absorb necessary nutrients and create the necessary neurotransmitters to feel good.

We invite you to find the root cause of your child’s anxiety or depression. Sign up for our mailing list to get more information on health and wellness and to find out when we offer classes.

If this resonates with you, request a free 20-minute consultation to see if Functional Medicine might be right for you.

How can Parents and Caregivers Support Children and Teens with Anxiety and Depression?

While seeking professional help for child anxiety & depression, here are some things that you can try at home.

The Basics:

Focus on a whole foods diet rich in nutrients and good quality protein. Protein contains the building blocks for neurotransmitters. Some good protein-rich snack ideas are an ounce or two of nuts, organic cheese, PaleoValley grass-fed meat sticks, or if you need something minimally processed to take on the go MariGold Bars are a good low-sugar, high protein option.
Eliminate or reduce sugar and processed foods, especially those containing artificial colors and sweeteners.
Encourage quality sleep. The National Sleep Foundation recommends 9-11 hours of sleep per night for 6-13 year olds and between 8-10 hours for 14-17 year olds.
Get active with your child. A study of 400,000 people found that those with an active lifestyle were 60% less likely to develop anxiety.

Supplements that can help support mental health and mood:

We know that shopping for supplements can be overwhelming. There are so many brands, and types, and dosages - it can be hard to know what to do - so you do nothing. Sound familiar?

To make it easy for you, we took the guess work out of it by linking our favorites below.

NeuroMood Pure Packs - designed to help support healthy neurotransmitter function as well as positive mood and emotional wellness. This pack replaces the need for a separate multivitamin and omega-3 supplement and makes it easy for those over 12 years old who can swallow pills.
High Quality Multivitamin – most of us don't get enough vital nutrients from our diets. It's important to use a brand that contains highly bioavailable versions of nutrients and methylated B vitamins. Most drug store brands don't cut it. We love Junior Nutrients for capsules and PurePals for chewables.
Omega 3 - these fatty acids are very important to the health of your body and brain. Notably, omega-3 fatty acids can reduce the production of molecules and substances linked to inflammation. Our favorite capsules are ONE Omega because of their high dose of the most important molecules and there are Chewable Omega-3 for kids.
L-Theanine - an amino acid associated derived from green tea that helps with easing anxiety, stress and insomnia. This comes in capsules and chewables for younger kids.
Magnesium Glycinate - this form of magnesium is easily absorbed and may help reduce symptoms of depression, anxiety, insomnia. Capsules can be opened and mixed with drinks like our Sea Salt Lemon Water recipe (tastes like weak lemonaide) for those who can't swallow pills.
Best-Rest Formula - supports healthy sleep cycles by encouraging an easy transition to sleep and a restful night's sleep. The supplement contains passionflower, chamomile, lemon balm and hops, which have been clinically shown to naturally calm and relax the central nervous system.

Improve Digital Hygiene:

Reduce the amount of time on digital devices – they are very stimulating and can have negative effects on the brain. Use parental controls to limit the amount of time each day that children can use their devices and establish a digital curfew one hour before bedtime to help wind down and promote deeper sleep. Do not allow digital devices in bedrooms.
Limit media exposure that feeds negative thoughts. Read the news versus watching or listening in the presence of your child.
Encourage a break from social media and/or review their feed with them. Teach them how to alter their feed to bring in more positive influences such as @icanhelp and @work2bewell. Reduce exposure to negative people. We recommend that parents watch Childhood 2.0 (not with your kids) to better understand the social dangers that come with phones for kids.
Use technology as a tool for practicing meditation. Employ an app such as Calm, or Headspace. Kids and teens can also learn Tapping (Emotional Freedom Technique), which actually lowers cortisol levels.

Other Strategies:

Encourage your child to go outside first thing in the morning and again in the later afternoon/evening, even for 10 minutes. Stand on the ground barefoot if possible - this helps to connect the body to the benefits of negative electrons present in the earth. This pratice is called Earthing or Grounding and has been correlated with better sleep, reduced pain, and stress reduction. Natural light exposure can help reset the circadian clock (10-60 minutes depending on how sunny/overcast it is outside) which promotes healthy (and anxiety-busting) sleep patterns.
Practice being present. Worry is all about “what if.” Help your child come back to the present moment by using their senses. Name something you can see right now. Name something you can hear. Name something you can smell. Etc.
Help your child name their emotions. Encourage them that feelings are normal and they come and go. Saying it out loud or writing it down can help the child release the pressure of keeping that emotion inside.
Start a gratitude practice with your child. This could be a journal, app or taking turns at the dinner table sharing one thing you are grateful for (bonus: gratitude boosts your immune system).

When should I seek help for Child and Adolescent Anxiety and Depression?

Follow your instincts. If you are asking the question, it does not hurt to seek a professional consultation. Children are sensitive to the stress level of the adults in the home...so if you are feeling anxious over your child’s mental health it may be exacerbating the issue. This Child & Adolescent Anxiety Questionnaire could help you assess which symptoms are most troublesome for your child.

If this resonates with you, request a free 20-minute consultation to see if Functional Medicine might be right for you.

Additional Resources

Crisis Hotline

National Suicide Prevention Lifeline

Sources:

_{Earthing: Health Implications of Reconnecting the Human Body to the Earth's Surface Electrons}

_{Anxiety in Children - A Quick Guide - Child Mind Institute}

_{Global prevalence and burden of depressive and anxiety disorders in 204 countries and territories in 2020 due to the COVID-19 pandemic - The Lancet}

_{https://childmind.org/article/what-to-do-and-not-do-when-children-are-anxious/}

_{https://www.anxietycanada.com/learn-about-anxiety/anxiety-in-children/}

_{https://www.aetna.com/health-guide/kids-anxiety-whats-normal-seek-help.html}

_{https://www.health.harvard.edu/blog/anxiety-in-children-2018081414532}

_{https://www.healthline.com/health/anxiety/whats-up-with-todays-kids-and-anxiety#Helping-your-child-cope-with-anxiety-disorder}

_{Children's mental health is now a national emergency, health leaders say : NPR}

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