Appropriate testing for anxiety?

[Anonymous]

Our 2nd grader has significant anxiety, for which she receives weekly therapy from a psychologist. She excels academically and socially, and is not a behavior problem at school, so an IEP seems unlikely at best. But her anxiety, which mostly manifests itself at home, is pretty extreme.

Siblings have ASD and ADHD. She clearly does not have ASD and I have no reason to suspect ADHD.

Is there anything further I should be doing? E.g., does anyone recommend a neuropsych exam? I already know she has anxiety so it's unclear what we would get from it.

Other suggestions?

At what stage (and age) do people consider medication? Definitely not my first, second or third choice....

Thanks.

[Anonymous]

If she's not having issues at school, there's no reason to try for an IEP.

Do you think the psychologist is helping? Have you met with a psychiatrist yet? Do you think family counseling might help? That it manifests itself at home means you need to focus on what's going on there.

[Anonymous]

Of course she doesn't misbehave at school, she has anxiety. Don't take that as a marker of how she is feeling inside. At home she can be more at ease and voice her anxiety, be it with anger, panic or being even aggressive. Is she aggressive at home towards siblings or are there any behaviors that are harmful towards herself or others? If not, as long as you are aware of the issue and managing it, that might be all that is needed for now.

[Anonymous]

Anonymous wrote:If she's not having issues at school, there's no reason to try for an IEP.

Do you think the psychologist is helping? Have you met with a psychiatrist yet? Do you think family counseling might help? That it manifests itself at home means you need to focus on what's going on there.

Yes, the psychologist is helping, but not a silver bullet.

We have not tried a psychiatrist; obviously if we ever try medication, we need to go that route.

The anxiety manifests itself when she's alone, which happens (sometimes) at home. (E.g., child is afraid to sleep in a room alone, be on a separate floor, etc.)

Anyway, my primary question has to do with the utility of testing.

[Anonymous]

Anonymous wrote:Of course she doesn't misbehave at school, she has anxiety. Don't take that as a marker of how she is feeling inside. At home she can be more at ease and voice her anxiety, be it with anger, panic or being even aggressive. Is she aggressive at home towards siblings or are there any behaviors that are harmful towards herself or others? If not, as long as you are aware of the issue and managing it, that might be all that is needed for now.

She is not aggressive or harmful to herself or others.

At school she's anxious about wanting to be perfect.

Also, among other concerns, at home she's not sleeping well--due to fear of monsters, spiders, etc. So she's increasingly exhausted during the day.

I want to get her all the supports she needs now.

[Anonymous]

We started medication when my DD was 8. But her anxiety was seriously impeding her daily life at that point. School refusal, unable to leave the house, barely able to sleep, panic attacks, etc. If your DD is getting through normal life for her age ok, you probably don't need to consider meds at this point. Is her therapist good? We struck gold on our third try and it's made a big difference.

We haven't done any testing. She has some accommodations at school like being able to leave the classroom whenever she needs to get herself together. No academic accommodations currently. We will get a neuropsych for her eventually because of a family history of ADHD and some other medical issues she has.

On psychiatry, my only suggestion is not to wait until she's falling apart before you try to find a doctor. They are hard to get a new patient appointment with and it would be good to have a relationship already established if you get there and decide you need to try meds so you are not waiting months for an appointment.

Also, no one wants to give their young child meds, but they have worked miracles for us. She was completely non-functional before starting them.

[Anonymous]

We did therapy for a year and it helped a lot before adding in Zoloft. It made things a lot better. Meds take 1-3 months to really kick in at the right dose so keep that in mind if you are thinking of starting. It was no magic bullet from day one, but the teachers mentioned improved anxiety even without knowing we had started.

[Anonymous]

How is her test performance? I would want to consider a 504 to have a history of extended time and other test taking accommodations if she is informally receiving those now. That way in case her anxiety worsens she can receive the same adjustments for higher stakes testing later on. Anxiety is not helpful in those situations.

[Anonymous]

Respectfully, you sound very anxious yourself.

[Anonymous]

Anonymous wrote:

Anonymous wrote:If she's not having issues at school, there's no reason to try for an IEP.

Do you think the psychologist is helping? Have you met with a psychiatrist yet? Do you think family counseling might help? That it manifests itself at home means you need to focus on what's going on there.

Yes, the psychologist is helping, but not a silver bullet.

We have not tried a psychiatrist; obviously if we ever try medication, we need to go that route.

The anxiety manifests itself when she's alone, which happens (sometimes) at home. (E.g., child is afraid to sleep in a room alone, be on a separate floor, etc.)

Anyway, my primary question has to do with the utility of testing.

Poor thing! how awful for her.

I would definitely look for a good ped psychiatrist who has a good reputation for proceeding with caution so you don't feel like you're walking into a done deal when you meet.

[Anonymous]

OP, I'm not the best situated to answer, because I'm in sort of a similar situation.

We're looking into getting my DD assessed, and I'll let you know how it goes.

In the meantime, I would be most worried about side effects from not sleeping. My DD had a period at about that same age where she was not sleeping much at all. (No specific fears, but then I think she was anxious about not sleeping...). She would have days where she acted just utterly irrational, and I think part of it was something approaching sleep deprivation psychosis (like insisting I'd said things I hadn't said, etc.) We ended up using melatonin and it seemed to really help her reset. I know a lot of people say it's only good for kids that can't get to sleep, but we saw benefits as far as night waking. We used a half an adult dose, for about a year. If I were you, I think I would try to treat the sleep issue and persist on psychotherapy to get her more comfortable being alone. Luckily, 8 year olds don't have to be alone too often!

[Anonymous]

I would like to point out that kids (especially girls) can use their anxiety to perform well in school but it's still not a healthy thing. Anxiety only builds if it's not treated. I've recently begun treatment as an adult and only now realizing how it's dominated my life from at least middle school if not earlier.

My DS also has anxiety that we're treating through therapy. The sleep issue is really hard but it's also been debilitating in other ways for him. His was diagnosed alongside testing for other disorders. If you don't want to go the route of a full neuro-psych, you could talk to a developmental pediatrician for diagnosis. I personally think it would be beneficial because the how you address the issue will probably evolve and change over time.

[Anonymous]

I think you're doing the right thing by having her in weekly therapy and monitoring her closely. It's possible at some point her anxiety will impact her social relationships or academics or make her depressed (or sad or have low self-esteem) and it would be at that point that I would consider medication.
I don't see any need for further testing at this point unless you feel like the anxiety is out of control which it doesn't seem to be.

[Anonymous]

Besides melatonin, you can also use essential oils which help promote calm/sleep. Try those before medication.

[Anonymous]

I suspect my 6 yr old has anxiety? Is that even possible at 6?? How is it diagnosed. What would show up on a neuropsych to say anxiety? What tests are they using to find it? Also, as far as medications go, when they age, does puberty affect dosing or medication reactions?