medication for kid with significant performance anxiety?

[Anonymous]

Our 10 year old has pretty significant performance anxiety. He loves baseball with every fiber of his being and skills-wise is very good but has many games when he just loses it. Forget about pitching. He ends up messing up and sobbing.
At try-outs he was won of the top 2 kids out of close to 200. He is just a complete anxious head-case in stressful game situations (which happen almost every game).
He also has a ton of anxiety before school exams. However, the rest of the time he does quite well with life. He's a bit moody but nothing too concerning. He does very well in school and has lots of friends.
It's just that any sort of high pressure, performance situation makes him really, really anxious and this can be accompanied by a mix of crying/screaming/anger. etc.

We have tried CBT (he's worked with therapists for months at a time) but when he's in the heat of the moment of an anxiety fueled melt-down he CANNOT talk him self out of it.
When he's not in this state he could teach a course in CBT. Then he can tell you exactly what he should be doing and feeling to talk himself down.

Are there medications that can be used or this type of performance anxiety in kids? Obviously we will ask his psychiatrist (just got referred to one from our psychologist) but I'd love to hear any thoughts.
We are getting desperate (as is he).

[Anonymous]

You must be a troll. "Performance anxiety" isn't in the DSM. Good luck finding a child psychiatrist who's taking new patients or one that's willing to loose his/her license for prescribing drugs in this situation.

Part of competing is being able to compete. Maybe he should try a different sport or just play recreationally. This is a life lesson that we don't always get what we want. If you're not a troll, then you can practice meditation and relaxation techniques with your kid.

[Anonymous]

I asked our psychiatrist if there were anti-anxiety medications that could be taken on an as-needed basis. He said no, other than something like xanax, which he would only prescribe for kids in an emergency situation.

[Anonymous]

aconite - in homeopathy
brahmi - in ayurveda.

[Anonymous]

OP here. I'm not a troll. WTF.
I have an anxious kid who does well when he's in his normal routine in the classroom, with familiar friends, with our family, etc.
He really struggles when he's in critical situations in baseball, has to take tests, do any sort of performing arts, etc. Whenever he's confronted with new or difficult situations he's not able to talk himself down and once he gets anxious he spirals into very frustrating behavior. Once he's anxious he has almost zero emotional regulation.

I wish I was making this up. I'd give just about anything to help him and have spent thousands on CBT but it really hasn't helped.

We haven't seen the psychiatrist so my term of "performance anxiety" is just my own jargon. Perhaps he has generalized anxiety. I don't know. I was just hoping that maybe his story would be similar to someone else's child and I could get an idea of what may have helped.

And honestly, why the heck are you being rude on a "special needs" forum? Horrible.

[Anonymous]

OP I'm troubled that you say your child has no diagnosis but you've spent 'thousands' on dollars on CBT. I believe you -- but if that's the case your son wasn't well served by the therapist or the therapist never shared his or her diagnosis with you.

I'd start from square one with a new psychologist. Get a full evaluation and figure out next steps.

[Anonymous]

Sounds like his performance anxiety stems from feeling as though he needs to perform for you. Dragging the poor kid to therapy and considering medication for a 10 year old who gets nervous? I mean this with kindness, but that's freaking nuts.

[Anonymous]

Have you done family therapy? What about sitting out baseball for a season or switching to a different sport?

[Anonymous]

He's seen a psychologist in NW DC and it's close to $300/hour. "Thousands" isn't that many hours of therapy. She has diagnosed him with "anxiety" but nothing more specific than that.
He's never had full neuro-psych testing which I'm sure would be helpful.

I brought up the baseball thing as one time when his anxiety manifests himself. He's a kid who lives and breathes baseball. He loves it. We don't push him to play. We don't push him
to perform. Heck, I'd MUCH prefer he not play. I could care less if he's an athlete. It's just hard to watch him struggle when he's doing something he loves.
He looks forward to a game all week. Then something goes wrong (he misses a fly ball or whateve

And baseball is just one small component to this (and I probably shouldn't have mentioned it). He's the same before big tests, or walking into unfamiliar situations, or with performing arts stuff.
Basically, this is a kid who is fine 90% of the time when he's in his classroom routine, with his good friends, with our family. But when he's asked to "perform" he's really anxious and this anxiety spirals
into emotional dis-regulation that he can't get himself out of. I know you're probably all thinking that I'm some tiger mom who is pushing him to perform. But I really am not. Which is what makes this
all so frustrating. He's been like this since he was much younger and we are so careful to not foist any expectations upon him.

[Anonymous]

shoot something went wrong with my previous post---few sentences missing.
This is what i meant to post:

He's seen a psychologist in NW DC and it's close to $300/hour. "Thousands" isn't that many hours of therapy. She has diagnosed him with "anxiety" but nothing more specific than that.
He's never had full neuro-psych testing which I'm sure would be helpful.

I brought up the baseball thing as one time when his anxiety manifests himself. He's a kid who lives and breathes baseball. He loves it. We don't push him to play. We don't push him
to perform. Heck, I'd MUCH prefer he not play. I could care less if he's an athlete. We've mentioned to him that we think that perhaps baseball isn't a good fit for him and he's been devastated at the thought.
It's just so hard to watch him struggle when he's doing something he loves. He looks forward to a game all week. Then something goes wrong (he misses a fly ball or anything else that happens all the time to any player) and then it just goes downhill from there and he gets so anxious at his next at bat and he spirals into a mess of emotional dis-regulation.

And baseball is just one small component to this (and I probably shouldn't have mentioned it). He's the same before big tests, or walking into unfamiliar situations, or with performing arts stuff.
Basically, this is a kid who is fine 90% of the time when he's in his classroom routine, with his good friends, with our family. But when he's asked to "perform" he's really anxious and this anxiety spirals
into emotional dis-regulation that he can't get himself out of. I know you're probably all thinking that I'm some tiger mom who is pushing him to perform. But I really am not. Which is what makes this
all so frustrating. He's been like this since he was much younger and we are so careful to not foist any expectations upon him.

[Anonymous]

It's not normal for a kid who "lives and breathes" baseball to have so much anxiety around it - I'd stop the sport immediately. It can't be good for him if he anxiety is real. Why haven't you done this already?

[Anonymous]

How long have you been doing CBT? It is a long slow process.

[Anonymous]

Anonymous wrote:It's not normal for a kid who "lives and breathes" baseball to have so much anxiety around it - I'd stop the sport immediately. It can't be good for him if he anxiety is real. Why haven't you done this already?

Because I suck as a parent?
Because he has some good games interspersed between some hard ones? Because I keep hoping he will mature out of it and get better? Because he looks forward to these games all week long?
Because it's really sad that my kid can't handle doing the one thing he really loves.
Also, because it's not behavior that's limited to baseball. He approaches some tests, new situations, anything anxiety-producing the same way.

[Anonymous]

How many months has he worked with the therapists? Are you and DH also participating in family therapy with him?

Typically a therapist would have a child limit exposure to triggering things for a time and reintroduce them. Have you gotten any school accommodations for the anxiety?

He may have GAD. He could also have ADHD. Or both. Oreven ASD. We don't know.

I'd do a full neuropsych but in the meantime ask the therapist if stepping back from baseball and asking for alternative assessments is a good idea.

[Anonymous]

NP. I recommend a full neuropsych at a place like Stixrud. There may be something else there.

And while you wait for the appointment, I recommend you limit stressful situations. Ask him about stopping that sport. Don't take him to school on test days, see what happens.