Sep 16, 2020
Jeffrey R. Strawn, MD, talks with host Lorenzo Norris, MD, about
assisting children and adolescents with anxiety and anxiety
disorders, particularly during the COVID-19 pandemic.
previous Psychcast guest, discusses ways for mental health
clinicians to think about proportionate anxiety versus anxiety that
is severe, continual, and persistent. He is director of the anxiety
disorders research program at Cincinnati Children’s Hospital
Medical Center and an associate professor of psychiatry at the
University of Cincinnati.
Dr. Strawn has received research support from several
pharmaceutical companies and from the National Institute of Mental
Health. He also has received royalties from Springer.
Norris is assistant dean of student affairs, and assistant
professor of psychiatry and behavioral sciences at George
Washington University, Washington. He has no conflicts of
- Anxiety is a normal emotional reaction critical to survival.
Yet, when the emotions become extreme, anxiety can negatively
affect day-to-day functioning.
- With any event that may cause stress, the anxiety should be
expected and proportional to the event.
- Clinicians and parents can support children and adolescents by
pointing out different emotional reactions and discussing them to
promote self-awareness, as well as maintaining routines while also
acknowledging the loss of normalcy.
- Clinicians should keep in mind several dimensions of the
child-parent relationship and how they interact with the
ever-changing home and schooling environment. The dimensions to be
considered include: Flexibility versus control, which is a spectrum
that ranges from rigid to chaotic, and cohesion and support, which
ranges from disengaged to enmeshed.
- If the triggering event is severe, persistent, and uncertain,
such as the COVID-19 pandemic, the anxiety may last and become an
anxiety disorder, which results in functional impairment.
- Anxiety (not yet a disorder) may provoke changes in emotions
and behaviors, such as irritability, frustration, poor sleep, and
so on, that are proportional and expected to the major changes
produced by the pandemic. So, parents and clinicians need to
monitor for impact on functioning.
- Clinicians and parents can support children by pointing out
different emotional reactions and discussing them to promote
self-awareness. Adults should acknowledge that children are going
through loss and trauma and be open to discussing how life is
different now but not lose sight of the future. Parents will have
to balance trying to keep normalcy in place where possible and
discussing when life feels far from the norm.
- In his clinical practice, Dr. Strawn has noticed more reports
of irritability and frustration. These emotions need to be
evaluated but not necessarily pathologized. Those emotions likely
arise from the drastic changes in home environment. Also parents
now have more opportunity to observe their children in the learning
- The pandemic has come with certain benefits, such as more time
at home together allowing families time to slow down and engage in
different, more fulfilling activities. Yet, the pandemic has
created chronic and variable stressors that can negatively affect
physical and mental health. This combination of the dark and light
has the potential to foster resilience as we reflect on our
vulnerabilities and strengths. But we must also think about how to
inoculate ourselves against loneliness, and the risks of how social
distancing and societal discord may fray our social fabric.
Current Psychiatry. 2020 May;19(5):9-10.
Brooks D. The pandemic of fear and agony. New
York Times. 2020 Apr 9.
Delgado SV, Strawn JR.
Difficult Psychiatric Consultations: An Integrated Approach.
New York: Springer, 2013.
Strawn JR et al. Depress
Strawn JR et al.
Child Adolesc Psychiatr Clin N Am. 2012;21(3):527-39.
Show notes by Jacqueline Posada, MD, who is associate producer
of the Psychcast and consultation-liaison psychiatry fellow with
the Inova Fairfax Hospital/George Washington University program in
Falls Church, Va. Dr. Posada has no conflicts of interest.
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