Massachusetts General Hospital | Psychiatry

Conditions and Diseases

Pediatric Anxiety  |  Attention-Deficit/Hyperactivity Disorder  |  Bipolar Disorder

Pediatric Anxiety

Almost everyone experiences fear and anxiety, and these can be helpful or even crucial in some situations, such as situations of danger. Feeling fear and the physical signs and thoughts that go with it can save our lives if it helps us escape danger. Fear and anxiety develop naturally early in life, and can be helpful for children—fear and distress at being apart from a parent can help keep an infant safe and protected; fear of strangers can help children be cautious if they don’t know whether a person is trustworthy; and worry can motivate children to plan ways to handle a situation they are worried about (e.g. studying for a test).

But when fear or anxiety comes up too often, lasts for too long, takes up too much time in a day, and arises in situations where it is not helpful, interfering with learning, playing, and having relationships with friends, then a child is said to have an “Anxiety Disorder.”

There are several different types of anxiety disorders. Children with Separation Anxiety Disorder are unusually afraid of being apart from a parent, and may worry continually about being harmed or about their parent being harmed if they are apart. These children often gets very distressed to have to go to school or activities without their parents present, and may even try to stop going to school.

Children with Social Anxiety Disorder are unusually fearful of situations where they are watched by others (e.g. talking in class, giving oral reports, performing or playing sports), and may have a general fear of meeting or talking to new or unfamiliar children. These children may avoid group activities and have difficulty making friends.

Children with Generalized Anxiety Disorder tend to worry about many different situations, have trouble stopping worrying, and may ask for constant reassurance. They also may have physical signs of anxiety such as muscle tension, aches and pains, and sleep difficulties. These children may have trouble doing schoolwork because of fear that it has to be perfect.

Children with Specific Phobias have intense fears of specific situations or objects (e.g. dogs, storms, closed places) that last for over six months, and cause intense distress, interfering with their ability to learn and play. Children and adolescents can also get other anxiety disorders, including Panic Disorder, a tendency to get sudden intense bursts of panic that may come on out of the blue.

Anxiety Disorders in children and adolescents can be treated with cognitive-behavioral therapy (CBT), medication, or their combination.

Attention-Deficit/Hyperactivity Disorder (ADHD)

Attention-Deficit/Hyperactivity Disorder (ADHD) refers to a set of clinical features that include a deficit in attention to tasks, distractibility, defects in regulation of motoric activity (also known as hyperactivity) and defects in inhibiting impulses (also known as impulsivity).

This set of symptoms usually onsets in early childhood but tends to be manifested more clearly when the child begins school. The symptoms tend to be stronger when circumstances are boring or less interesting to the child, thereby affecting schoolwork both at home and in school. This variability in the clinical picture has been confusing to parents, doctors, and teachers since the affected person, at any age, can concentrate well on tasks and activities that he or she finds interesting, such as videogames or hobbies, but not on other, less interesting activities. The most prominent and visible symptoms of ADHD, those associated with hyperactivity, tend to wane or permute over time, yet the problems with attention deficits and impulsivity tend to persist.

ADHD is a biological disorder most likely caused by genes that affect the way that key circuits in the brain function, leading to the clinical symptoms described above. Unfortunately there is no test to diagnose this disorder. The diagnosis continues to rely on clinical assessment by a trained clinician focusing on eliciting a detailed history of the symptoms described above.

Although treatment with medications of various types can be very helpful to mitigate the symptoms that characterize ADHD, improve function, and enhance the quality of life of affected individuals, these treatments are not curative and need to be taken chronically to maintain their benefits.

In addition to medications, some individuals with ADHD require additional psychological and educational support. Untreated, ADHD can have very negative effects on all aspects of life including educational and occupational attainment, driving accidents, alcohol, drug and cigarette abuse, as well as social and marital difficulties.

Bipolar Disorder Bipolar Disorder is a severe condition marked by dramatic shifts in mood from hopelessness and depression, to rage and irritability, to high energy and euphoria.

At any age, Bipolar Disorder is among the most impairing psychiatric conditions facing the mental health field. Recent research has determined that the majority of adults with bipolar disorder had an onset of their illness in the childhood or adolescent years. Groundbreaking research from our program as well as others has identified hundreds of children and adolescents with bipolar disorder who come for treatment and to participate in research studies.

Children with bipolar disorder have always been in our midst, but in years past professionals, due to pre-conceived ideas that children could not have bipolar disorder, often recognized in them the other conditions that co-occur with bipolar such as Attention-Deficit/Hyperactivity Disorder, Conduct Disorder and Oppositional Defiant Disorder, and missed the mood diagnosis.

Our work has consistently documented that bipolar disorder in children presents with mood episodes characterized by highly irritable, often aggressive behavior, which can be long lasting and frequent, with simultaneous states of sadness and joylessness, characteristic of depression. Because bipolar disorder itself is so disruptive to family, school and play, we strive to treat it with medication and non-medication interventions as soon as it is diagnosed.

In addition, we hope to prevent the negative outcomes associated with bipolar disorder, including substance abuse and addiction, delinquency and incarceration, and suicide.