Children inherit certain temperaments (see Understanding Biological Psychiatry, Hedaya, 1996, pp 47-61). Those who are born with a ‘harm avoidant’ temperament (intense reaction to an aversive stimulus, inhibition of behavior in response to newness and change) are more prone to have anxiety, shyness, separation anxiety, school phobia, and even panic attacks. However, a number of environmental factors can play a very big role in causing a child develops an anxiety disorder. These factors include:
- The level of emotionality in the home (how angry, sad, upset are the parents likely to get in response to stress)
- The balance between structure and freedom. While each child’s needs are different, there needs to be a reasonable degree of structure and predictability, balanced with room for self-exploration and freedom.
- Food and nutrition: Children who eat a good breakfast (some form of protein, and a complex carbohydrate), a diversity of foods that are minimally processed (meaning they grow in nature almost the same way they are served-an egg is minimally processed when hard boiled, but a Twinkey is completely processed-there are no Twinkey trees), avoid sweets (candy, cookies, muffins, syrups, juices, cakes, etc) will have more stable blood sugar, better immune systems, better intestinal function, and do better in school (thus enhancing self esteem). In today’s rushed society the best way to accomplish this is to teach your children to have left over dinner (usually meat/fish/vegetables) for breakfast. It is well balanced, quick (microwave), and hopefully tasty.
- Peer relationship quality (siblings, school mates, friends, cousins)
- Immunity (food and respiratory allergies)
- Uniquely high nutritional requirements (e.g., zinc, B6 etc)
- Toxic exposures to chemicals, molds, mercury, pesticides, other biotoxins, especially if genetically vulnerable and nutritionally deficient
- Learning disabilities (frequently reduced if above are addressed)
Using the Whole psychiatry approach, I have found that when the above are addressed, medication is rarely needed in children. I am reminded of a cute, bright 12 year old boy who was regularly threatening his parents and siblings with a knife, when he would become anxious and angry. He was hospitalized shortly after I first saw him. I prevailed upon the hospital psychiatrist to avoid medication. Upon his release form the hospital, eliminating food allergies, mold in the home, parental therapy, and personal therapy for the boy, has resulted in his growing up to be 22 years old now, stable with health relationships with his family, and never needing medication.