Childhood Anxiety and Learning Disorders

Some of us are born anxious – or, more accurately, born predisposed to be anxious, obsessive compulsive and show signs of hyperactivity, or even borderline personality of antisocial behavior. Babies differ according to inborn temperament and 15 to 20 percent will react strongly to novel people or situations – thus these strongly reactive babies are more likely to grow up to be anxious, obsessive and hyperactive.

While temperament persists, the behavior associated with it doesn’t always. There are three ways to identify an emotion: 1) the physiological brain state, 2) the way an individual describes the feeling and 3) the behavior the feeling leads to. Not every brain state sparks the same subjective experience. One person might describe a hyper-aroused brain in a negative way, as feeling anxious or tense, while another might enjoy the sensation and instead use a positive word like “alert.”  Nor does every brain state spark the same behavior: some might repress the bad feelings and act normally; others might withdraw. While the behavior and the subjective experience associated with an emotion like anxiety might be in a person’s conscious control, physiology usually is not.

This is what Jerome Kagan calls “the long shadow of temperament.”  The oldest high-reactive subjects in Kagan’s studies are in their late twenties now, and for many of them, no matter how much they manage to avoid looking anxious, to an outsider, fears still grip them. They remain anxious just below the surface, their subconscious brains still twitchy, still hyper-vigilant, still unable to shift attention away from perceived threats that aren’t really there.

ANXIETY IS NOT FEAR, not exactly, because fear is focused on something right in front of you, a real and present danger. It is instead, a kind of fear gone wild, a generalized sense of dread about something out there that seems menacing – but that in truth is not menacing, and may not even be out there.  If you’re anxious, you find it difficult to talk yourself out of this foreboding; you become trapped in an endless loop of what-ifs.

When the “clamor of terror” starts to interfere with functioning, worrying turns into a clinical anxiety disorder, of which there are several forms:

panic, social anxiety, phobias, obsessive-compulsive, post-traumatic stress (PTSD), and a catchall called generalized anxiety disorder.

In the brain, these thoughts can often be traced to over-reactivity in the amygdala, a small site in the middle of the brain that, among its many other functions, responds to novelty and threat. When the amygdala works as it should, it orchestrates a physiological response to changes in the environment.  That response includes heightened memory for emotional experiences and the familiar chest pounding of fight or flight. But in people born with a particular brain circuitry, the kind seen in Kagan’s high-reactive study subjects, the amygdala is hyper-reactive, prickly as a haywire motion-detector light that turns on when nothing’s moving but the rain. Other physiological changes exist in children with this temperament, many of them also related to hyper-reactivity in the amygdala. They have a tendency to more activity in the right hemisphere, the half of the brain associated with negative mood and anxiety; greater increases in heart rate and pupil dilation in response to stress; and on occasion higher levels of the stress hormones cortisol and norepinephrine.

But having all the earmarks of anxiety in the brain does not always translate into a subjective experience of anxiety. The brain state does not make it a disorder. The brain state exists, and the statement, “I’m anxious” exists, and the correlation is imperfect. Two people can experience the same level of anxiety, Kagan said, but one who has interesting work to distract him or her from the jittery feelings might do fine; while another who has just lost his job spends all day at home fretting and might be quicker to reach a point where the anxiety becomes overwhelming. It’s all in the context, the interpretation, and the ability to divert your attention from the knot in your gut.

Hypothesis: Anxious children are “born with a lower threshold” for arousal of various brain regions, in particular the amygdala, the hypothalamus and the hypothalamic-pituitary-adrenal axis, the circuit responsible for the stress hormone cortisol.

At age 4, children who had been high-reactive were four times as likely to be behaviorally inhibited as those who had been low-reactive. By age 7, almost half of the jittery babies had developed symptoms of anxiety – fear of thunder or dogs or darkness, extreme shyness in the classroom or playground – compared with just 10 percent of the more easygoing ones. About one in five of the high-reactive babies were consistently inhibited and fearful at every visit up to the age of 7.

Fear is an incredibly complex concept. Fear of social things is different from fear of physical things. The same brain circuitry is probably involved in both, but different fears tend to show up at different points in development: fear of things like clowns, balloons or spiders emerging early in life; fear of things like social situations with peers emerging later. In addition, it’s relatively easy to avoid physical things that frighten you; if you’re afraid of dogs, you can just take a different route to school to keep from passing that bull terrier down the street. It’s much harder to avoid social fears – you can avoid the dog on the way to school, but you still have to go to school.

Children tended to get a better grip on their fearfulness as they got older. By adolescence, the rate of anxiety declined overall, including in the high-risk group. At age 15, about two-thirds of those who had been high-reactors in infancy behaved pretty much like everyone else.

Protective Factors:  Talent, benevolent home and accepting the fact that they’re just tense people.

In high-risk children, anxiety often takes the form of excessive vigilance and misdirected attention. Temperamental type tends to reveal itself in structural M.R.I.s, which studies brain anatomy rather than activity. The subjects who were high-reactors at 4 months tended to show significant thickening in the prefrontal cortex, compared to those who were low-reactors. The temperament exhibited as infants, still seemed to leave a fingerprint in the brain 18 years later.

It is not known whether a thicker cortex is a cause of high-reactive temperament, or an effect, or something else entirely. One job of the prefrontal cortex is inhibitory, putting a damper on signals that come from the amygdala. Could it be that the cortex thickens more in the anxiety-prone, as it is busy tamping down the overactive amygdala and growing new neural connections? Or does a thicker cortex come first, and contribute to a tendency to be anxious in the first place?  One explanation of this could be that a thicker cortex is protective in the anxiety-prone. Those subjects who developed problems did so in part because their cortex was thinner, and the high-reactives who had avoided social anxiety had the thickest cortexes of all.

THE BEHAVIORAL STRAND of the brain-behavior-experience triad is the one that seems most amenable to intervention. Scientists are investigating how it is that two-thirds of those with a high-reactive temperament manage to avoid trouble.

Many environmental factors no doubt come into play – some of them malleable, some less so. Birth order seems to be relevant. Behaviorally inhibited children were much more likely to have older siblings: two-thirds of them did, compared with just one-third of the uninhibited children. Could having older siblings mean being teased and pushed, which becomes a source of chronic stress, which in turn amplifies a biological predisposition to inhibition? The high-reactive babies who went to day care when they were young were significantly less fearful at age 4 than were the high-reactives who stayed home with their mothers.

Attempts to see what kind of parenting works best with anxiety-prone temperament leave almost as many questions asked as answered. Which is better for a fearful, high-strung child – a parent who coddles the child and says everything will be all right, or a parent who sets firm, strict limits and has no tolerance for skittishness?

The best outcome, however it happens, is to rear a child who learns to wrestle his demons on his own. Some children figure out themselves what works best.

Tools designed to stop the endless recursive loop of rumination:

  1. Teaching anxious people to do what non-anxious people do naturally.
  2. Joke a lot about anxiety.
  3. Get everything done in lots of time.
  4. We drink (misadvised)
  5. We procrastinate (misadvised)
  6. Pretend there is no deadline
  7. Mentors and friends

LOOKING at the neurology of anxiety raises the inevitable question of why a trait that causes so much mental anguish in the first place. As a whole, it is most likely an advantage to have some group members who are hyper-vigilant and who see everything as a threat, always ready to sound an alarm and leap into action. For the individual though, being inhibited can mean having fewer mating opportunities, not to mention the psychic burden, wearing yourself ragged with a brain that’s always on high alert.

In the modern world, the anxious temperament does offer certain benefits: caution, introspection, and the capacity to work alone. Because they are more restrained than their wilder peers, and the high-reactive kids are less likely to experiment with drugs, to get pregnant or to drive recklessly.

People with a high-reactive temperament – as long as it doesn’t show itself as a clinical disorder – are generally less conscientious and almost obsessively well prepared. Worriers are likely to be the most thorough workers and the most attentive friends. Someone who worries about being late will plan to get to places early. Someone anxious about giving a public lecture will work harder to prepare for it. Test-taking anxiety can lead to better studying; fear of traveling can lead to careful mapping of transit routes and the like.

– Author Unknown