Anxiety? What anxiety?

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High Anxiety

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A couple of months ago, at the request of the school board, we had M assessed by a psychiatrist. 

Initially, we were told that she was accepting patients into her private practice and depending on her assessment, he might be able to see her for follow-up care. But within the first few minutes of meeting with the psychiatrist, she made it clean that her only role was to provide the assessment, as requested by the board.  If M needed any follow-up, we would need to seek out these services in the community.  Since we have been trying to find a child psychiatrist for a couple of years, this wasn’t terribly helpful.

But we kept an open mind about the process and did our best to answer the psychiatrist’s questions.  As part of the assessment, she also spoke to M and to the principal at his school.

It took a while for the report to arrive.  When it finally did come, it contained a number of recommendations, the most puzzling of which related to his anxiety.  The recommendation began “the parents see the child as anxious” and went on to conclude that once found a medication that better managed his ADHD, any anxiety could be expected to diminish.

The recommendation was supported in the body of the report by the following observations: “the principal did not see M as anxious”  and “M didn’t see himself as anxious”.  Even though we raised it during the interview, the report did not mention that both the psychiatrists in the treatment program M was in a couple of years ago had diagnosed him with anxiety.  Nor was there any reference to the fact that the psychologist M has been seeing since September definitely sees him as anxious. 

The principal’s statement made no sense to us.  She sees M every day and we’ve had numerous discussions about how to help him manage his anxiety.   

But even more confounding was the fact that the psychiatrist appeared to give more weight to M’s perceptions than ours.  He doesn’t think he suffers from anxiety?  He’s 10.  When he gets angry, he punches other kids.  And sometimes he thinks he’s a cat.  I’m all for taking the child’s perception into account, but wouldn’t we, as his parents, have a pretty good idea of whether or not our child is anxious?   

It turns out the that the principal was misquoted – she did tell the psychiatrist that M was anxious but that she wasn’t always certain how much his anxiety played into some of his interactions with his peers. This is a fair observation, because when he lashes out at other kids, it isn’t always obvious to us that he’s anxious, as opposed to pissed off. 

I prepared a long letter back to the psychiatrist and highlighted a number of factual errors and other areas that were problematic for us. To her credit, she responded promptly and made the requested revisions, including a reference to the previous diagnoses of anxiety.

Although the process was a bit frustrating, it was highly instructive.  Perhaps the most important thing we learned is that we know our son better than anyone else.  While the principal may not always see a casual relationship between M’s behaviour and his anxiety, his dad and I know that anxiety is at the root of most of M’s issues, particularly at school and daycare.  But connecting the dots isn’t always easy –  it’s rarely a straight line from point A to point B.  More like start at point P and veer off to point T and then swing back to point F.

The connection between M’s anxiety and how he interacts with the rest of the world was brought back to me earlier in the week when we had to go in and speak to the daycare about his behaviour.  It was clear to me  that M was increasingly anxious about his recent difficulties with a group of boys at daycare (admittedly, totally of his own making).  As a result, the daycare was seeing an escalation in M’s behaviour – he was starting to react  negatively to things the other were saying and jumping to conclusions that weren’t based on any observable evidence, to the point where he was striking out and being verbally and physically aggressive.  After M punched another child earlier this week, for no apparent reason (that they could observe), the daycare staff decided he couldn’t participate in active games for the next couple of weeks.  At first, M was upset, but he didn’t have any additional conflicts this week at the daycare.  By sitting out the active games, he hasn’t had much contact with the group of boys he’s having difficulties with, significantly reducing his anxiety.  It isn’t just his relations with the other kids, it’s the fact that the games are mostly unstructured and a free-for-all.  Not an ideal situation for M, who finds this sort of mass chaos really stressful.  He won’t tell us this, but the fact that he hasn’t yelled rude words or punched anyone since Monday is pretty strong evidence that this is the case.  Plus, the school was starting to see some escalation in his behaviour late last week and early in the week, but things were back to normal (M’s normal) by mid-week.  I did get a call from the school today, but as the principal hastened to tell me, M was not feeling well.  The fact that he was coming down with a cold may also have played a part in some of his struggles this week – we know from experience that M often starts to act out a few days before he actually falls ill.

So the next time someone tries to tell me that M isn’t anxious, I will be as polite as I can and suggest to them what I already know – just because they can figure out what’s causing the anxiety, doesn’t mean it isn’t there.  We just have to look harder and dig a little deeper.

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