By Dr. Michael Oberschneider, Ashburn Psychological & Psychiatric Services

Dear Dr. Mike,

My eight-year-old daughter is showing signs of anxiety. She has difficulty being confident in her fundamental decisions and almost breaks down with indecision. When do I chalk this up to her personality or seek help? Can someone as young as her exhibit anxiety that warrants therapy or medication?

Dear Concerned Parent,

Childhood anxiety is not uncommon, with estimates of significant concern occurring for 10% to 15% of school-aged children. Eight-year-olds are typically fearful or anxious about things that they have been exposed to — something they have heard from friends, something they learned about at school or in the media (e.g., a plane crash or shootings), going to the doctor’s office, something they experienced in their family, etc.

Specific phobias are also not uncommon for individuals your child’s age — storms, dogs, spiders, germs, planes, and eating only select foods are a few of the more common ones. Social anxiety and school avoidance are also two areas where anxiety can show itself in elementary school children.

Anxiety may or may not be the main problem for your daughter. While stress can lead to low confidence and breaking down when overwhelmed, as you describe, so too can other things, for example, low self-esteem, depression, ADHD, family struggles, academic or school struggles, etc.

The first thing you need to do is acknowledge with your daughter (if you have not done so already) what you see and your concerns. Invite your daughter to speak with you about what upsets her and develop a game plan for what you will do to support her (and what she can begin to do to help herself) when she becomes upset next.

I would have this one-on-one conversation casually, warmly, and in an attractive setting — maybe over a bowl of ice cream or frozen yogurt at her favorite spot. Suppose the two of you can identify the triggers or antecedents and develop productive coping strategies for the negative feelings and behaviors that follow. In that case, she should be on the way to some nice improvements.

If, however, your daughter’s struggles continue, I recommend you seek the help of a child psychologist. Cognitive-behavior therapy (CBT) is considered the best therapy for anxiety; plenty of very well-done studies support that. In my opinion, medications can and should be regarded as if parental efforts and CBT have not brought about the needed changes, and only if your daughter’s symptoms are in the moderate to severe range. Most parents do not want to turn to medications unless all other approaches have been exhausted first, which is my position. A child psychiatrist is the best professional to see if drugs appear warranted. Your pediatrician and your friends might be able to recommend an excellent doctor and therapist.