By KARA YORIO STAFF WRITER | The Record

Elementary school should be for developing friendships, taking weekly spelling tests and playing kickball at recess. For too many children, however, these hours are consumed with an overriding fear of failure, sickness and a struggle to manage the daily routine.

Anxiety is the most prevalent psychiatric illness among children and teens. As many as 1 in 4 children and adolescents are affected by an anxiety disorder at one or more times in their lives; disorders can strike children as young as 3 but typically get diagnosed when they are between 7 and 9, according to mental health experts.

Diagnosis isn't always easy. Anxious kids can be angry, manipulative and defiant. They can be dismissed as just spoiled or badly behaved.

If left unaddressed in childhood, alcohol or substance abuse can develop when they become teens as a method of avoidance and numbing the pain. The anxiety also carries into adulthood for those who never learn the tools to manage their fears and emotions.

Parents struggle with whether such behavior is part of typical development, what to do if it's not, and how much it is affecting daily life.

If a kid in North Jersey is deathly afraid of rattlesnakes, it probably doesn't affect his life very much, said Matthew Goldfine, a Cresskill clinical psychologist who specializes in treating children with anxiety and mood disorders and disruptive behavior. But if he fights leaving the house because he might see a dog, that should be addressed.

"I see this all the time," said Goldfine, who also has a Manhattan office. "Parents say, 'Oh my gosh, my child is doing X, Y and Z' and I say, 'That's kind of normal behavior.' What's key here and what's key [for] any parent — is there really damage to the child's life as a result of this?"

There are biological, hereditary and environmental reasons for anxiety, but whatever the cause, the effects are undeniable and wide-ranging:

• The headaches and upset stomachs may stem from emotional distress, but the pain and discomfort are real.

• Friendships suffer as other kids decide they don't want to be around the child who is always crying, creating drama or can't just let go and have fun. Anxious kids may get made fun of, fueling their cycle of negative thoughts.

• Anxious kids can't focus on schoolwork, become perfectionists or refuse to go.

• Marriages are tested by the stress and possible disagreement on the severity of the child's issue and what to do about it. Also, relatives might offer unsolicited opinions and be judgmental, creating tension.

• Parental friendships can be tested as well. Even friends who are aware and promise to help will often succumb to the emotional roller coaster and frequent dra-mas. If they are not living it themselves, it is very difficult to understand and be patient with the parents and child.

Increased pressure

One Bergen County mother described her 9-year-old daughter as a nervous child who has had issues with separation anxiety at school drop-off, sleepovers and extracurricular activities and an overwhelming fear of the dentist.

"It's upsetting for her and us, and frustrating at times, because I feel like she pulls herself out of certain experiences because of her anxieties," she wrote in an email.

This family is not alone. For anxious kids, avoidance is paramount. They will do anything to get out of a situation that makes them scared or uncomfortable, from saying they are sick to kicking and screaming no matter their age.

Anecdotally, anxiety and anxiety disorders in children are on the rise.

"I don't know if I can give you a hard number, but there is an increase in the number of students who are experiencing anxiety," said Debra Keeney, president of the New Jersey Association of School Psychologists. "I hear it every day from a teacher or a parent."

Increased pressure on kids may also be taking a toll. "It's not necessarily that there might be more anxiety across the board, but kids who have a low threshold, who have that vulnerability toward it, are probably getting triggered more because they're expected to do more," said clinical psychologist Sarah Trosper Olivo, who works with area families at her Manhattan, Brooklyn and Westchester offices. "They have more on their schedule. They have more homework. There's more testing."

There are no numbers, no studies to support the claim that more children suffer now from anxiety and anxiety disorders than 15 to 20 years ago, but teachers, doctors and parents now recognize signs of anxiety and seek treatment instead of dismissing the issues.

"What's great about this day and age of media and the Internet, if there's an upside to all of it, it's when good information gets out there," said Dr. Anne Marie Albano, director of the Columbia University Clinic for Anxiety and Related Disorders. "Parents — especially parents who only have one child or have their first child — they're able to get some information about what is typical and then they start saying, 'Wait a minute.' So they're coming in earlier than 10, 15 years ago. I think it's wonderful they're coming in earlier."

An anxious child's mind works in all-or-nothing mode — everything is her fault, nothing will ever get better. Past successes are forgotten. Every event is an emotionally catastrophic 10 on a 1-10 scale. There is mind reading ("They must think I'm an idiot"), fortune telling ("I know I won't have fun there") and overgeneralization ("I lose at everything").

On the way to school each morning, there are tears and the search for constant reassurance that everything will be OK. Once there, frequent trips to the nurse with stomach pain, headaches and consuming worries about peer and teacher opinions become routine.

At home, hands are washed raw, meltdowns occur when things don't go exactly as planned, panic hits before a new experience, bedtime brings pleading for a parent to stay in the room and nightmares often interrupt sleep once it finally comes.

For parents, the most difficult decision often is if and when to seek professional help. They repeatedly ask themselves: "Are we overreacting, or is this really an issue?"

"There's a perception from a lot of people — are we seeing things that aren't really there, are we taking a typical child and exaggerating," said Goldfine. "I think certainly there's a tendency for caring parents to [think] anything that's not perfect, there's something that may be wrong."

There are developmentally appropriate fears, and they pass. Younger children are afraid of the dark and strangers, even experience separation anxiety, but those fears don't last very long, and the children grow out of them. If a fear or worry continues beyond a month and is disrupting life or making it more difficult for everyone, especially the child, it is time to at least have her assessed.

"If her fears are interfering with her ability to engage in everyday activities with her peers or causing her more distress, if she's doing things but she could be having a ton more fun if she wasn't stressed, that's usually when we say they need help," said Donna Pincus, director of the Child and Adolescent Fear and Anxiety Treatment Program at Boston University and author of "Growing Up Brave: Expert Strategies for Helping Your Child Overcome Fear, Stress, and Anxiety."

Parents can unintentionally become part of the cycle of anxiety. They may start avoiding events because they don't want the drama or judgment of their family and peers. They offer constant reassurance or allow the child to avoid whatever is making him distraught just to keep the peace and spare him some suffering.

The behavior of anxious kids can defy common sense. It can be frustrating and difficult for family and friends to understand that a child can perform onstage or excel in a sport without any nervousness, but cry hysterically at the thought of going out to dinner with her grandparents and not her parents.

Effective treatment

"Anxiety is so idiosyncratic," said Trosper Olivo. "I've seen children who ski down the most treacherous mountain. They come back and tell me stories about how they went [skiing] down a black diamond, but they worry and worry and worry they aren't going to do well on a test they are fine with. They can go down the block as long as their mom is with them, but if they're separated from their mom, that's a problem.

"Anxiety often attacks you where your heart is. Meaning, if you love your family, anxiety will make you worry about your family. If you care about how you do in school, anxiety will make you worried about tests. It's why anxiety can make a child fearful in some situations and incredibly brave in others."

Specialists in children's anxiety say that there is effective treatment for these disorders: Kids can get better and learn tools to help manage future anxiety. Cognitive Behavioral Therapy (CBT) is the gold standard for treating childhood anxiety. Aspects of CBT, such as mindfulness and relaxation techniques, can be helpful on their own in certain circumstances. Yoga can be used to help anxious kids, and some parents opt for medication.

Getting treatment isn't always easy. Access to child anxiety specialists, availability, cost and insurance all can present obstacles. There is a shortage of mental health workers in general and specialists in this field in particular. Trained anxiety therapists in North Jersey and New York have months-long waiting lists. Costs and the limits of insurance coverage can be daunting.

They are just some of the many challenges of parenting an anxious child, whether seeking professional help or not.

"I've learned when to push her through so that she doesn't approach life with never pushing past her fears," said one North Jersey mom. "But I've also learned, through trial, error and emotional exchanges, when it's just not something she's going to get past. I have to just accept that she'll never be 'that kind of kid.' "

Some families believe it is all just a phase and wait for the kids to grow out of any issues, biding time until the anxiety disappears.

But, said Boston University's Pincus, "it doesn't go away. It really doesn't."