Pediatric Anxiety and Tic Disorders Program
Welcome to the Pediatric Anxiety and Tic Disorders Program. Our program offers individualized clinical treatment services for children and their families, conducts innovative research aimed at better diagnosing and treating anxiety, and provides training for future mental healthcare professionals. Our interdisciplinary clinical team is staffed with child psychiatrists, child psychologists, social workers and researchers, all of whom specialize in the recognition, assessment and treatment of pediatric anxiety and related disorders, such as tics.
What will happen at my visit?
By combining state of the art psychometric measures with important details from child and parent clinical interviews, our clinicians are able to provide expert assessments of children and adolescents, and can also measure change in symptoms over time. The clinical services that we provide include:
- Consultation and evaluations for diagnosis and treatment recommendations
- Medication management
- Cognitive behavioral therapies
How to make an appointment
To schedule an initial appointment:
Depression Center & Ambulatory Psychiatry
Depending on the volume of patients coming into our clinic, there may be times when you are told that you must wait some weeks for your appointment. Thus, in addition to clinical services, our program also offers free treatment as part of some of our research studies (see below).
How do I know if my child has an anxiety disorder?
Anxiety is a very common phenomenon among school-aged children, with about 70% of grade school children reporting at least some worry "every now and then." Common worries relate to school performance, illness of self or others, getting teased, making mistakes, or concern about physical appearance. In moderation, worry can be helpful to a child; for instance, motivating to prepare for a test or an athletic event. However, if worry is intense, distressing and/or difficult for a child to control, it may impair a child's daily functioning -- at school, at home and with friends.
How we treat anxiety
The good news is that anxiety is treatable. Thanks to the participation of children, adolescents, and their families in recent clinical research studies, we now have better treatments available for pediatric anxiety than ever before. Knowing the symptoms of anxiety and making an appointment with a healthcare provider are important first steps towards treatment which typically involves cognitive behavior therapy with or without medication. Early treatment can improve an anxious child’s day-to-day functioning and prevent progression to more chronic anxiety and related conditions, such as depression.
How to get involved in anxiety research
Effective treatments are currently available for pediatric anxiety, but some youth fail to respond, respond only partially or do not have access to the existing evidence-based therapies. At the Pediatric Anxiety and Tic Disorders Program, we are actively pursuing research to improve diagnostic and treatment strategies for patients. Participants are paid for their time and some research studies may also provide free treatment.
Current Research Studies on Pediatric Anxiety at the University of Michigan
Cognitive Behavior Therapy in Obsessive Compulsive Disorder
In this study, we are using brain imaging to understand how effective cognitive behavior therapy works to improve symptoms in pediatric patients with OCD. Youth with OCD are provided with cognitive behavioral group therapy, delivered by an expert clinician at the University of Michigan over about 12 weeks. Volunteers also receive a magnetic resonance imaging (MRI) scan before and after this treatment. MRI is safe for children and does not involve any needles or radiation. For more information about this study, you may contact us by phone (734) 232-0443 or email firstname.lastname@example.org
The developing brain in pediatric OCD and other anxiety disorders
Brain imaging data suggests that a certain brain region, the ventral medial prefrontal cortex (vmPFC), responds too much to performance errors in adults and children with anxiety disorders, particularly OCD. From the earliest stages of illness, OCD symptoms are associated with a nagging sense that a mistake has been made, leading researchers to believe that altered development of brain response to errors may be linked to the emergence of OCD, and possibly other forms of anxiety.
Brain study of youth at risk for OCD
EEG technology has been used to demonstrate an exaggerated electrical signal in response to performance errors in patients with pediatric OCD, but whether this abnormality may be inherited remains unknown.
Who we are: Pediatric Anxiety Faculty and Staff
Kate Dimond Fitzgerald, M.D.
Dr. Fitzgerald’s clinical work is focused on the diagnosis and treatment of childhood anxiety, and is complemented by her brain imaging research in pediatric obsessive compulsive disorder (OCD). Currently, she is studying how response to errors -a psychological process that may underlie OCD – could interact with developmental stage to lead to obsessions and compulsions in youth. In conjunction with ongoing genetic research at the Child Anxiety Clinic, this work aims to elucidate risk factors for pediatric OCD in order to guide the development of better treatment and preventative strategies for early onset illness.
Gregory Hanna, M.D.
Gregory Hanna, M.D. completed his child and adolescent psychiatry fellowship at UCLA, his general psychiatry residency and internship at the University of Michigan, and medical school at the University of Oklahoma. He is an associate professor of psychiatry. His clinical interests include the anxiety and tic disorders. His research interests include psychiatric genetics and the neurobiology and treatment of obsessive-compulsive disorder.
Jenna Nienhuis, LMSW
Jenna Nienhuis, LMSW is a Clinical Social Worker in the Department of Psychiatry at the University of Michigan. She received her Bachelor of Science at Clemson University, her master’s degree in theology from Western Theological Seminary, and completed a master’s degree in Social Work at the University of Michigan. Her clinical interests include child and adolescent depression, anxiety and obsessive compulsive disorder. Jenna specializes in cognitive behavioral therapies. Her research interests include obsessive compulsive disorder.
Aileen Prout, MSW, LMSW
Aileen Prout received her BA from Boston College and her Masters Degree in Social Work from the University of Michigan. Her clinical interests include the diagnosis and treatment of children with anxiety disorders including obsessive-compulsive disorder, generalized anxiety disorder, social phobia, separation anxiety disorder and specific phobias. Other clinical interests include child and adolescent depression, trichotillomania and tic disorders. Aileen specializes in cognitive-behavioral therapy for pediatric anxiety.
Learn more about pediatric anxiety
Anxiety disorders are the most common psychiatric problem in children and adolescents, affecting up to one third of youth, and leading to impairment across academic, social, and family domains. Pediatric anxiety disorders are classified into several different categories, as described below. If you are interested in learning more about a particular anxiety disorder, you may find the following resources helpful.
Obsessive Compulsive Disorder: characterized by recurrent, intrusive thoughts (obsessions) and repetitive, ritualistic behaviors (compulsions). Patients often intend for compulsive behaviors to control anxiety-provoking thoughts, but end up being controlled by their OCD.
- International OCD Foundation website
Separation Anxiety Disorder: associated with severe distress upon separation from a place or person with whom a patient is emotionally attached. Children may refuse to go to school or camp, and often have fears regarding the health and safety of their parents during even brief separations.
Generalized Anxiety Disorder: characterized by chronic, exaggerated “every day” worries that are more intense than the situation warrants.
Social Phobia: characterized by a fear of being judged by others and/or being embarrassed in front of them, sometimes getting in the way of going to school or other activities (eating, talking, writing) in public.
Specific Phobia: excessive fear of a specific object or situation (animals, heights, bridges) that often leads to avoidance of places where the feared object/situation could be encountered.
Post-Traumatic Stress Disorder: PTSD is an anxiety disorder related to exposure to a severe psychological trauma. Symptoms include re‐experiencing the event, avoidance and arousal as well as distress and impairment resulting from these symptoms.
- Anxiety & Depression Association of America - Posttraumatic Stress Disorder (PTSD)
Panic Disorder: associated with recurring panic attacks in which patients experience a sudden feeling of terror for no reason, often in combination with physical symptoms such as shortness of breath, fast heart beat, and dizziness.
Tic Disorders: Tics are sudden involuntary movements or sounds that affect up to 10 percent of children during school-age years, and occur commonly in association with anxiety disorders, especially OCD.
There are also many great books out there! Below, we have broken down our suggestions by whether or not the book is directed towards anxious children, adolescents or their parents.
- “Talking Back to OCD” by John S. March, M.D.
- “What to do when your Child has Obsessive-Compulsive Disorder: Strategies and Solutions” by Aureen Pinto Wagner, Ph.D.
- “Freeing Your Child from Obsessive-Compulsive Disorder” by Tamar Chansky, Ph.D.
- “Triumph Over Shyness” by Murray Stein, M.D. (Social Phobia)
- "I Bet I Won't Fret: A Workbook to Help Children with Generalized Anxiety Disorder" by Timothy A Sisemore, Ph.D. (Generalized Anxiety Disorder)
- “Worried No More: Help and Hope for Anxious Children” by Aureen Pinto Wagner, Ph.D. (non-OCD anxiety disorders)
- “Freeing Your Child from Anxiety: Powerful, Practical Solutions to Overcome Your Child's Fears, Worries, and Phobias” by Tamar Ellsas Chansky, Ph.D. (non-OCD anxiety disorders)
- “Up and Down the Worry Hill: A Children's Book about Obsessive-Compulsive Disorder and Its Treatment” by Aureen Pinto Wagner, Ph.D.
- “Mr. Worry: A Story About OCD” by Holly L. Niner
- “What to Do When Your Brain Gets Stuck: A Kid's Guide to Overcoming OCD” by Dawn Huebner, Ph.D.
- "When My Worries Get Too Big!: A Relaxation Book for Children Who Live with Anxiety" by Kari D. Buron (non-OCD anxiety disorders)
- "David and the Worry Beast: Helping Children Cope with Anxiety" by Ann Marie Guanci and Caroline Attiab (non-OCD anxiety disorders)
- "What to Do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety" by Dawn Huebner, Ph.D. and Bonnie Matthews (non-OCD anxiety disorders)
- "A Boy and a Bear: The Children’s Relaxation Book" by Lori Lite and M. Hartigan
- "The Thought That Counts" by Jared Kant (OCD)
- "Touch and Go Joe" by Joe Wells (OCD)
- "Life In Rewind" by Terry Murphy (OCD)
- "Triumph Over Shyness" by Murray Stein, M.D. (Social Phobia)