Therapy Helps Children Meet Fear : Anxiety: Psychologists now recognize that shyness and normal childhood apprehension may develop into serious mental disorders that can last a lifetime.

Ben Lazarus spent most of his adolescence hiding. He never dated, seldom spoke in class, and ate alone in the library, shunning the social clamor of the cafeteria.

“I kept a low profile,” Lazarus said. “I didn’t really see myself as having a problem.”

It wasn’t until his mother took him to Albany’s Phobia and Anxiety Disorders Clinic in 1990 that Lazarus was diagnosed with social phobia. A pioneering 15-week group therapy helped him shed his cocoon and go on to college with hopes of a career in police work.

“It turned my life around,” said Lazarus, now 20 and a sophomore at the State University of New York at Geneseo. “I never would have gone to college if it weren’t for group. No way. I couldn’t bear to leave home.”

A decade ago, Lazarus may have been considered simply shy, bookish, or a loner. Psychologists now recognize that in some children, shyness and normal childhood fears may develop into full-blown mental disorders which, if not treated, may last into adulthood.

“Anxiety disorders are the No. 1 mental health problem in this country,” afflicting more than 23 million people, said David Barlow, founder and director of the State University at Albany clinic that treated Lazarus.

“We’re not talking about normal fears or shyness,” he said. “We’re talking about incapacitating, debilitating anxiety problems that keep people from pursuing daily life, making relationships, working, functioning in society.”

With about $1 million a year in grants from the National Institute of Mental Health and pharmaceutical companies, Barlow has been researching and treating adult anxiety disorders at the clinic since 1982.

Childhood anxiety disorders weren’t officially recognized by psychiatrists until 1987, said Anne Marie Albano, who developed group and individual therapies at the Albany clinic for children age 7 to 17.

“Based on recent studies, it is estimated that between 5% and 10% of children have anxiety disorders,” said Jerilyn Ross, president of the Anxiety Disorders Assn. of America and director of the Ross Center, a clinic in Washington, D.C.

She said anxiety disorders in children are about half as common as disruptive disorders such as attention deficit and hyperactivity. About 25% to 40% of children with disruptive disorders also have anxiety disorders, she said.

Barlow said the five types of anxiety disorders--phobias, panic disorder, obsessive-compulsive disorder, post-traumatic stress disorder and generalized anxiety disorder--once were lumped under the heading of neuroses and treated with years of talk on the psychoanalyst’s couch.

Now, he said, the disorders are recognized as distinctive, and controllable through cognitive-behavioral therapy, which seeks to identify and change harmful thought patterns and the behavior and physical symptoms they cause. The therapy is brief, averaging 12 sessions, he said.

Medications, such as the antidepressants Toffrinal and Prozac, are also effective in treating anxiety disorders, Barlow said.

But he said only one in four people with serious anxiety disorders is diagnosed and treated. “These things can masquerade as physical complaints: malaise, stomach upset, chest tightness, headaches.”

Children with social anxiety are often overlooked until the problem is severe because the nature of their ailment is to avoid attention, Albano said. When an anxiety disorder prompts frequent trips to the nurse’s office or a refusal to go to school, a child may be seen as a malingerer, she said.

Such was the case with Steven Marks, 13, of Bethesda, Md. “My parents had to drive me to school and carry me in,” the teen-ager said. “I’d yell, scream, kick.”

Steven started having panic attacks two years ago, after he swooned during soccer practice. The faintness was attributed to overexertion in the heat, but the boy subsequently developed a terror of school and other public places that would bring on nausea and heart-pounding panic.

Steven said medication and cognitive-behavioral therapy at Ross’s clinic helped him conquer his fears. His therapist taught him to recognize his panic symptoms and subdue them with diversions, like deep breathing, counting squares on the sidewalk or adding numbers on a hand-held counter.

She accompanied him to school for a while and persuaded the teacher to excuse him to a computer room when he felt panicky, so he wouldn’t feel trapped.

“Now, I like school a lot,” he said. “I’m totally back into sports, soccer, baseball, basketball, tennis, lacrosse, everything.”

Anxiety disorders are most common in children between 10 and 13, Albano said. “That’s a transitional age, when a lot is going on: puberty, academic pressures . . . there’s a lot of overanxiousness and social phobia.”

That’s when Ben Lazarus’ troubles started. “Ben started withdrawing in sixth grade,” said his mother, Marty Lazarus of suburban Delmar. “He dropped out of Little League, then Cub Scouts. He couldn’t go into a store alone.”

A school psychologist and psychiatrist were of little help. But when he was a junior in high school, Lazarus joined a group of four other teen-age social phobics in Albano’s program.

“Not one of those kids in group ever ate in the cafeteria,” he said. “One girl was so nervous, she kept her hair over her face to hide.”

The teens role-played the situations they found most stressful, such as asking someone out or giving a report in class. They even held a mock prom, which helped Lazarus psyche himself up for the real thing.

“You find out in group that you will probably never get rid of the anxiety,” Lazarus said.

“But you learn to deal with it instead of avoiding it. That’s the key. My heart still pounds, my hands still get sweaty. But I learned to take a deep breath, think about the situation logically, and just do it.”