Comorbidity Between Balance and Childhood Anxiety

Previous studies report frequent comorbidity of anxiety and sensory-motor imbalance in adults (Sklare et al., 2001). Only a few studies tested the comorbidity in children. We confirmed that: a) children with primary diagnosis of poor balance demonstrate an elevated anxiety level (Brat et al., 2006, submitted) and, b) children with primary diagnosis of generalized anxiety disorder demonstrate poor balance performance (Erez et al., 2004). These studies demonstrate the presence of balance-anxiety comorbidity in children with primary disorder of either balance or anxiety. Our theoretical reasoning formalized under the "three stage theory of learning" points to the possibility that poor balance may either predispose or cause the emergence of anxiety disorder (Erez et al., 2004). Thus, in the present study we test two predictions: (a) high prevalence of comorbidity of anxiety and balance disorders in children with a primary diagnosis of generalized or separation anxiety disorder, and, (b) intensive balance training, but not training of flexibility and power, will reduce the level of anxiety in children with primary diagnosis of anxiety.

Study sample: 64 children, 8 to 14 years old, with diagnosis of generalized or separation anxiety.

Training: 32 of these children will undergo balance training and the other 32 children will undergo motor training of power and flexibility. Training will last 7 weeks, twice per week, 1 hr each session.

Tests: Balance and anxiety tests will be applied before training period, immediately after the last training session and again 2 months after the last training session.

Tests will include standard balance performance tests and questionnaires of anxiety.

• Behavioral: Balance training
  Physical exercise of balance. The training will last 7 weeks, twice per week, 1 hour per session.
• Behavioral: Motor training
  Motor exercise of power and flexibility. The training will last 7 weeks, twice per week, 1 hour per session.

• Active Comparator: A
  Balance training group
  Intervention: Behavioral: Balance training
• Active Comparator: B
  Motor Training
  Intervention: Behavioral: Motor training

• Erez O, Gordon CR, Sever J, Sadeh A, Mintz M. Balance dysfunction in childhood anxiety: findings and theoretical approach. J Anxiety Disord. 2004;18(3):341-56.
• Sklare DA, Konrad HR, Maser JD, Jacob RG. Special issue on the interface of balance disorders and anxiety: an introduction and overview. J Anxiety Disord. 2001 Jan-Apr;15(1-2):1-7. Review. No abstract available.

Inclusion Criteria:

• Ages 8-14
• Boy or girl
• Generalized or separation anxiety disorder
• Agreement to participate and written informed consent

Exclusion Criteria:

• Major affective disorders
• Severe developmental disorders
• Refusal to participate

• Tel Aviv University
• Institute of Physical Education and Sports Sciences
• University of Haifa