Anxiety is a normal human emotion, that can be adaptive and can be important to our success and our survival. Anxiety can help us to be aware of our surroundings when we are not safe, and can motivate us to focus and concentrate when preparing to speak publicly, or studying for a test.
Children have anxieties that can be developmentally normal, such as a preschooler who is fearful of the dark, or a 5-6 year old who is afraid of insects.
Sometimes, a person’s anxiety can be more severe. They may spend a great deal of time worrying, they may feel exhausted due to the energy spent worrying, or they may be unable to function to do the things that are necessary to function. Anxiety is a disorder when a person worries excessively to a degree that interferes with his or her life.
- Anxiety Disorders result from a combination of family and biological influences.
- Studies suggest that young children who are temperamentally (at birth) shy or tentative in unfamiliar situations may be more prone to anxiety.
- Some research suggests that anxiety may be caused by a chemical imbalance involving norepinephrine and serotonin.
- Other research implicates specific brain mechanisms, involving hormones and respiratory functions, as potential pathways to anxiety.
- Anxiety Disorders tend to run in families, but the complex relationship between genes, biological systems, and anxiety is not yet well understood.
- Evidence suggests that anxiety and phobic reactions can be learned, either through direct experience or observations of others.
- Anxiety disorders are among the most common mental, emotional, and behavioral problems during childhood and adolescence.
- 13 % of children and adolescents between 9 and 17years of age experience some type of anxiety disorder.
- 50% of children and adolescents with one anxiety disorder have a second anxiety disorder or other mental or behavioral disorder, such as depression.
- Children with physical health conditions may develop anxiety disorders that require treatment.
- Anxiety disorders can strike at any age
- Some anxiety disorders are more common in younger children and others tend to develop in adolescence
- Researchers suggest watching for signs of anxiety disorders when children are between the ages of 6 and 8, when children generally grow less afraid of the dark and imaginary creatures and become more anxious about school performance and social relationships.
- An excessive amount of anxiety in children this age may be a warning sign for the development of anxiety disorders later in life.
- Panic Disorder more often begins in adolescence, but can occur in children
Girls are affected with anxiety more often than boys.
- Children or adolescents are more likely to have an anxiety disorder if they have a parent with anxiety disorders.
- It is uncertain whether the disorders are caused by biology, environment, or both.
- More data are needed to clarify whether anxiety disorders can be inherited.
To determine whether a child or adolescent has an Anxiety Disorder, professionals will need to know:
- How long have the symptoms been present?
- What efforts have been made to alleviate the anxiety
- What is the child’s chronological and developmental age?
- To what extent does the child’s anxiety interfere with their ability to function?
- Are there situations that are contributing to the behaviors and anxieties?
For the criteria for diagnosis for specific forms of anxiety, see the Diagnosis section of each disorder
Separation Anxiety Disorder: A child has intense fears about being away from home, or is fearful that something bad may happen to their caregivers, such that they have difficulty functioning away from home, such as at school or in social situations. A child with separation anxiety disorder may cling to their parents, refuse to go to school, or refuse to sleep alone.
Generalized Anxiety Disorder: Children with GAD have recurring worries and fears that they find very difficult to control. They may worry about just about everything–school performance, natural disasters, being on time. Childrenen may appear restless, tense, tired, irritable, and they may have trouble with concentrating and may have trouble sleeping. Children with GAD typically want to please others, and can become very upset when their performance isn’t perfect.
Social Phobia: Children with social phobia are typically shy, and fearful of social or performance situations. They may avoid public speaking or eating in public. Social phobia can be associated with physical symptoms, such as blushing, sweating, feeling one’s heart beating, feeling short of breath, and having muscle tension. Children with social phobia are typically sensitive to criticism, have trouble asserting themselves, and have low self-esteem.
Obsessive Compulsive Disorder: Children have frequent and uncontrollable thoughts that we call obsessions, and will perform routines and rituals that we call compulsions that they engage in to eliminate the thoughts. These kids will engage in behaviors to avoid imagined consequences. Most people are familiar with the idea that people may wash their hands excessively to avoid germs, b but symptoms can also include repeatedly checking on tasks, counting rituals, repeating words silently over and over. These behaviors become a disorder when the obsessions and compulsions take up so much of a child’s time that it interferes with their ability to function in daily activities.
Acute Stress Disorder: Consists of the immediate reactions of fear and helplessness, and horror that occur after exposure to a traumatic event. This is usually time-limited, lasting a month or less. If symptoms persist beyond this interval, we call it Post traumatic stress Disorder.
Post Traumatic Stress Disorder: When a child experiences a physical or emotional trauma, such as witnessing a shooting or disaster, being in a car accident, or surviving physical or sexual abuse. Children may re-experience the trauma through nightmares or constant, intrusive thoughts about what happened, and they may re-enact the trauma during play or in other social interactions. Children wtih PTSD may have symptoms of generalized anxiety,., may be irritable, and may also have difficulty eating or sleeping.
Panic Disorder: is characterized by recurrent, discreet periods of time in which a person experiences symptoms of panic, which can include shortness of breath, lightheadedness, rapid heart rate, fear of losing one’s mind. People typically experience these symptoms in certain situations, and many people will then develop agoraphobia.
Agoraphobia: includes the fear and avoidance of any situation where escape would be difficult or help would be unavailable if an episode of panic were to occur. This often includes crowds or fears of riding in a car.
Specific Phobia: occurs when a person is intensely and unreasonably fearful of a specific object or situation, such that it interferes with the ability to function. Common examples are spiders, dogs, heights, and closed in spaces.
Selective Mutism: consists of anxiety about speaking in some environments. Typically, children will speak at home within the family, but not in school or in unfamiliar situations.
School Phobia: children may refuse to attend school, or may frequently need to leave school during the day. There are many reasons a child may refuse to attend school, including social anxiety, separation anxiety, generalized anxiety, or even conduct disorders.
Anxiety disorders can be effectively treated.
- Treatment should always be based on a comprehensive evaluation of the child and family.
- Treatment recommendations may include cognitive behavioral therapy for the child, with the focus being to help the child or adolescent learn skills to manage his or her anxiety and to help him or her master the situations that contribute to the anxiety.
- Some children may also benefit from treatment with antidepressant or antianxiety medication to help them feel calmer
- Parents play a vital, supportive role in any treatment process.
- Family therapy and consultation with the child’s school may also be recommended.
- Cognitive-behavioral treatment (CBT): This is a treatment that teachers people with anxiety to change the ways they think and behave to assist a child or adolescent control their anxiety and regain more normal function. Through CBT a child or adolescent learns, in a step–by–step fashion, to master the situations that cause anxiety. CBT includes:
- educating the child (and caregivers) about the nature of anxiety
- helping the child identify unhealthy, negative beliefs and behaviors and replace them with positive ones,
- teaching specific skills for managing the physical sensations, negative thoughts, and problematic behaviors that accompany anxiety.
- Exposure and Response Prevention (ERP) In ERP treatment, patients learn to resist the compulsion to perform rituals and are eventually able to stop engaging in these behaviours
- The patient is either directly exposed or imagines exposure to the anxiety-provoking trigger in a controlled setting.
- The patient is asked not to engage in their ritual “response” when the exposure occurs.
- Over time, the patient will have less and less anxiety in response to the exposure, with a reduced need to engage in the ritual response
- Habit Reversal Training (HRT)
Habit reversal (HR) is a behaviorally based treatment that is used to reduce repetitive behaviors which may bothersome and serve no adaptive function, such as tic disorders, nailbiting, thumbsucking, hairpulling(trichotillomania) and other nervous habits.
HR is based on the premise that people are often not aware each time a tic or other repetitive behavior occurs, and that repetitive behaviors often follow an urge or feeling of discomfort which is only relieved by engaging in the behavior itself. HR works to increase awareness of one’s behaviors, and to provide relief with strategies that replace the unwanted behavior with a less bothersome behavior.
HR has been used and found effective, rapid and lasting in treating chronic tics, other repetitive behaviors, and Tourette’s Disorder. Despite numerous studies, only a few controlled studies have been conducted. In these studies HR was found effective when compared to individuals on a wait list and when compared to supportive psychotherapy. When compared to exposure and response prevention treatment, no differences were found and both treatments were found effective. Overall, a large body of evidence supports the effectiveness of habit reversal. It is critical that additional research be conducted, using controlled studies with larger sample sizes and comparing behavioral interventions with medication.
- Relaxation techniques
- Biofeedback (to control stress and muscle tension)
- Family therapy
- Parent training
- Medications: may be prescribed to help youngsters feel calmer as they work toward healthier everyday functioning
Support and Resources
Anxiety Disorders Association of America
8730 Georgia Avenue, Suite 600
Silver Spring, MD 20910
Tel: (240) 485-1001
Fax: (240) 485-1035
Promotes the prevention and cure of anxiety disorders and works to improve the lives of people who suffer from them. It disseminates books, publications, and tapes, and provides listings of self-help/ support groups as well as referrals to treatment providers nationwide.
676 State Street
New Haven, CT 06511
Tel: (203) 401-2070
Educates the public and professional communities about OCD and related disorders; provides assistance to individuals with OCD and to their family and friends; and supports research into the causes of OCD and effective treatments.
Gateway to Post Traumatic Stress Disorder Information
Gateway to four national and international organizations, with articles, references, web-links, mini-courses, 800 phone access and e-mail pen-pal resources.
Frequently Asked Questions
How did my child become so anxious? Is it my fault?
Looking for blame is not productive for parents or children. Anxiety disorders are most likely the result of the interaction between a child’s biological sensitivity and experience. Children react in a physically anxious way to various situations, especially when they feel they are not in control. In addition, they may distort or exaggerate events in their minds; for example, thinking that if something can happen to someone else it can happen to them in an even worse way. This thought process is called catastrophizing.
Isn’t this just a phase my child is going through? It’s normal to be scared sometimes.
Anxiety disorders can start in childhood and can be a chronic problem. Certainly all kids and adults go through phases when they are more worried about things than at other times. Periodic anxiety and worries are a normal part of life. This kind of worry is different from the anxiety that interferes with home life, academic performance, peer relationships, and the ability to distract oneself and move on from the problem.
What should I look for when I think my child may have a real problem with anxiety?
With the help of a professional, it is important to identify how intense the symptoms are, whether the reaction and the behaviors are extreme, and how long the problem has persisted.
Will my child always be like this?
Everyone must learn to live with a certain amount of anxiety. Fortunately, anxiety disorders are highly treatable. Appropriate treatment can reduce or completely prevent the recurrence of problems in 70 to 90% of patients. Cognitive behavioral treatments teach children skills to cope with both the physical symptoms and the behavioral reactions. For example, children are taught coping and mastery skills such as relaxation techniques and coping phrases to tell themselves when anxiety is at its height.
How do I parent a child with an anxiety disorder?
With good intentions, parents are apt to rescue their children—to try to comfort and soothe them when they are feeling upset and anxious. However, this approach can teach the child to give up quickly and rely on others to make him feel better. Although it is difficult, parents should let their child feel some distress, question the child about what is happening, and think about what he or she should do. In this way, parents let the child experience some struggle rather than be rescued; they help the child choose ways to manage the situation, and praise them for their attempts as well as for their successes.
Anxiety untreated may lead to loss of friendships, failure to realize social and academic potential, and feelings of low self-esteem. Proper treatment may include cognitive behavioral therapy, social enhancement groups, and/or medication.
Some anxiety disorders are more common in childhood than others. Separation Anxiety, Selective Mutism and Specific Phobias are more common in younger children, about ages 6-9 years old, while Generalized Anxiety Disorder (GAD) and Social Anxiety Disorder (SAD) are more common in middle childhood and adolescence.