by JUSTINE DE MAYNARD

Understanding Anxiety in Children

Article by Linda Pollitt

Anxiety symptoms and disorders are a significant health problem in all developed countries. According to recent research, up to 25% of adults will experience an anxiety disorder at some time. The frequency in children is unknown, but it is generally felt to be significantly underreported and under-diagnosed.

Although quite common, Anxiety Disorders in children often are overlooked or misjudged, despite being very treatable conditions with good, persistent medical care. Children and adolescents with anxiety disorders typically experience intense fear, worry, or uneasiness that can last for long periods of time and significantly affect their lives. If not treated early, anxiety disorders can lead to:

- repeated school absences or an inability to finish school;

- impaired relations with peers;

- low self-esteem;

- increased alcohol or other drug use;

- problems adjusting to work situations; and

- anxiety disorder in adulthood.

Many different anxiety disorders affect children and adolescents. Several disorders and their signs are described below:

Generalised Anxiety Disorder: Children and adolescents with generalised anxiety disorder engage in extreme, unrealistic worry about everyday life activities. They worry unduly about their academic performance, sporting activities, or even about being on time. Typically, these young people are very self-conscious, feel tense, and have a strong need for reassurance. They may complain about stomach-aches or other discomforts that do not appear to have any physical cause.

Separation Anxiety Disorder: Children with separation anxiety disorder often have difficulty leaving their parents to attend school or camp, stay at a friend’s house, or be alone. Often, they ‘cling’ to parents and have trouble falling asleep. Separation anxiety disorder may be accompanied by depression, sadness, withdrawal, or fear that a family member might die. About one in every 25 children experiences separation anxiety disorder. Separation anxiety is a normal part of emotional development in pre-school children.

Phobias: Children and adolescents with phobias have unrealistic and excessive fears of certain situations or objects. Many phobias have specific names, and the disorder usually centres on animals, storms, water, heights, or situations, such as being in an enclosed space. Children and adolescents with social phobias are terrified of being criticised or judged harshly by others. Young people with phobias will try to avoid the objects and situations they fear, so the disorder can greatly restrict their lives.

Panic Disorder: Repeated ‘panic attacks’ in children and adolescents without an apparent cause are signs of a panic disorder. Panic attacks are periods of intense fear accompanied by a pounding heartbeat, sweating, dizziness, nausea, or a feeling of imminent death. The experience is so scary that young people live in dread of another attack. Children and adolescents with the disorder may go to great lengths to avoid situations that may bring on a panic attack. They also may not want to go to school or to be separated from their parents.

Obsessive-Compulsive Disorder: Children and adolescents with obsessive-compulsive disorder, sometimes called OCD, become trapped in a pattern of repetitive thoughts and behaviours. Even though they may recognise that the thoughts or behaviours appear senseless and distressing, the pattern is very hard to stop. Compulsive behaviours may include repeated hand washing, counting, or arranging and rearranging objects. About two in every 100 adolescents experience obsessive-compulsive disorder.

Post-traumatic Stress Disorder: Children and adolescents can develop post-traumatic stress disorder after they experience a very stressful event. Such events may include experiencing physical or sexual abuse; being a victim of or witnessing violence; or living through a disaster, such as a bombing or hurricane.

Anxiety disorders are among the most common mental, emotional, and behavioural problems to occur during childhood and adolescence. About 13 of every 100 children and adolescents ages 9 to 17 experience some kind of anxiety disorder; girls are affected more than boys. About half of children and adolescents with anxiety disorders have a second anxiety disorder or other mental or behavioural disorder, such as depression. In addition, anxiety disorders may coexist with physical health conditions requiring treatment.

Researchers have found that the basic temperament of young people may play a role in some childhood and adolescent anxiety disorders. For example, some children tend to be very shy and restrained in unfamiliar situations, a possible sign that they are at greater risk for developing an anxiety disorder. Research in this area is very complex, because children’s fears often change as they age.

Researchers also suggest watching for signs of anxiety disorders when children are between the ages of 6 and 8 years of age. During this time, 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.

Children and adolescents with anxiety disorders can benefit from a variety of treatments and services. Following an accurate diagnosis, possible treatments include:

- Cognitive-behavioural treatment, in which young people learn to deal with fears by modifying the ways they think and behave;

- Relaxation techniques;

- Biofeedback (to control stress and muscle tension);

- Family therapy;

- Parent training; and

- Medication.

While cognitive-behavioural approaches are effective in treating some anxiety disorders, medications work well with others. Some people with anxiety disorders benefit from a combination of these treatments. More research is needed to determine what treatments work best for the various types of anxiety disorders.

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