Anxiety Disorders

All children experience anxiety. In fact, some anxiety can help children make safe choices (not cross the street without looking both ways) and perform well (study before a big test). Anxiety is concerning when it no longer protects the child, and instead gets in the way of their ability to function in a healthy way. For example, children experiencing problematic anxiety may avoid participating in certain activities, complain of frequent aches and pains, have difficulty sleeping, and have trouble focusing in school.

There are several different types of anxiety disorders. The most common anxiety disorders in children are:

• Separation anxiety disorder
• Generalized anxiety disorder
• Social anxiety disorder
• Phobias
• Obsessive-compulsive disorder
• Post-traumatic stress disorder

Treatment for anxiety disorders usually includes therapy, medication, or a combination of both. The most common and successful form of therapy used to treat anxiety disorders is called cognitive behavioral therapy (CBT). CBT involves helping children to understand how their thoughts and behaviors can affect how they feel and learn ways to change unhelpful thoughts and behaviors. Therapists can also help parents to understand how their behavior may increase their child’s anxiety (for example, allowing their child to sleep with them at night). It is very important to seek out medical advice if you are concerned that your child has an anxiety disorder, because if left untreated, anxieties grow bigger and can cause increased problems.

Anyone can be affected by an anxiety disorder when worries become so intense that they interfere with daily functioning and cause distress.

Anxiety disorders are the most common mental health problem in childhood, with up to 1 in 10 children and adolescents having an anxiety disorder.

All kids experience anxiety. Certain fears and worries are typical for specific age groups. For example, young children are often afraid of loud noises, strangers, the dark, and imaginary figures. Most of these fears will disappear as the child gets older. However, if these fears or other worries get so big that they begin to interfere with a child’s daily functioning (they avoid activities, can’t relax, or concentrate), they may have an anxiety disorder.

Unlike adults, children usually don’t realize how intense or abnormal their feelings of anxiety have become. It can be difficult for a child to know that something is “wrong.”

Seeking help for your child at the first sign of excessive worrying will help to keep worries from growing so big that they are likely to develop into an anxiety disorder. Some other tips include:

• Staying calm in front of your child, as he/she often looks to you for how to react in new and uncertain situations.
• Avoiding a lot of reassurance and instead teaching your child how to problem solve and reassure him/herself.
• Discouraging avoidance of feared situations/objects, as this may temporarily reduce distress, but will allow the anxiety to grow and make things more difficult for your child in the future.

Anxiety disorders can cause both and physical and emotional symptoms.

Physical symptoms Include:

• Rapid heart rate
• Quick breathing or difficulty catching one’s breath
• Muscle aches (especially stomach and headaches)
• Shaking, dizziness, tingling
• Sweating
• Fatigue

Emotional symptoms include:

• Ongoing worries about friends, school, or activities
• Worrying about things before they happen
• A need for everything to be “perfect”
• Constant thoughts and fears about safety (of self or of others, such as parents and siblings)
• Reluctance or refusal to go to school
• ”Clingy” behavior with parents
• Inability to concentrate
• Irritability
• Trouble sleeping
• Inability to relax

All of us are born with the natural “fight or flight” response that helped our ancestors escape predators and other threats. When we are afraid or stressed, the part of our brain in control of the fight or flight response will cause the nervous, fearful feeling we call anxiety.

While everyone experiences anxiety at times, people with anxiety disorders feel worry that is difficult to control and interferes with their functioning. There are biological, family, and environmental factors that may contribute to a child having an anxiety disorder.

• Biological factors: The brain has special chemicals, called neurotransmitters, that send messages back and forth to control the way a person feels. Serotonin and dopamine are two important neurotransmitters that, when “out of whack,” can cause feelings of anxiety.
• Family factors: Just as a child can inherit a parent’s brown hair, green eyes, and nearsightedness, a child can also inherit that parent’s anxiety. In addition, anxiety may be learned from family members and others who are noticeably stressed or anxious around a child. For example, a child whose parent is a perfectionist may become a perfectionist too. Parents can also contribute to their child’s anxiety without realizing it by the way they respond to their child. For example, allowing a child to miss school when they are anxious about going likely causes the child to feel more anxious the next school day.
• Environmental factors: A traumatic experience (such as a divorce, illness, or death in the family) may also trigger the onset of an anxiety disorder.

A child may be diagnosed with an anxiety disorder if symptoms:

• Are present for at least six months
• Cause significant distress for the child
• Do not go away, no matter how much the child tries to relax or stop worrying
• Impair functioning at home, at school, or with peers

The clinician who evaluated your child will likely recommend that your child participate in therapy and possibly take anti-anxiety medication.

Treatment for anxiety disorders usually includes therapy, medication, or a combination of both.

The most common and successful form of therapy used to treat anxiety disorders is called cognitive behavioral therapy (CBT). CBT involves helping children to understand how their thoughts affect how they feel (emotionally and physically) and how they behave. For example, if they think dogs are mean and bite, they will feel afraid if they see a dog and may run away. Alternately if they think dogs are nice and friendly, they will feel happy if they see a dog and may approach it. CBT involves changing unhelpful thoughts and behaviors through practicing different skills both in therapy and in daily life. These skills can be learned in individual therapy or as part of a therapy group with other children experiencing similar challenges. Treatment is usually structured and time-limited.

There are many different medications used to help control anxiety. A prescribing clinician (psychiatrist or nurse practitioner) will choose a medication that will work best to help your child.

With proper treatment, the majority of children diagnosed with an anxiety disorder experience a reduction or elimination of symptoms within several months.