Worries and fears are a natural and adaptive part of child development. Anxiety and fear become concerning for a clinical anxiety disorder only when they are persistent and excessive, causing significant distress or impairment in everyday life.
What are “Anxiety disorders”?
Anxiety disorders really refer to a group of different disorders, namely:
- Generalized anxiety disorder
- Social anxiety disorder
- Panic disorder with or without agoraphobia
- Agoraphobia without a history of panic disorder
- Specific phobia
- Separation anxiety disorder
- Selective mutism
Anxiety disorders as a whole, are the most common childhood-onset psychiatric disorders. The development of childhood anxiety disorders is determined by complex interactions between biological, psychological, social and environmental factors.
What are the symptoms or behaviors?
- Avoidance of academic and social activities such as school, parties, camp.
- Somatic symptoms such as headaches, stomach aches, or dramatic presentations of pain
- Difficulty falling asleep or waking up in the middle of the night
- Excessive need for reassurance, or excessive fears of bad things happening.
- Poor school performance such as inattention in class or having difficulty completing tests within the allotted time
- Explosiveness and oppositional behavior triggered by an anxiety-provoking stimulus
- Eating insufficiently or overeating to cope with anxiety
A child with generalized anxiety disorder (GAD) typically has many different worries. Many are preoccupied with academic performance. These children and adolescents tend to focus on mistakes they had made, rather than successes. They may have a number of personal safety or health concerns, relating to themselves or their family and friends.
With social anxiety disorder, the child or adolescent often fear of saying or doing the wrong thing, being laughed at, or being embarrassed, resulting in avoidance of social and performance situations.
Youth’s with a panic disorder will describe experiencing panic attacks, and a fear of having another attack, which contributes to the distress and avoidance of any situation they associate with an attack.
Agoraphobia is marked by pronounced fear in particular environments or situations. The focus of the fear, and subsequent avoidance, of these places or situations is related to thoughts of being unable to escape or cope. Youth with agoraphobia will avoid school or common social experiences, or will require the presence of a “safe” person, such as a parent.
In separation anxiety disorder the child may have trouble separating from their parent. Parents may also display anxiety about being separated from their child. The child will typically report worries about something bad happening when they are separated. It may be difficult getting the child to sleep on their own.
In selective mutism the child readily talks at home, and/or around select family or friends, but does not speak in school or other settings.
How can a child with an anxiety disorder be helped?
Research suggests a developmental progression of anxiety disorders in childhood and adolescence:
- Selective mutism typically develops prior to age five, usually from 2 -4 years of age
- Age of onset for separation anxiety and specific phobias is approximately 7 years old
- School refusal has a bimodal age of onset: between 5 -6 and 10 – 11 years old
- Generalized anxiety disorder occurs in school-age years, starting around 7 years old
- Social anxiety disorder is most common in early adolescence
- Panic disorder starts in later adolescence
Early onset anxiety disorders are often chronic if untreated, although the nature of the symptoms may change across child and adolescent development. Anxiety disorders in children (up to 12 years old) and adolescents (13 – 18 years old) frequently co-occur with a second anxiety disorder, attention deficit/hyperactivity disorder, oppositional defiant disorder, language disorders, learning disabilities, and depressive disorders. They are associated with educational underachievement and other psychiatric conditions, as well as functional impairments that can extend into adulthood.
