Anxiety can affect kids and teens; however, anxiety disorders often go unrecognized because children and adolescents express distress in a way that may be hard for an adult to recognize. Children will demonstrate their anxiety in a number of ways. The younger the child, the less his or her ability to identify anxiety or fear. Different types of anxiety disorders appear to affect children of differing age groups. For example, Separation Anxiety Disorder appears to be more common in younger children while Generalized Anxiety Disorder is more frequently diagnosed in adolescents. Most common of all the anxiety disorders is Specific Phobia; it’s important to keep in mind, however, that certain fears are normal for children as they develop. Girls appear to be affected by problems with anxiety more frequently than boys, but any child is capable of developing an anxiety disorder.
“I don’t want to go to school.”
“I have a tummy ache.”
For many parents, these are familiar complaints. But for children who express physical complaints on a regular basis, who miss too many days of school or who persistently avoid being alone or with other children, the problem may be more serious than physically ill.
Many people believe that children do not have anxiety problems. All the signs of a problem may be there, but the child is expressing distress in a way that is hard for an adult to recognize. Often, a child’s fearful behavior is regarded as a passing stage. A painfully shy child may be seen as cute or endearing. Sometimes temper tantrums are not the product of a willful or disobedient youngster, but the only means a child has of expressing how afraid he or she is.
Anxiety is the body’s natural alarm system. It warns of danger. There are situations when it is perfectly normal to feel a little anxious, such as before an important test. Anxiety has physical, mental and behavioral aspects. Children who are anxious usually experience some physical symptoms, such as rapid heartbeat, dizziness, shortness of breath, muscle tension or difficulty sleeping. They also experience fearful thoughts such as, “I can’t sleep with the light off. There may be a monster under my bed and it could get me.” They often express their anxiety behaviorally by avoiding situations, which makes them uncomfortable.
What is an Anxiety Disorder?
Anxiety becomes a “disorder” when the discomfort or disability it creates significantly interferes with day-to-day living. Certain problems, such as avoiding school, are readily apparent. However, a child may express fear in less obvious ways. For example, physical illness, such as frequent stomach aches for which there is not a medical diagnosis, may be a sign of anxiety. Other signs include behaviors that are uncharacteristic of a child, such as temper tantrums, oppositional behaviors or refusing to be separated from family members.
It is important to keep in mind that certain fears are developmentally appropriate for children. Especially with young children, it is important that parents check with a pediatrician or family doctor in order to find out whether a child’s fears are typical, or if they are uncommon for his or her age. Children’s teachers can help determine if anxious behavior seen at home is also happening at school and whether the behaviors are age-appropriate.
What are the Kinds of Childhood Anxiety Disorders?
There are a variety of anxiety disorders that can occur in children. Some anxiety disorders affect both adults and children. Other disorders are diagnosable only in children.
Generalized Anxiety Disorder
GAD is a condition characterized by excessive worry. People with GAD typically worry about normal concerns of life (health, family welfare, finances, etc.). However, the extent of the worry exceeds normal behavior and causes substantial distress or interference with functioning. Other symptoms of GAD may include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbance.
If you or a loved one suffers from GAD, give us a call. We have been providing anxiety treatment programs for over 30 years and can provide relief from the constant fear, panic, and/or worry. Our anxiety treatment team can be reached at 314-289-9411.
Separation Anxiety Disorder
Developmentally inappropriate and excessive anxiety concerning being separated from home or from those to whom a child is attached (usually parents).
Repeated panic attacks consisting of periods of intense fear or discomfort in which several physical symptoms develop abruptly and reach a peak in a short period of time, such as a racing heart, sweating, trembling, shortness of breath, choking sensation, dizziness, nausea or stomach ache. Children are not always able to express fear and may describe these attacks with terms such as “a yucky feeling”.
Panic Disorder with Agoraphobia
Panic attacks accompanied by anxiety about being in places or situations from which escape may be difficult or embarrassing or in which help may not be available in the event a panic attack occurs. This condition is more common in adults.
Marked and persistent fear that is excessive or unreasonable and is triggered by the presence of a specific object or situation (e.g., animals, heights, blood or injury, tunnels, driving, flying, etc.). Temporary specific phobias (e.g., fears of the dark or strangers) are common in childhood, but phobias, which persist, can be problematic.
Persistent fear of social situations (e.g., parties), performing in front of others or other situations in which the person is the center of attention and fears he or she may do something embarrassing or humiliating or may experience the disapproval of others. Children may express social anxiety by crying, tantrums, freezing or shrinking from social situations or unfamiliar people. Severe shyness may be a sign of social phobia.
Persistent thoughts, impulses or images which are intrusive, unwanted and cause marked anxiety or distress and which the person attempts to neutralize by engaging in repetitive behaviors (such as hand washing, ordering, checking) or mental acts (such as praying, counting, or repeating “good” thoughts or words silently).
Posttraumatic Stress Disorder
Children that have experienced, witnessed, or been confronted with an event that involved actual or threatened death, serious injury, or threat to the physical integrity of themselves or others may experience depression, anxiety, and other disturbing symptoms long after the traumatic event. Also, they may persistently re-experience the traumatic event in the form of repetitive play, nightmares, flashbacks, or re-enacting a theme relating to the trauma.
Generalized Anxiety Disorder
A general tendency to worry excessively about a variety of concerns. Common symptoms are restlessness, fatigue, difficulty concentrating, irritability, muscle tension and disturbed sleep.
Other Problems Related to Anxiety Disorders
While not specifically an anxiety disorder, trichotillomania can involve anxiety. It is characterized by repeatedly pulling out ones hair (including scalp hair, eyebrows, lashes, and other body hair) and is frequently seen in children and adolescents. Tourette’s Disorder is a neurological disorder that in some cases has an anxiety component. Individuals with tourette’s have motor and sometime vocal tics. Tics are sudden, rapid, recurrent non-rhythmic, stereotyped motor movements or vocalizations. This disorder sometimes occurs along with obsessive-compulsive disorder.
What should I do if I think a child has an anxiety disorder?
If you suspect a child has a problem with anxiety, a thorough evaluation by a mental health professional knowledgeable in the diagnosis and treatment of anxiety disorders may be helpful. A comprehensive evaluation will incorporate information from a variety of sources including family and, with permission sometimes others who interact with a child, such as teachers and physicians. The evaluation should consider anything that might be contributing to a child’s problem. When the evaluation has been completed, the professional should provide specific recommendations regarding treatment.
What kinds of Treatment are Available?
Anxiety disorders are very treatable. A treatment plan should be developed that is tailored to the particular needs of each child. Often, treatment includes a well-balanced combination of several approaches.
Cognitive Behavior Therapy:
The primary goal of cognitive behavior therapy is to help people modify the way they think, feel and behave. Although every child’s therapy is somewhat unique, there are several common components. Both the child and family members are educated about the nature of the particular anxiety disorder present. Misperceptions are corrected. Treatment may also include behavioral experiments or “exposures” designed to help children confront feared situations in a gradual, step-by-step manner. Anxiety management skills are taught to help a child learn to manage the symptoms of anxiety effectively. In addition, other behavioral skills or interventions (e.g., assertion, habit control, contingency management, response prevention) may be a necessary part of treatment, depending on the particular problem.
With most children, family involvement is critically important. This may involve the parents or even the entire family participating in therapy. Typically the child’s therapist educates the family about the problem and provides guidelines for how to be helpful. In some instances, the therapist may help the family set-up a reward program to help motivate the child to comply with treatment. More extensive family counseling is sometimes needed.
Learn more about the anxiety disorders treated at St. Louis Behavioral Medicine Institute. To schedule an appointment, please contact us at (314) 289-9411 for our St. Louis City location and (636) 532-9188 for our Chesterfield location, you can also choose to complete our online inquiry form. We look forward to speaking with you.