Anxiety Disorders in Children

By Jennifer L.W. Fink, RN, BSN

Did you know anxiety disorders affect one in eight children? Everyone experiences anxiety and worry sometimes, but for kids with anxiety disorders, the world can seem scary and overwhelming. Without treatment, kids with anxiety disorders are likely to struggle in school and in life, and are at increased risk for substance abuse.
The good news is anxiety disorders are manageable. Whether you’re a parent, teacher, family member or friend, here’s what you need to know about anxiety disorders in children.

Symptoms of Anxiety Disorders

Kids almost never say they’re anxious. They show their anxiety in other ways. One of the most common symptoms of anxiety in children is frequent physical complaints and avoidance of activities, such as school or extracurriculars. Headaches and stomachaches are two common physical symptoms of anxiety.

A child who is experiencing anxiety may have a hard time falling asleep at night, or may wake up at night. A child who has been contentedly sleeping alone may ask to sleep in your bed or bedroom. Some kids eat more or less than usual when they are anxious.

Crying and clinging—especially upon separations—can be another symptom of anxiety. Temper tantrums and frequent irritability might actually be signs of anxiety, not anger or disobedience.

Other symptoms of anxiety include persistent negative thinking (“I’ll never be any good at this,” “No one likes me”), difficulty concentrating, and excessive worry.

Of course, all kids exhibit these symptoms sometimes. But when these symptoms are commonplace and interfere with the child’s functioning, they may be a sign of an anxiety disorder.

Common anxiety disorders in children include:

Generalized Anxiety Disorder (GAD): Perhaps best explained as excessive worry about a lot of things, generalized anxiety disorder affects between 3 and 5% of kids and teens. Children with GAD are often perfectionists who think something thbad will happen if they don’t get perfect grades or perform perfectly in sports or at home.
Panic Disorder: Panic disorder is diagnosed in kids who have had at least two unexpected panic or anxiety attacks, followed by at least one month of fear or concern that another attack could happen at any moment. Panic attacks can be particularly scary to kids, as they may not understand what’s going on. Because many of the symptoms of a panic attack are physical—pounding heartbeat, shortness of breath, sweating, difficulty breathing—the child may fear he or she is dying.
Social Anxiety Disorder: Kids who have social anxiety disorder (also called social phobia) are very fearful of being placed in the spotlight. They may be reluctant to speak in class and may avoid social interactions.
Separation Anxiety Disorder: Separation anxiety—intense feelings of distress upon separation from familiar caregivers—is common in children between the ages of 18 months and 3 years. At this stage, it’s a very normal part of development, and rarely a big problem. However, older children who became extremely upset at the thought of leaving you, or who cannot handle separations without substantial distress, may have separation anxiety disorder. Separation anxiety disorder affects about 4% of children and is most common in children ages 7 to 9.
Selective Mutism: A child who refuses to speak to others may have selective mutism. Many of these kids talk normally at home or with friends or family members, but clam up in other environments.
Phobias: An irrational fear of something specific—clowns, closed spaces, spiders— is actually a form of anxiety disorder.

Risk Factors for Anxiety Disorders

Anxiety affects everyone sometimes, but some people have an increased risk of anxiety disorders. A child who has a family history of anxiety disorders, panic attacks, and depression is more prone to an anxiety disorder than kids from families with no history of anxiety. (Experts think the family connection may be part biology and part sociology. Kids may inherit genes that increase the likelihood of an anxiety disorder. They may also learn anxious behaviors and thinking from family members.)

A history of trauma—such as abuse, natural disaster or war—increases a child’s risk of anxiety disorders. So does chronic exposure to stress, whether that stress is poverty, an unsafe neighborhood, or parental fighting.

Treatment for Anxiety Disorders in Children

thTreating anxiety disorders allows affected children to grow and develop without being hindered by fear and worry. The two most common treatments include psychotherapy and medication.

Therapy helps children cope with their fears. It may include exposure therapy, or gradual exposure to feared objects or situations, and cognitive therapy, which teaches children how to replace unhelpful thoughts that feed their anxiety. Look for a therapist who has experience working with children with anxiety disorders.

In some cases, medication may be used, often as a complement to therapy. Both antidepressants and anti-anxiety medications can help children with anxiety disorders. It can take a few weeks for medication to be effective. A child who is taking medication for an anxiety disorder should see a healthcare provider on a regular basis to monitor its effectiveness, along with any side effects.

Learning to recognize and manage anxiety disorders in children can be a challenge. Be kind to one another, and be patient. With time and support, most families find anxiety disorders very manageable.

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