As many as 1 in 10 children under 18 may have a type of anxiety disorder (SAMSHA, 2009). Anxiety is the feeling of intense fear, distress and apprehension that appears out of proportion to the situation. Anxiety disorders have a broad category of diagnoses. While every child experiences fear and apprehension (as do adults) from time to time, an anxiety disorder involves more intensified feelings of fear and apprehension that cause problems in daily functioning. These problems can occur in brief episodes or in prolonged periods. Additionally, anxiety disorders can have a specific onset such as after a traumatic event (PTSD or Post-Traumatic Stress Disorder) or they may be more general with no identifiable triggering event (Generalized Anxiety Disorder).
Some anxiety disorders are very specific in the ways individuals are affected. For example, some children with Panic Disorder may fear leaving a caregiver with much more fear and distress than is appropriate (separation anxiety). Some with phobias have intense fear, for example, when going outside (Agoraphobia) or encountering other, very specific things or situations such as snakes, heights and so on. While anxiety disorders are varied, typically each type will have periods in which the condition is more manageable than others. In difficult periods, acute anxiety can be debilitating with severe symptoms such as nausea, dizziness, sweating and a fear of death (panic attack). Some anxiety disorders can be debilitating because attempts are made to ward off feelings of anxiety by repeating certain behaviors (compulsions) and repetitive thoughts (obsessions) as in Obsessive Compulsive Disorder or OCD. Children with severe OCD can become involved in compulsive behaviors such as handwashing, counting or arranging objects. Physicians will look for such specific symptoms when diagnosing an anxiety disorder. Because there is a wide spectrum of these disorders only some characteristics are listed here. Please keep in mind that these are for illustration purposes only and the diagnosis of a specific anxiety disorder will require that a group of specific symptoms be identified (American Psychiatric Association, 2000) .
Symptoms of anxiety disorders are:
Other Conditions that Frequently Occur with Anxiety Disorders
Many children and adults will have other disorders and debilitating symptoms along with an anxiety disorder. Some of these are mood disorders (particularly depression), performance anxiety, social anxiety, ‘stage fright’ and other avoidant behaviors. Personality disorders can also develop in which a person’s patterns of coping become problematic. All such conditions can interfere with academic, social, recreational and, eventually, occupational functioning. There is a high risk of physical complaints and symptoms such as stomach aches, ulcers, hypertension, headaches,TMJ, muscle tension, cramps and spasms. Hypochrondia can also occur along with anxiety. As the anxiety disorders do tend to persist into adolescence and adulthood, there is a high risk of substance abuse (American Psychiatric Association, 2000).
The Impact of Anxiety Disorders upon Children and Families
Children with anxiety disorders are prone to many related problems and issues. When anxiety interrupts sleep and nutrition, daily functioning suffers and health problems can arise. Parenting of anxious children can be intensified and daily routines can be complex or interrupted by the child’s symptoms. Anxiety can cause children to cling to ‘safe’ family members and others. This can prevent the child from participating in age-appropriate behaviors on a regular basis. Consequently, educational problems can result as can problems with development in independence, social skills and age-appropriate coping. Children with anxiety disorders can be isolated from peers and stigmatized. Low self-esteem and depression often result from limitations imposed by symptoms and the embarrassment of obvious symptoms. Children with anxiety disorders are at risk to become adolescents and adults with these disorders as well. If anxiety is chronic and untreated, many will accumulate multiple negative experiences that will compound fears and increase symptoms over the years.
Treatment Options
Multiple approaches are used to treat anxiety. Medications are often used—some on a daily basis and others as needed when symptoms increase. Anti-anxiety medications (benzodiazepines or anxiolytics) and/or anti-depressants may be recommended. A physician can discuss these and other medication options that can target the symptoms of the child’s specific disorder. Additionally, psychotherapy can provide many beneficial interventions such as Cognitive Behavioral Therapy in which negative thoughts and related behaviors are replaced with more adaptive ones. A gradual exposure to distressful events, situations or things can, over time, decrease symptoms for many (desensitization). Therapy that ‘debriefs’ a child who has become anxious after a traumatic event can dramatically decrease symptoms. Supportive therapy that provides reassurance and a ‘safe’ relationship in which to express fears and worries can boost confidence and reduce symptoms for many. Children are often treated for anxiety while engaged in art activities (art therapy), when using toys or games (play therapy and sand tray therapy), music, movement and other expressive techniques. These types of techniques allow the therapists to engage the child in psychotherapy while providing fun and age-appropriate activities to do so. Other methods such as relaxation training, the use of mental imagery to feel safe and calm and the use of self-soothing techniques (comforting self-talk, deep-breathing, rocking, for examples) are useful for children with anxiety as well.
References:
American Psychiatric Association. (2000). Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, D.C.: American Psychiatric Association.
Dufton, L., Dunn, M., & Compas, B. (2009). Anxiety and Somatic Complaints in Children with Recurrent Abdominal Pain and Anxiety Disorders. Journal of Pediatric Psychology, 34(2) , 176-186.
SAMSHA. (2009). Childrens Mental Health Facts: Children and Adolescents with Mental, Emotional and Behavioral Disorders. Retrieved April 9, 2009, from Childrens
Mental Health Facts: http://mentalhealth.samhsa.gov/publications/allpubs/CA-0006/default.asp