What is childhood anxiety?

  • Anxiety is a common feeling of fear that all children experience. It could be the result of real or imagined events
  • It is normal at some stages of children’s development.

Anxiety becomes a disorder when it is

  • Excessive
  • Beyond what is expected for the situation and the child’s developmental level
  • Persistent
  • Affecting the child’s social, personal, and academic life

How common is the occurrence of anxiety?

  • Anxiety disorders are quite common in children (2% to 15%).
  • They are more frequent in girls than boys.
  • They may continue into adulthood

What causes anxiety?

  • There is no single cause for anxiety disorders. It is usually a mix of biological and environmental factors and it seems to run in families

What are the symptoms of anxiety disorders?

  • Anxiety may affect a child’s thoughts:
    • Difficulty concentrating
    • Overreacting
    • Seeing minor events as a catastrophe
    • Memory problems
    • Worrying
    • Irritability
    • Perfectionism
    • Fear of losing control
    • Fear of failing
    • Difficulties with problem solving
  • Anxiety may affect a child’s actions:
    • Shyness
    • Withdrawal
    • Asking a lot of questions
    • Needing reassurance frequently
    • Needing things to be the same
    • Avoidance
    • Rapid speech
    • Excessive talking
    • Restlessness and fidgetiness
    • Habits such as hair twirling or pulling
  • Anxiety may affect a child physically:
    • Fast heartbeats
    • Sweating
    • Trembling body/voice
    • Shortness of breath
    • Dizziness
    • Chest pain or discomfort
    • Nausea/vomiting/diarrhea
    • Muscle tension
    • Sleep problems

What are the different types of anxiety disorders?

TypeDescriptionExample
Separation AnxietyExcessive fear of being separated from home or parents or loved ones.After dropping off the child at school or at a birthday party, etc.
Generalized Anxiety DisorderChronic, excessive worrying about many areas of life.Excessive worry about family, school, activities, health, and natural disasters, etc.
Specific PhobiaExcessive fear of a specific object or situation.From snakes, heights, flying, elevators, etc.
Social PhobiaFear and anxiety in social settings or performance situations.When meeting new people, being in a crowded place, speaking in front of a class, making a mistake, etc.
Panic DisorderSudden attacks of fear and worry that come out of nowhere and without any cause.Common symptoms are: sweating, chest pain, dizziness, racing heartbeat, feeling of choking.
Obsessive-Compulsive Disorder (OCD)Constant troubling thoughts that control the child and cause him/her to do repeated behaviors. The recurring thoughts are called obsessions. The behaviors that he/she feel forced to do over and over again are called compulsions.Irrational fear of germs, washing hands constantly, counting things, etc.
Post-traumatic Stress Disorder (PTSD)Exposure to a traumatic event which causes the child to have symptoms such as nightmares, and avoiding things that remind him/her of the trauma.After the death of a loved one, car accident, war, etc.
Adjustment Disorder with AnxietyAnxiety symptoms which appear within 3 months of a stressful change in the child’s life. These symptoms cause more distress than expected and affect the child’s life.After changing schools, divorce, etc.

What are the things to expect when your child has an anxiety disorder?

  • Children with anxiety disorders may have additional conditions as well.
  • Almost half of the children with anxiety disorders (especially if untreated) may develop depression.
  • The behavior of a child with an anxiety disorder may appear similar to the behavior of a child with Attention Deficit Hyperactivity Disorder (ADHD) since both affect concentration and attention. Only a specialist can diagnose these disorders.

How does your child’s anxiety affect academic performance?

  • Children with an anxiety disorder may have difficulties at school. They may especially have difficulties with tasks requiring concentration and organization.
  • They may be perfectionists and become upset if their work is not perfect.
  • They may be afraid of taking exams, or speaking in front of a class. They may even miss school days because of their fear of going to school.

What is the treatment for childhood anxiety?

Treatment may include a combination of:
  • Individual psychotherapy
  • Family therapy
  • Medications
  • Behavioral treatments
  • School consultation

The child should be treated as early as possible. Early treatment can prevent future difficulties such as loss of friendships, inability to succeed academically, and feelings of low self-esteem.

Recommendations for parents

  • Remember that anxiety is not an intentional behavior. It reflects the inability of your child to control his/her behavior. Be patient and be willing to listen to him/her.
  • Have a consistent and flexible routine, especially when doing homework and recreational activities.
  • Keep your goals realistic and achievable for your child. Do not let him/her think that you expect them to be perfect. Children with anxiety disorders are usually trying to satisfy their parents and teachers. They will try to be perfect if they think that this is what is required of them.
  • Accept that your child’s errors are a natural part of his/her growth, and do not expect them to be perfect in everything.
  • Praise and reinforce his/her efforts through positive encouragement such as saying Good work, you did well.”
  • If your child is worried about an upcoming event (such as giving a speech in a classroom), encourage him/her to practice it several times to increase self-confidence. The goal is to reach an acceptable level of anxiety which your child can control.
  • Listen to your child and talk to him/her regularly. Avoid being critical or giving a lot of tips. Critical behavior pressures your child into exerting more effort, which may make the problem worse.
  • Do not label your child’s feelings, or questions or concerns as silly or unimportant. They may not seem important to you, but they are realistic for your child.
  • Do not assume that your child is misbehaving and that his/her problem will go away. Consult a specialist if this problem persists and affects your child’s daily activities and performance.

Useful Links on Anxiety in Children and Adolescents

http://www.aacap.org/AACAP/Families_and_Youth/Resource_Centers/Anxiety_Disorder_Resource_Center/Home.aspx
http://www.nimh.nih.gov/health/topics/anxiety-disorders/index.shtml