by Julie T. Steck, Ph.D., HSPP
In today’s world of anxiety and stress, adults are often oblivious to the high rate of anxiety in children and adolescents. Based on a study published in 2010 (Merikangas, et al.), the lifetime prevalence of anxiety in adolescents is 31.9%. This is similar to the rate of anxiety in adults, but anxiety in children is often under-recognized. Adult anxiety disorders often have their roots in childhood. While the form the anxiety takes may change over time, the tendency to have anxiety disorders often begins in early childhood.
Anxiety in certain forms is developmentally appropriate at some ages. For example, stranger anxiety is normal and expected in infants from 8 to 10 months of age. Separation anxiety is typical from 10 to 18 months age. Shyness and self-consciousness are typical in adolescence. These types of anxiety become concerning when they last beyond the normal developmental period and when they begin to interfere with the drive toward autonomy, independence and socialization with peers. Anxiety disorders are more frequent in females than in males and the frequency in females increases with age. There is a strong genetic factor in anxiety disorders, so anxiety is more than just the result of how a child is parented. It is important that the genetics and the environment be considered in treating anxiety disorders. At least one in three children with anxiety disorders meet criteria for at least two anxiety disorders.
Separation Anxiety Disorder is the earliest form of anxiety typically identified in children. Children with this form of anxiety display excessive and developmentally abnormal fear of separating from their parent or primary caregiver. As they get older, they are able to describe their fear that something will happen to their parent or themselves when they are apart. They are often reluctant to sleep alone and may have physical complaints of stomachaches and headaches at times when they must separate from their parents.
Specific Phobias, such as fear of animals, doctor visits, and other specific experiences, often emerge during the elementary school years.
Social Phobia (also known as Social Anxiety Disorder) typically begins in late childhood and continues through adolescence. Children and adolescents with social phobia tend to be seen as “shy” but their discomfort in social settings goes beyond “shyness.” Those with social anxiety will go to great lengths to avoid situations in which they feel uncomfortable, resulting in avoidance of important developmental activities and relationships. In some severe cases, Social Anxiety manifests in earlier childhood (usually prior to age 5) in the form of Selective Mutism. Children with selective mutism are able to speak and can understand what others say but they are unable to speak in certain situations. Typically, these children talk normally and interact normally within the family setting but do not talk in social situations or at school. Their overall behavior and demeanor are very inhibited. They refrain from interacting with those whom they do not know well.
Up to half of adults with Obsessive-Compulsive Disorder (OCD) have reported that their symptoms began in childhood or adolescence. Childhood onset OCD typically begins to manifest in late childhood (10 to 12 years of age). Common obsessions can include fear of contamination and violence, safety concerns, need for exactness and symmetry, and physical complaints and concerns. Common compulsive behaviors include checking, cleaning or washing, counting, repeating, arranging and organizing, and hoarding. Children often try to engage their parents in their compulsive rituals while adolescents tend to try to hide or normalize their rituals.
Generalized Anxiety Disorder (GAD) has also been referred to as “what-if” thinking gone awry. Individuals with GAD worry excessively about the future and what can go wrong. They tend to have high degrees of perfectionism and worry about their competency and performance. This form of anxiety is highly related to physical symptoms of anxiety, also known as somatic complaints. Headaches, stomachaches, and muscle tension are common. Children and adolescents with GAD have often been seen by several medical specialists to evaluate physical symptoms prior to being seen by a behavioral health specialist.
From a developmental perspective, Panic Disorder is usually the last of the anxiety disorders to emerge. Panic disorder is characterized by panic attacks that are discrete periods associated with physical symptoms of distress. These symptoms may include heart palpitations, sweating, tremors, shortness of breath, numbness and tingling as well as an impending feeling of doom. When individuals experience their first panic attacks, they may be taken to a medical facility for evaluation. Panic disorder does not usually emerge prior to adolescence and typically manifests itself between the ages of 15 and 19.
Post-Traumatic Stress Disorder (PTSD) is a form of anxiety that is caused by a single event or recurrent events that cause extreme trauma. The trauma may involve the threat of death or threats to the physical or emotional integrity of the child or adolescent. As a result, the child or adolescent has intrusive flashbacks or nightmares that cause reliving the event in his or her mind. This results in an elevated sense of fear or arousal. People with PTSD avoid situations that remind them of the event.
Just as in adults, anxiety takes many forms in children and adolescents. And just as in adults, anxiety will not just “go away.” Treatment of anxiety in children and adolescents is seen as the first line of treatment for preventing anxiety and other mental health and physical health problems in adulthood. The good news is that anxiety in children and adolescents is treatable. Treatment requires the following:
* recognition of the signs and symptoms of anxiety
* evaluation of the anxiety to rule in or rule out other developmental, medical or environmental factors which need to be addressed
* parent, teacher and child/adolescent education regarding anxiety
* therapeutic intervention including parent training and psychotherapy aimed at the developmental level of the child or adolescent
* environmental supports and accommodations at home, school and in other settings
* consideration of medication to treat the symptoms of anxiety
REFERENCES
* Merikangas, K.R., He, J.P., Burstein, M., Swanson, S.A., Avenevoli, S., Cui, L., Benjet, C., Georgiades, K., & Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication – Adolescent Supplement (NCS-A). Journal of the American Academy of Child Adolescent Psychiatry, 49(10), 980-9.
* Speaking of Psychology: Treating Anxiety in Children. http://www.apa.org/research/action/speaking-of-psychology/children-anxiety.aspx
* National Institute of Mental Health https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder.shtml
* Understood.Org https://www.understood.org/en/friends-feelings/managing-feelings/stress-anxiety/anxiety-why-its-different-from-stress
