Anxiety in Children and Adolescents

What is Anxiety?

Anxiety is a basic emotion experienced by all human beings. Everyone experiences anxiety at times in response to stress or to fear-provoking events. An anxiety reaction as a response to danger is actually helpful because it warns people to avoid or escape potentially dangerous situations. An anxiety reaction can be adaptive in certain situations, such as test-taking. Sometimes, however, anxiety becomes excessive and causes significant distress. When anxiety results in fear or apprehension that is out of proportion to an individual's life situation or developmental stage and impairs an individual's ability to function, it is a mental health disorder.

For example, some children have unusually strong or overwhelming feelings of anxiety. While many children are scared of things like the dark, taking tests, and meeting other kids, most eventually learn that there is nothing to fear about the dark, that studying helps pass tests, and that other kids are usually pretty friendly. Some children, however, have difficulty managing their anxiety and, instead of taking charge of their fears, they feel worse about themselves and their inability to control their anxiety. Anxious feelings might take the form of headaches, stomachaches, cold and clammy hands, rapid heartbeat, feelings of faintness, and a general feeling of tension. To avoid feeling anxious, these children may avoid the situations that are anxiety-provoking for them.

Where does anxiety come from?

Anxiety results from a combination of factors - genetic, biological, and environmental. Anxiety disorders have a genetic component, with anxious parents being more likely to have anxious children (although the specific anxiety disorder often differs between parent and child).

It has also been found that people with anxiety disorders anticipate and experience threat even when no threat is present, and are more likely to interpret ambiguous situations as threatening than other people. The overestimation of threat may be due not only to a genetic predisposition but also to a chemical imbalance or biological differences in the hardwiring of the brain.

In addition to the genetic and biological factors, environment also plays a role in the development and perpetuation of anxiety. For example, parents who express excessive amounts of fear in a given situation teach their children that such a situation requires a strong fear response. In fact, parents might inadvertently teach their children to be unnecessarily fearful of a neutral situation.

Example: Julia's mother is afraid of meeting new people and confronting new situations. Julia, who is 5 years old, is beginning to learn that new people and new places must be scary, because her mom is so afraid of them.

Parents who are themselves fearful of a situation and avoid the situation at all costs in order to prevent feelings of anxiety teach their children that avoiding the anxiety-provoking situation is an acceptable way to reduce anxiety.

Example: Victor's dad is afraid of dogs and won't leave the house if there is a dog anywhere in the vicinity. Victor has learned that avoiding the situation is an acceptable way to prevent anxiety, and that not going to play at his friend's house is an acceptable way to deal with being afraid of new places.

Anxiety in children takes different forms

• Separation Anxiety Disorder Anxiety over separation from familiar people and situations is a normal part of growing up, and generally this anxiety eases as a child gets older. A child or adolescent who experiences excessive anxiety on routine separation from parents, caregivers, home, or other familiar situations may be suffering from separation anxiety disorder. Common markers include crying, clinging, or panic when faced with separation as well as excessive worrying about harm to loved ones or fear that they will not return home. Children may be reluctant to sleep alone and may refuse to attend school.

• Social Phobia As children develop, they are expected to interact socially with peers and adults. Some children, however, experience unusually high levels of anxiety when faced with certain social situations. They report anxiety and avoidance of these situations due to fears of looking foolish, being rejected, or being evaluated negatively. When such anxiety and avoidance causes significant distress and interferes with daily function, it may be considered social phobia. Common markers include fears of starting or joining a conversation, making and keeping friends, giving oral reports, taking exams, being assertive, eating in public, or taking part in performance-based activities like gym or music.

• Generalized Anxiety DisorderEvery child and adolescent worries about things at school and in everyday life. Some, however, can't stop worrying no matter how much reassurance is given to them. Children and adolescents with generalized anxiety disorder have excessive and uncontrollable worry about a variety of topics from school performance and personal health to world events and family issues. Common markers include worrying about a wide spectrum of topics (e.g. competence, school, future events, past events), increased irritability, sleep disturbance, and muscle aches and pains.

• Panic Disorder With or Without Agoraphobia Panic disorders are recognizable by symptoms such as shortness of breath, pounding heart, tingling and numbing sensations, hot or cold flushes, and terror when in certain situations or places. During a panic attack the child feels intense fear or discomfort, a sense of impending doom or sensations of unreality. Panic attacks may or may not accompany agoraphobia, the fear of being stuck in a situation where help or escape is unavailable. Panic attacks occur less frequently in children, but are not unusual in adolescents.

Childhood anxiety disorders may exist along with other disorders, such as depression and disruptive behavior disorders.

When to be concerned about a child's anxiety

During certain developmental stages anxiety in children is a normal response. For example, stranger anxiety in children ages 7 to 11 months, and separation anxiety in children from 8 months to 3 years, is a healthy, protective response.

For example, when a 2-year-old child is afraid of leaving his mother that fear will protect him from wandering alone into potentially dangerous situations. Young children may have short-lived fears, such as fear of the dark, animals, etc. But when an 8-year-old is afraid of leaving his mother, that's a problem.

Anxiety becomes a problem when it interferes with a child's daily activities. For example, if a child is so worried about leaving her parents that she won't go to school, or if she is so worried about what others will think of her, that she can't enjoy her extracurricular activities and friends, she may be experiencing excessive anxiety. If left untreated, over time, anxiety can compromise a child's self concept, school performance may decline, and peer relationships may become strained. Existing problems such as family tension may worsen, and may even lead to additional problems, like reluctance or refusal to attend school.

How anxiety is treated

Anxiety disorders are the most common psychological disorders, affecting up to 18 percent of the American population at some point in life. Fortunately, anxiety disorders are also highly treatable; 90 percent of those treated for anxiety recover fully. Treatment for anxiety is based on an extensive body of scientific research which has focused on identifying which treatments are most suitable and effective for the specific form of the disorder. When formulating a treatment plan, the mental health professional takes into account many factors, including the level of distress experienced by the child and the degree of social, academic, and family disruption.

The two modalities for treatment of anxiety disorders are medication and Cognitive Behavioral Therapy (CBT).

Medication for anxiety disorders acts directly on the central nervous system to calm an individual and reduce anxious behaviors.

Cognitive Behavioral Therapy for anxiety disorders involves a two-step process: targeting anxious thoughts, and then targeting anxious behaviors. Through this process an individual learns in a step-by-step fashion how to master situations that cause anxiety. The individual is taught strategies such as relaxation techniques and phrases to help when anxiety is at its height. For some children, a combination of medication and CBT is the most effective course of treatment. The length and type of treatment varies by disorder, and treatment for one anxiety disorder may not be appropriate for another. Learn more about CBT in our related article, Cognitive Behavior Therapy: What Is It and How Does It Work?

How parents can help

The following are some helpful tips for dealing with an anxious child:

• Helping your child avoid or escape anxious situations only perpetuates her anxiety. Instead of rescuing her, encourage the child to work through her fears, and praise efforts aimed at coping. In this way she will learn not to rely on others to make her feel better.

• Question the child about what's happening and encourage him/her to think about what to do.

• Children model their parents' emotions and behaviors and look to parents for clues on how to respond to a situation. Manage and monitor your own reactions to anxiety-provoking situations as well as your response to your child's expressed anxiety.

 

About the NYU Child Study Center

The New York University Child Study Center is dedicated to increasing the awareness of child and adolescent psychiatric disorders and improving the research necessary to advance the prevention, identification, and treatment of these disorders on a national scale. The Center offers expert psychiatric services for children, adolescents, young adults, and families with emphasis on early diagnosis and intervention. The Center's mission is to bridge the gap between science and practice, integrating the finest research with patient care and state-of-the-art training utilizing the resources of the New York University School of Medicine. The Child Study Center was founded in 1997 and established as the Department of Child and Adolescent Psychiatry within the NYU School of Medicine in 2006. For more information, please call us at (212) 263-6622 or visit us at www.AboutOurKids.org.