Anxiety in Children and Adolescents (page 2)
Alex, 15, describes what anxiety feels like:
I grew up in New York, the son of two loving parents. I played little league, I took piano lessons, and I was a good student. In the sixth grade I started feeling different. I began to believe that I would not be liked by anybody. I also began to be very nervous and panicky around people. Fear became a major part of my life. Fear I would say the wrong thing in front of friends and teachers or that I might somehow embarrass and humiliate myself. My desire to not let anyone see my nervousness became so dramatic that everything was pre-meditated. I gave great thought to things that others would find routine - how I moved from place to place, how I held a book or what I did with my hands.
I began to avoid anything that involved risk. If I wasn't doing anything, I couldn't screw up. If I was alone in my room, there was no risk involved and no fear of failure and embarrassment. I never dated, I never spoke with anyone on the phone if it wasn't about homework, and Saturday nights might be spent at a movie with a friend. That was the extent of my social life.
"Why are you so quiet? Why don't you like to go to parties? Why don't you have a girlfriend?" I would hear people say these things and I would become so angry that people had discovered I wasn't normal.
I found myself making excuses. The fact is, I really wanted to not be so quiet, to go to parties and to have a girlfriend, but I was too scared to risk failure. I began to believe that I was simply not meant to be a socially confident person and that everyone else was.
Some common signs:
- Difficulty going to, or staying in, school
- Afraid of being separated from parents
- Excessive worrying
- Trouble concentrating
- Extreme shyness of self-consciousness
- Frequent physical complaints-headaches or stomachaches
- Avoids specific places or situations
- Cries easily
- Lacks energy or interest in age-appropriate activities
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.
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.
- 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.
Reprinted with the permission of the NYU Child Study Center. © NYU Child Study Center.