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Anxiety Disorders in Children and Adolescents

We all experience anxiety, and although anxiety is not a pleasant emotion, it is sometimes useful. Anxiety alerts us to threats and problems or motivates us to do well or prepare for a challenge. Young children often become anxious around unfamiliar animals or strangers, in dark places or during storms. Teenagers will experience anxiety the night before an exam and use this to become motivated to study.

However, when a child or adolescent frequently experiences intensive anxiety in everyday situations, they may have an anxiety disorder.

How can I recognize an anxiety disorder?

Anxiety disorders can cause both an emotional and physical reaction. Unexplained or unreasonable feelings of fear and obsessive or negative thoughts are psychological symptoms of an anxiety disorder. This can lead to behaviors like refusing to go to school on a test day.

Increased heart rate, rapid breathing or difficulty catching one’s breath and excessive sweating in non-threatening situations are common physical symptoms of anxiety disorders. They may happen in a normal situation when a teenager is faced with a difficult situation like speaking in front of the class but when they appear suddenly for no reason, an anxiety disorder might be the cause.

These reactions come from the “fight or flight” response we all share, but become a problem when triggered without a good reason.

Anxiety disorders often occur with other mental health conditions such as depression or ADHD. Teenagers with an anxiety disorder are placed at an increased risk for abusing alcohol and drugs and this can result in what is known as a co-occurring disorder.

How common are anxiety disorders in children and adolescents? Which are the most common?

Anxiety disorders are the most common mental health issues in America. The National Institute of Mental Health (NIMH) reports that 8 percent of adolescents have an anxiety disorder. The average age for symptoms to develop is 6 years old.

All anxiety disorders have some traits in common:

  • Each disorder has a trigger—a situation or object—which causes fear and anxiety.
  • The amount of fear and anxiety is excessive and lasts well beyond a normal experience.
  • Anxiety disorders often last at least 6 months, but anxiety disorders in very young children may not last as long.

The most common anxiety disorders affecting children and adolescents include:

Generalized anxiety disorder. This type of anxiety disorder may cause a young person to worry about a range of issues like friendships, grades, family issues or athletic performance.

Children and adolescents who experience this type of anxiety become “people pleasers” and need approval and reassurances. They may be particularly hard on themselves and become perfectionists. Some common symptoms include complains of fatigue, tension, headaches and nausea.

Separation anxiety disorder. This type of anxiety disorder is very common and affects 4 percent of all children. Normally, a very young child will experience a period of distress when a parent leaves the room or a child may cry when be dropped off at day care, but a child with separation anxiety disorder experiences extreme anxiety and cannot be distracted or engaged in activities for a significant period of time.

Often they will fear something bad like an injury, disaster or death will happen to their parents or loved ones while they are separated, or worry that they will experience something disastrous such as getting lost, kidnapped or becoming sick. These distressful feelings can cause a young person to refuse to go to school, camp or friend’s sleepover. Bedtimes could become a struggle as the child resists being left alone in the bedroom. A teenager could become devastated over the break-up of a relationship.

Social anxiety disorder. Social anxiety disorder, or social phobia, produces an extreme fear of being humiliated or embarrassed in front of other people. Sometimes this problem is also related to feelings of inferiority or low self-esteem.

Social anxiety disorder is much more than shyness and most often affects older children and teenagers. It can produce uncontrollable, extreme and negative reactions to social situations and can result in isolation, depression or substance abuse. A young person with this disorder may experience extreme fear at the thought of using a public restroom, speaking in public, eating in a restaurant or dating. They often feeling as if everyone is watching them and fear “doing or saying something stupid” which will be humiliating. They may also see every small mistake as a major issue.

Panic disorder. Panic disorder often begins during adolescence, though it may start during childhood. It is characterized by “panic attacks” that cause dramatic physical changes like chest pain and heart palpitations, shortness of breath or dizziness or stomach distress Young people will try to avoid situations if they fear a panic attack will happen, and this avoiding behavior may interfere with school, home and social relationships.

Obsessive-compulsive disorder (OCD). OCD involves obsessions and related compulsions that happen frequently in response to triggers. OCD causes young people to feel anxious or distressed and interfere with normal home and school life.

Is there help for anxiety?

Anxiety can be successfully treated many times with a combination of therapy, family therapy, education, support and possibly medication.

Successful treatment begins with a thorough evaluation of symptoms, including duration and severity. Taking a look at medical and psychiatric history and family history is also very important. Getting input from teachers or other involved adults can help provide a clearer picture.

Locating a mental health professional with experience assessing and treating young people with an anxiety disorder is best. The American Academy of Child & Adolescent Psychiatry, other professional societies or your insurer can help you identify someone. You may want to interview potential therapist to learn about their approach to treatment.

Parent involvement is very important to the evaluation process as well as the development of a treatment plan. What does treatment look like?

Successful treatment plans often include:

Cognitive behavioral therapy (CBT) which focuses on the relationships between negative or automatic thoughts, feelings and behaviors. Ask potential therapist about their training.

Medication in combination with therapy is an effective treatment. In a major study on this topic, the combination of medication and CBT was far more effective than either alone. Parents should discuss the risks and benefits of medications with their child’s doctor. Antidepressants carry a U.S. Food and Drug Administration (FDA) black box warning for use in children and adolescents.

Family therapy, education and support are also important. Your child’s mental health professional can offer suggestions about family therapy options. NAMI offers family education programs and support groups. NAMI Basics Education Program is designed for parents and caregivers of children and teens experiencing a mental health disorder. You can locate a program near you at Find Your Local NAMI.

My child is experiencing a lot of anxiety. I think it’s becoming a problem. How can I help?

Learning about anxiety disorders is an excellent way to understand what your child is experiencing. If anxiety is preventing them from engaging in school, friendships or other important areas of life treatment might be necessary to restore wellness.

However, there are many things you can do to help your child or teenager:

  • Pay attention to your child’s feelings and learn what triggers their worry or anxiety. You need to be calm when your child becomes anxious.
  • School environments can also have a big impact on anxiety symptoms. For example, a big school with crowded hallways or large classes may be causing your teenager unnecessary anxiety.
  • If the child’s symptoms are interfering with their education, an Individual Education Plan (IEP) may be helpful to provide additional support, reduce anxiety and improve school performance. To begin looking at educational options or accommodations talk to your child’s counselor or school psychologist.
  • Create routines during the day around mealtimes, homework, quiet time and bedtime. It helps children manage anxiety, but it’s also OK to be flexible.
  • Reduce stress and tension at home. Arguing, too many activities, performance pressure are a few things you can try to address.
  • Recognize and praise achievements, but set reasonable consequences for inappropriate behavior. Don’t punish mistakes or slow progress.
  • Avoiding things or events that cause anxiety is a nature reaction. However avoidance only works temporarily. Fears will grow and make things more difficult in the future.
  • Encourage your young person to try things on their own or take small risks. Be supportive, but don’t take over.

Anxiety disorders are no one’s fault. However, they can complicate and add stress to your family life. Building a support network of friends and relatives helps. At NAMI, we understand the difficulties you may be facing and can help by connecting you with a support network and information to guide your family on the path of recovery.

Reviewed by Ken Duckworth, M.D., May 2014

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