Fear and anxieties are normal parts of child development. Sometimes, however, anxiety and distress become so severe that they interfere with a child's activities, school performance, or relationships. This could indicate a pediatric anxiety disorder.
Pediatric Anxiety Disorders affect up to one-eighth of all youth and are the most common mental health problem in children.
Pediatric anxiety disorders can cause impairment in all aspects of a child's life, including scholastic, social, and familial. They can also occur in conjunction with other disorders such as depression, eating disorders and attention deficit/hyperactivity disorder (ADHD).
Pediatric Anxiety Disorders Include:
Separation Anxiety Disorder - severe distress upon separation from a person or place to whom the child is emotionally attached. A child with Separation Anxiety Disorder may refuse to go to school (or elsewhere), often stating fears regarding their parent's safety during this separation.
Separation Anxiety disorder affects about 4% of children and is most common in children ages seven to nine. Some symptoms include extreme anxiety when away from home, parents or caregivers. Other symptoms include: excessive homesickness, feelings of misery, refusal to go to school, camp or sleepover.
Normal separation anxiety usually occurs in children from 18 months of age to three years of age. Crying after being dropped off at daycare/sitters is normal and usually subsides after the child is engaged in a new activity.
Social Phobia - a fear of being judged by others and/or embarrassed in front of them. Social phobia may interfere with attending school or other public forum activities (speaking, eating, writing in public).
Specific Phobia - excessive fear of an object or situation (insects, heights, bridges) that leads to avoidance of situations wherein the child may encounter the feared object. Unlike adults, children do not recognize their fear as irrational. Crying, tantrums, clinging, headaches, and stomachaches are common manifestations of the anxiety or fear.
Generalized Anxiety Disorder - chronic, exaggerated worries about every day situations that are much more exaggerated than the situation dictates.
Post-Traumatic Stress Disorder - children who display an intense fear and anxiety, who are emotionally numb and easily irritable, and avoid places, people and activities after experiencing a traumatic event. Not every child who suffers a traumatic event will develop PTSD; however, children who have previous mental health issues, witnessed the trauma first-hand and were directly affected (such as an injury or death of a parent) or lack a strong supportive network are at a greater risk of developing PTSD. Witnessing domestic violence also raises a child’s risk for developing PTSD after traumatic event.
Panic Disorder - recurring panic attacks during which a child feels a sudden, inexplicable jolt of terror, often occurring with physical symptoms such as rapid heartbeat, dizziness, and shortness of breath. This disorder is diagnosed after at least two unexpected panic/anxiety attacks, followed by concern over having another attack, losing control or ‘going crazy’ for a period of 1 month or more.
Obsessive-Compulsive Disorder - recurrent, intrusive thoughts (obsessions) and repetitive, ritualistic behavior (compulsions). OCD is usually diagnosed around ten years of age. Boys are more likely to be diagnosed before puberty, girls during adolescence.
Tic Disorders - sudden, involuntary movements or sounds that affect up to ten percent of school-age children. Tic disorders often occur with anxiety disorders (especially OCD).
Social Mutism - children who are otherwise talkative but refuse to speak in situations where talking is expected, to the extent that it interferes with school performance and making friends. These children may stand motionless, twirl their hair, avoid eye contact, or hide in a corner to avoid speaking.
How Is Normal Pediatric Anxiety Different From A Pediatric Anxiety Disorder?
Normal pediatric anxiety is very common for school-aged children. Generally, worries revolve around illness, school performance, getting teased, athletic prowess, and making mistakes.
Sometimes the worry is more intense, distressing, persistent and difficult to control. This anxiety may impair a child's functioning, lead to increased absences in school or other important functions, and result in the child engaging (later in life) in substance abuse.
Diagnosis of Childhood Anxiety:
Due to correlation between anxiety and other mental health issues, anxiety can be hard to diagnose in children. A comprehensive and exhaustive medical history is needed as background. The goal is to differentiate an anxiety disorder from a different medical issue.
Medical personnel should remember there is often a significant difference between what a parent says about anxiety issues and the child’s own accounting.
New research has shown that children and adolescents have the same reactions to established treatments for adults. This includes a combination of medication, cognitive behavioral therapy, and parent/child education.
Anxiety is classified into the disorders outlined above.
An appropriate diagnosis of pediatric anxiety disorder is made by a trained psychologist based upon the symptoms, how anxiety is triggered and the course the anxiety tends to follow.
Psychological - stressors overwhelm normal coping abilities.
Psychodynamic - instincts and impulses conflict internally and cause distress.
Behavioral - an unhealthy learned response from a past bad experience becomes the ‘normal’ response to similar situations.
Spiritual - occasionally, people feel a profound emptiness that causes them to seek a higher purpose in life. This especially is common when people fear their own morality or death.
Genetic - people who have close relatives with anxiety disorders are 50% more likely to develop an anxiety disorder themselves.
Biologic - in some people, there appears to be a dysregulation of the noradrenergic and serotonergic neural systems, two interrelated areas of the brain. Brain imaging studies have shown some evidence of abnormal function in several regions of the brain in those with anxiety.
Medical - being sick, especially with a life-threatening illness, can cause anxiety.
Treatment of Pediatric Anxiety:
Anxiety disorders are often chronic unless they are properly managed and treated. Children often need professional guidance to overcome their anxiety disorders.
The two scientifically proven treatment methods used to treat childhood anxiety are:
Cognitive Behavioral Therapy (CBT) is a type of talk-therapy that's been scientifically proven to be effective in treating anxiety disorders. CBT will teach skills and techniques to help a child reduce their anxiety.
A child in CBT will learn to replace negative thought patterns and behaviors with positive ones. The child will learn to separate unrealistic thoughts from realistic thoughts.
Medication can be helpful to manage anxiety disorders and are often used in conjunction with cognitive-behavioral therapy. Medication may be used for the short or long-term, depending upon how well the child responds.
Tips for Parents:
- Remember: childhood anxiety disorders aren't a reflection upon you or a result of poor parenting.
- Stay calm when your child becomes anxious.
- Recognize and praise even minor accomplishments.
- Pay attention to your child's feelings.
- Don't punish mistakes or lack of progress.
- Be flexible and try to maintain a normal routine.
- Modify the routine during stressful times.
- Plan for transitions.
Additional Pediatric Anxiety Resources
Child Anxiety Network: provides user-friendly information and direction to parents and caregivers about child anxiety.
Anxiety Disorders Association of America: The mission of the Anxiety Disorders Association of America (ADAA) is to promote the prevention, treatment, and cure of anxiety and stress-related disorders through advocacy, education, training, and research. The ADAA offers a screening checklist for parents to assess whether their child may be suffering from an anxiety disorder. It also offers information about anxiety and schools to help you understand what schools should be able to provide your child in terms of individualized programs to help ease and manage their day-to-day anxiety.
Worry-Wise Kids: This is a site devoted to transforming the lives of families affected by pediatric anxiety through research, resources, and advocacy. Many useful links and helpful tips for parents who are struggling with a child dealing with pediatric anxiety.