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Anxiety Disorders in Children and Adolescents

What are Anxiety Disorders in children and adolescents?
Children and teens with anxiety disorders often feel excessively frightened, distressed, and uneasy during many situations that would not cause the same reaction in other children.  Anxiety disorders can dramatically reduce productivity and school attendance in children and adolescents.  Severe anxiety can contribute to low self-esteem, problems in interpersonal relationships, alcohol abuse, and adjustment difficulty.

Anxiety Disorders affects as many as one in 10 children; it is the most common mental disorder in America.  As with any mental illness, it is often not discovered because people are too ashamed to seek help.

The most common anxiety disorders include:
Panic Disorder:  Children and adolescents with Panic Disorder may experience unrealistic worry, self- consciousness, and tension.  They may also get a Panic attack, which involves sudden feelings of terror that will strike continually, without warning.  Some physical symptoms include shortness of breath, fear of dying, abdominal pain, dizziness and heart palpitations.

Obsessive-compulsive Disorder (OCD):  please refer to Obsessive Compulsive Disorder in Children and Adolescents.  

Phobias:  A phobia is an irrational fear that something is dangerous, even when it is not.  Phobias can be quite disabling and can lead to avoidance of objects or situations.  When a person is phobic, they may experience extreme feelings of terror, dread, and panic.  Their life becomes quite restricted, depending on how many objects or situations cause great fear.  A phobia can be specific, i.e., centering on particular objects (e.g., certain animals) or situations (e.g., heights or enclosed spaces). Common symptoms can be clinging, tantrums, crying, headaches and stomachaches.  Children and adolescents with "social" phobia may display hypersensitivity to criticism, difficulty being assertive and low self-esteem.

Social Anxiety Disorder:  Social anxiety disorder, or social phobia, is characterized by an intense fear of social and performance situations and activities such as being called on in class or starting a conversation with peers.  Social Anxiety disorder can have a significant impact on school performance and attendance.  Children with Social Anxiety disorder have difficulty socializing with peers and developing and maintaining relationships.

Selective Mutism: Selective Mutism is characterized by a refusal to speak in situations where talking is expected, such as the classroom.  This obviously affects their performance in school and in their ability to develop social relationships in school.

Children who are selectively mute may stand motionless and expressionless, turn their heads, chew or twirl hair, avoid eye contact, or withdraw into a corner to avoid talking.  At home or other places where they feel comfortable, these children will display good verbal expressive abilities and will display normal behaviors.  Thus, parents are sometimes shocked to discover that their child in selectively mute in school.

The average age of diagnosis is between 4 and 8 years old, or around the time a child enters school.

Separation Anxiety Disorder:   Between the ages of 18 months to 3 years, children will often experience separation anxiety when a parent leaves the room or moves out of their sight.  In most cases, this is a normal reaction. It’s also common for children to cry when they begin their first school experience, such as pre-school.  In most cases, the crying will stop once they begin engaging in the classroom or new environment.

If your child is slightly older and unable to leave you or another family member, or takes longer to calm down after you leave than other children, then the problem could be separation anxiety disorder, which affects 4 percent of children. This disorder is most common in children ages seven to nine. A child with separation anxiety disorder will experience extreme homesickness and unhappiness when separated from the parent or caregiver

Other symptoms include refusing to go to school, camp, or a sleepover, and demanding that someone stay with them at bedtime. Children with separation anxiety commonly worry about bad things happening to their parents or caregivers or may have a vague sense of something terrible occurring while they are apart.

Post-traumatic Stress Disorder (PTSD):  PTSD often occurs following a trauma, such as witnessing or experiencing violence, abuse (physical, sexual or emotional) or natural disasters.  Symptoms include nightmares; flashbacks; the numbing of emotions; depression; feeling angry, irritable, and distracted; and being easily startled.

Children most at risk for PTSD are those who directly witnessed a traumatic event, who suffered directly (such as injury or the death of a parent), had mental health problems before the event, and who lack a strong support network. Violence at home also increases a child’s risk of developing PTSD after a traumatic event.

Not every child who experiences or hears about a traumatic event will develop PTSD. It is normal to be fearful, sad, or apprehensive after such events, and many children will recover from these feelings in a short time.

Generalized Anxiety Disorder (GAD):  Children with GAD are constantly worrying –about everything, even the most routine aspects of life.  If this kind of worry persists for at least 6 months, it is indicative of GAD. Children and adolescents with this disorder usually anticipate the worst and often complain of fatigue, tension, headaches, and nausea.

Children with GAD tend to be very hard on themselves and strive for perfection. They may also seek constant approval or reassurance from others.

What are the causes of anxiety disorders in children and adolescents?
There is some research that suggests that children and adolescents who present with an anxiety disorder are more likely to have caregivers who have some form of anxiety disorder.  Currently, it is unclear as to whether biology or environment plays a greater role in developing this disorder.  There are indications that children who are very shy or very anxious by 6-8 years of age may develop anxiety disorders later on.

PANDAS (Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcal infections) is an autoimmune disorder caused by strep bacteria that can cause obsessive-compulsive or tics symptomology.  Thus parents are encouraged to treat strep throats seriously and immediately.

What treatments are available for anxiety disorders in children and adolescents?
Effective treatments for anxiety disorders include medication, cognitive-behavior therapy (CBT), psychotherapy, family therapy or a combination of these. Cognitive-behavioral treatment is the most popular and effective treatment for OCD and involves the young person’s learning to deal with his or her fears by modifying the way he or she thinks and behaves by practicing new thinking strategies and new behaviors.

Ultimately, parents and caregivers should learn to be understanding and patient when dealing with children with anxiety disorders.  It is best when the treatment plan is developed with the involvement of the child or adolescent whenever possible.

At OHEL we can help.
The diagnosis and treatment of anxiety disorders in children and adolescents must be done by a licensed mental health professional or by a licensed psychiatrist.  The competent mental health professionals at OHEL can provide the help needed to empower children and teens impacted by anxiety disorders and allow them to regain control and improve their quality of life.

Remember, at OHEL, we are only a phone call or a click away from your road to recovery.

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