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Steven R. Fricke
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Anxiety Disorders in Children and Adolescents
(ADAA,
2003)
Children and teens have anxiety in their lives, just as adults do, and they can
suffer from anxiety disorders in much the same way. Stressful life events, such
as starting school, moving, or the loss of a parent, can trigger the onset of an
anxiety disorder, but a specific stressor need not be the precursor to the
development of a disorder. While children can develop any of the recognized
anxiety disorders, some are more common in childhood than others and tend to be
specific to age development:
 | Generalized
Anxiety Disorder (GAD) -
usually affects children between the ages of six and eleven. It is
characterized by excessive worry and anxiety over a variety of things,
including, but not limited to Grades, Performance in sports, Punctuality,
Family issues, Earthquakes, Health. Physical symptoms of GAD include:
Restlessness, Fatigue/Inability to sleep, Difficulty concentrating,
Irritability, Muscle tension. |
| Specific
Phobia -
defined as the
intense, irrational fear of a specific object, such as Animals,
Storms, Heights, Water, Blood, The dark, Medical procedures. Fears are common
in childhood, however if the fear persists for at least 6 months and
interferes with a child's daily routine, then a phobia is diagnosed. Children
will avoid situations or things that they fear, or endure them with anxious
feelings, by crying, tantrums, freezing, clinging, avoidance, headaches, or
stomachaches. |
|
Obsessive-Compulsive Disorder (OCD) -
characterized by
uncontrollable obsessions and compulsions, which the sufferer usually
recognizes as being excessive or unreasonable. Obsessions are recurring
thoughts or impulses that are intrusive or inappropriate and cause the
sufferer anxiety. Common obsessions include thoughts about contamination;
persistent doubts; extreme need for orderliness; and aggressive impulses or
thoughts. Compulsions are repetitive behaviors or rituals used to neutralize
the anxiety caused by obsessive thoughts, such as cleaning; checking;
repeating; slowness; hoarding. |
| Panic
Disorder -
diagnosed when a
child suffers at least two unexpected Panic Attacks, followed by at least 1
month of concern over having another attack, losing control, or "going crazy."
A Panic Attack is defined as the abrupt onset of an episode of intense fear or
discomfort, which peaks in approximately 10 minutes, and includes at least
four of the following symptoms: a feeling of imminent danger or doom; the need
to escape; palpitations; sweating; trembling; shortness of breath or a
smothering feeling; a feeling of choking; chest pain or discomfort; nausea or
abdominal discomfort; dizziness or lightheadedness; a sense of things being
unreal, depersonalization; a fear of losing control or "going crazy"; a fear
of dying; tingling sensations; chills or hot flushes. |
| Post
Traumatic Stress Disorder (PTSD) -
occurs after
exposure to traumas such as threatened death or serious injury to
one's person; learning about the death, near death, or serious injury of a
family member or close friend; witnessing the death, near death or serious
injury of another person. Symptoms include intrusive thoughts and
recollections, or recurrent dreams; avoidance behavior; general numbness and
loss of interest in surroundings; hypersensitivity, including: inability to
sleep, anxious feelings, overactive startle response, hypervigilance,
irritability and outbursts of anger. They must be present for more than one
month and be accompanied by a drop-off in the ability to socialize, work, or
participate in other areas of daily functioning. |
| Separation
Anxiety Disorder -
can occur any time
before age 18, but it is most common in children between the ages of seven and
nine. It is normal for a child between 18 months and three years of age to
feel some anxiety when a parent leaves the room or goes out of sight, but
children are usually able to leave their parents by the age of four-years-old.
Children suffering from Separation Anxiety Disorder may try to avoid going
places by themselves; refuse to go to school or camp; be reluctant or refuse
to participate in sleepovers; follow a parent around; demand that someone stay
with them at bedtime, or "appear" in their parent's bedroom during the night;
awake from nightmares about being separated from loved ones. |
| Selective
Mutism -
thought to be a
severe form of Social Anxiety Disorder, onset is usually before five years of
age, but it often comes to a head when the child enters school. The average
age of diagnosis is between 4-8 years old, but these children probably
exhibited "extreme shyness" at a much earlier age. Children can be very
talkative, even boisterous when at home, or in a place where they feel
comfortable, but exhibit a failure to speak in situations where speech is
expected or necessary, to the extent that the reluctance or failure interferes
with school and making friends. Common characteristics include standing
motionless and expressionless, turning his/her head, chewing or twirling hair,
avoiding eye contact or withdrawal into a corner; becoming anxious before
entering an uncomfortable situation with possible stomach aches, headaches,
and other physical ailments; display of frequent tantrums and crying,
moodiness, inflexibility, sleep problems and extreme shyness. |
| Social
Anxiety Disorder -
Characterized by a persistent fear and avoidance of social or performance
situations in which the individual may become embarrassed. In
feared situations, socially phobic children are concerned that they will
embarrass themselves and worry that peers and adults will view them as
anxious, weak, weird, or stupid. In the classroom,
they may fear public speaking, convinced that others will notice their
trembling voice or hands; or they may suffer intense anxiety when conversing
with others, fearing they will appear inarticulate.
Some children will avoid eating, drinking, or writing in public due to fear of
being embarrassed by having classmates or teachers see their hands shake, or
out of concern that they may spill, drop, or break something.
Socially phobic
children nearly always experience somatic and cognitive symptoms of anxiety,
including palpitations, tremors, sweating, blushing, muscle tension,
confusion, diarrhea, and gastrointestinal discomfort. |
Guide to Treatment
Anxiety disorders are real, serious
and treatable. Experts believe that anxiety disorders are caused by a
combination of biological and environmental factors, much like other disorders,
such as heart disease and diabetes.
The vast majority of people with an
anxiety disorder can be helped with professional care. Success of treatment
varies with the individual. Some people may respond to treatment after a few
months, while others may take a year or more. Treatment is sometimes complicated
by the fact that people very often have more than one anxiety disorder, or
suffer from depression or substance abuse. This is why treatment must be
tailored to the individual.
Although treatment is individualized,
there are several standard approaches that have proven to be effective.
Therapists will use one, or a combination of these therapies.
TREATMENT OPTIONS
Behavior Therapy
The goal of Behavior Therapy is to modify and
gain control over unwanted behavior. The individual learns to cope with
difficult situations, often through controlled exposure to them. This kind of
therapy gives the individual a sense of having control over their life.
Cognitive Therapy
The goal of Cognitive Therapy is to change
unproductive or harmful thought patterns. The individual examines his feelings
and learns to separate realistic from unrealistic thoughts. As with Behavior
Therapy, the individual is actively involved in his own recovery and has a sense
of control.
Cognitive-Behavior
Therapy (CBT)
Many therapists use a combination of Cognitive
and Behavior Therapies, this is often referred to as CBT. One of the benefits of
these types therapies is that the patient learns recovery skills that are useful
for a lifetime.
Relaxation
Techniques
Relaxation Techniques help individuals develop
the ability to more effectively cope with the stresses that contribute to
anxiety, as well as with some of the physical symptoms of anxiety. The
techniques taught include breathing re-training and exercise.
Medication
Medication can
be very useful in the treatment of anxiety disorders, and it is often used in
conjunction with one or more of the therapies mentioned above. Parents are
understandably hesitant about putting their children on medication without
knowing which ones are appropriate, how they will affect their child, and if and
when they are safe to use. Antidepressants and anxiolytics (anti-anxiety
medications) are often used to ease symptoms so that other therapy can go
forward. Medication may be a short-term therapy, or it may be required for a
lengthy period of time, depending on the patient. Below is a chart listing the
names of drugs commonly prescribed for anxiety disorders, their benefits and
drawbacks.
~
Medications Chart ~
*To help address parent concerns,
follow the link to ADAA's answers to frequently asked questions about treating
anxiety disorders in children with medication:
Anxiety medications and kids
        
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