What is an Anxiety Disorder:
Anxiety is a natural part of growing up and can be helpful, like pushing us through stressful situations, boosting our study efforts for exams, or aiding concentration during important speeches. 1 While young children usually outgrow common, temporary fears such as fear of the dark, storms, animals, and separation from parents, or strangers, some children and teenagers with an anxiety disorder experience ongoing fear, nervousness, and shyness. This can lead them to avoid certain places and activities. 2,3 For those with an anxiety disorder, comfort or reassurance doesn't ease their fear and anxious feelings. It becomes more challenging for them to overcome these emotions.
Differentiating Specific Anxiety Disorders
Recognizing the particular anxiety disorders that your child might be facing is essential in formulating an effective treatment strategy to conquer their fears and challenges. Below, we highlight some of the prevalent childhood anxiety disorders we commonly diagnose and treat:
- Generalized Anxiety Disorder: Children and teens with generalized anxiety face continuous excessive worry across various aspects of their lives, such as school, family, social situations, health, and natural disasters. They might be hard on themselves, aiming for perfection, and seeking constant approval. This disorder affects about 0.9% of individuals within a year, being more prevalent in females than males.
- Separation Anxiety: Children grappling with separation anxiety exhibit an intense fear of being away from their home or caregivers. They may resist attending school, camp, or sleepovers, often worrying about the safety of their parents or caregivers. These kids struggle to be distracted once a parent leaves and take longer to calm down afterward. The disorder affects 4% of children and 1.6% of adolescents.
- Specific Phobia:This is marked by anxiety about a specific object (like spiders) or situations (such as driving on highways). The fear, anxiety, or avoidance often escalates quickly in response to the phobic trigger, sometimes surpassing the actual risk. The prevalence of specific phobias is around 7%, with more females, especially during adolescence, exhibiting this disorder.
- Social Anxiety Disorder: More common among teenagers, social anxiety leads children and teens to feel anxious in social or performance settings. They might dread being called upon in class, initiating conversations, using public restrooms, public speaking, or eating out. This anxiety arises from the fear of humiliation or embarrassment in front of others, potentially leading to isolation, depression, or substance misuse.
- Panic Disorder: A panic disorder becomes evident when a child or teen experiences intense physical symptoms like rapid heartbeat or breathing difficulties seemingly out of nowhere. The disorder affects less than 0.4% of children under 14 and 2-4% of adolescents, with a higher occurrence among females.
- Obsessive-Compulsive Disorder: If your child struggles with intrusive thoughts leading to anxiety and engages in ritualistic behaviors, it might indicate Obsessive-Compulsive Disorder.
- Selective Mutism: Characterized by a consistent failure to speak in situations where speaking is expected, even if the individual speaks elsewhere. For instance, a child might not speak at school but does so normally at home. The prevalence of selective mutism ranges from 0.03% to 1%.
Understanding Typical Childhood Anxieties
It's common for children to experience certain anxieties at different stages of their growth. Here's what's usual for various age ranges:
- 2-4 years: Anxieties about using the potty, water (baths and pools), darkness, loud noises, strangers, "bad" people, characters in costumes, being away from parents, and getting lost.
- 5-7 years old: Fears of the dark, monsters/ghosts, "bad" people, parental absence, getting lost, bugs/animals/insects, visits to doctors/dentists, thunder and lightning.
- 8-11 years old: Concerns about supernatural entities, sickness or death of themselves, loved ones or pets, fitting in with peers, and performing well in school and tests.
- 12 and beyond: Anxieties about social judgments, personal appearance, school and sports performance, and global events (like natural disasters, war, terrorism, and crime).
Differentiating an Anxiety Disorder:
Anxiety disorders stand apart from normal, age-related fears by their intensity or duration. When fears extend beyond the expected scope, they could be a sign of an anxiety disorder. These disorders disrupt daily life, causing problems at home, school, or with friends. Children may go to great lengths to avoid anxiety-triggering situations. Physical symptoms (like headaches, and stomachaches), excessive reassurance-seeking, safety behaviors, rituals, and frequent outbursts are also common.
If you believe your child might be grappling with anxiety, don't hesitate to reach out to the professionals at Manhattan Psychology Group. We're here to provide guidance and support.
Recognizing Childhood Anxiety Signs:
Anxiety can manifest in various ways in children, and I address all these forms in my private practice:
- Specific Fears or Phobias: Common fears like the dark, solitude, animals, and monsters are treatable through exposure and cognitive-behavioral techniques.
- Insomnia: Sleep problems, including resistance to bedtime, difficulty falling or staying asleep, or waking too early, should be resolved promptly to prevent future psychological issues.
- Separation Anxiety: Difficulty separating from caregivers, nightmares about their safety, or fear of being alone, particularly common in younger children or following traumatic events.
- Generalized Anxiety: Uncontrollable worry, perfectionism, somatic complaints, restlessness, constant need for reassurance, and fear of performance, often more diffuse in nature, making treatment more challenging.
- Post Traumatic Stress Disorder (PTSD): Arising from traumatic events like abuse or death, resulting in dissociation, nightmares, flashbacks, hypervigilance, and avoidance of trauma-associated stimuli.
- Obsessive Compulsive Disorder (OCD): Marked by intrusive thoughts (obsessions) and ritualistic behaviors (compulsions) to ease anxiety about certain fears, like collecting objects or checking behavior.
- Selective Mutism (SM): Children refrain from speaking in specific situations for over a month, typically due to upsetting experiences. Behavior plans and rewards prove effective in school and at home.
- School Refusal: Children avoid attending school due to fear, requiring immediate return to prevent escalation.
- Social Anxiety: Adolescents may fear embarrassment in social settings, especially if underlying anxiety is present.
- Test Anxiety: More prevalent in older adolescents, characterized by physical symptoms like sweating, racing heartbeat, irrational thoughts, and panic during exams.
Anxiety often drives parents to seek help for their children. Left untreated, it can worsen over time.
When Does Anxiety Become a Disorder?
Anxiety becomes a disorder when it:
- Persists beyond what's typical for a child's development stage.
- Starts to interfere with the child's ability to carry out daily tasks effectively.
- It remains ongoing or becomes overly intense.
What Triggers an Anxiety Disorder?
The roots of anxiety disorders are complex and not attributed to a single cause. Typically, the development of an anxiety disorder is influenced by a combination of biological and environmental factors, including parenting styles. Genetic factors and a child’s inherent temperament also play a significant role in predisposing them to anxiety disorders.
For instance, a child who naturally exhibits caution, quietness, and shyness may be more susceptible to developing an anxiety disorder. Additionally, adverse experiences during childhood can contribute to the risk of developing anxiety disorders.
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Treating Anxiety Disorders: What You Need to Know
Recognizing anxiety disorders in children and teenagers can be challenging, especially since they may come across as quiet, compliant, and eager to please. Despite their outward demeanor, it's essential to understand that they could be grappling with anxiety or fear. A proven approach for addressing anxiety is cognitive behavioral therapy (CBT), which targets the connection between negative or automatic thoughts, emotions, and behaviors. CBT equips children and young individuals with fresh ways of thinking to better manage their anxiety.
Research has shown that CBT is significantly more effective than receiving no therapy, as it helps alleviate symptoms of anxiety. According to the National Institute of Mental Health, CBT, whether used alone or in conjunction with medication, can effectively treat anxiety disorders in children. It's important to note that anxiety disorders are not anyone's fault. However, they can complicate family life and contribute to stress. Building a support network of friends and relatives can offer valuable assistance during this journey.
Anxiety Disorder Treatment Options for Teens and Kids
When it comes to helping teens and kids manage anxiety disorders, various approaches can be effective. Let's break down some of these methods:
- Psychoeducation: This involves learning about anxiety's causes and how it persists through both positive and negative reinforcement. It's important for both parents and children to understand their roles in the treatment process.
- Relaxation Training: Learning how anxiety affects the body and then acquiring techniques to calm the body and activate the relaxation response can be quite beneficial.
- Cognitive Reframing: In this approach, the therapist and client discuss the worry-filled thoughts and then work together to challenge them. New, more reasonable thoughts are developed as a replacement.
- Exposure and Response Prevention (ERP): ERP involves facing fears head-on without avoiding them. With the help of a therapist, a hierarchy of feared situations is created. Clients then intentionally expose themselves to these situations, without engaging in behaviors that reduce anxiety. This method aims to reduce fear over time.
- Positive Reinforcement for Facing Fears: Purposefully confronting anxiety-inducing situations can be tough, especially for children. Rewards, like points or direct incentives, can boost motivation to participate in exposure. Reward charts are often used to track progress.
Using these techniques, teens and kids can develop effective tools for managing anxiety. It's about finding what works best for each individual and building a strong foundation to handle anxiety in a positive way.
