Childhood Anxiety


Anxiety disorders can develop in people of all ages including children. Social anxiety (or excessive shyness) and obsessive compulsive disorder, for example, can occur in children as young as five. Excessive fear of being separated from parents or caregivers (known as separation anxiety disorder) can occur at even younger ages. Despite the frequent media Example Imagefocus on other issues, recent studies have indicated that anxiety disorders may be present in as many as 24% of children and teens making it a far more common problem than mood disorders (7%) disruptive disorders (8%) and substance abuse (4%). If left untreated childhood anxiety disorders can lead to the development of significant ongoing difficulties in adult life.

What anxiety disorders may be experienced by children? It is normal for children to experience fear, worries and phobias at certain times during their development. For example children, when young, typically develop a fear of separation from their parents at around the same time as they begin to fear new people and strangers. Later most children will develop a fear of the dark and worry at night that there may be a monster under the bed or in their wardrobe. These types of fears are a normal part of development and are usually transient. Sometimes, however, anxiety occurring during childhood can become excessive and cause a significant problem for the child. Separation Anxiety Disorder (SepAD) is a disorder ascribed specifically to children that is thought to occur in around 4% of children and adolescents. SepAD is usually diagnosed if a child is experiencing excessive distress when anticipating separation from home or major attachment figures, when there is persistent excessive worry about harm coming to those they are close to and when they are excessively reluctant to be left alone at home and in other settings.

Other anxiety disorders which can occur in children are the same as those experienced by adults. Social anxiety disorder (SAD) in children is often viewed as excessive shyness. It is common in younger children and adolescents and frequently continues into adulthood (Click here for more information on SAD). Obsessive Compulsive Disorder (OCD) is also common in children with the typical age of onset being between the ages of 6 and 15 years. Common symptoms of OCD are excessive hand washing, ordering, checking and avoidance behaviours (such as not stepping on cracks) (click here for more information about OCD). Generalised anxiety disorder (GAD) can also occur in children the essential feature of which is excessive persistent worry. Children with GAD will frequently seek reassurance from their parents on a range of issues and are often described by their parents as "worry warts". Giving frequent reassurance to children with GAD can cause their anxiety to grow over time (Click here for more info on GAD). While less common in younger children, panic attacks and panic disorder (PD) also occur frequently among adolescents (Click here for more information on PD). Specific phobias such as excessive fear of spiders etc are also common. Click here for more information on specific phobias. Finally, as in adults, post traumatic stress disorder (PTSD) can also occur in children typically resulting from experience of a traumatic event such as a car accident (Click here for more on PTSD) or death of a family member. Childhood PTSD of this type can often also lead to the child displaying separation anxiety behaviours.

How do I know if my child is experiencing an anxiety disorder? A number of observable behaviours may be indicative of the development of an anxiety disorder. Often the first noticeable sign of childhood anxiety is avoidance or withdrawal from situations or places. Examples may include excessive 'clinginess' or not wanting to be separated from parents (which is typical of separation anxiety disorder). Not wanting to go to school, go to school camps, or stay at friends houses may also be signs of elevated anxiety. Depending on other factors your child may also appear overly withdrawn and reserved. The anxiety under some circumstances may also lead to a child throwing tantrums when being asked to do things that make them feel uncomfortable or anxious. Physical indicators of excess anxiety in children are the same as for adults and may include shallow breathing, blushing, sweating, shakiness or heart racing. Additionally, anxious children will often complain of strong butterfly's or an upset stomach prior to attempting to do something, or go somewhere that makes them anxious.

Since fear and anxiety are normal emotions experienced by all of us it can sometimes be difficult to tell if your child's anxiety is excessive? A good rule of thumb is to ask does the anxiety cause a significant problem for your child? Does the problem appear to be growing? Also, is it persisting long enough to indicate that it is more than a normal developmental phase? It is also important to rule out possible direct causes for your childs' anxious behaviours, by asking questions such as are they being bullied at school? If you suspect that your child may be developing an anxiety disorder you can find out for sure by having them properly assessed by a psychologist in your area or by arranging an assessment with a psychologist at this centre.

What can be done to help my child overcome anxiety? When a child becomes anxious they will usually seek reassurance from their mother or father and may become clingy. A natural response to this for most parents is to offer comfort and support to the child. Usually this is an important first step however, if the childs' need for reassurance and level of avoidance seems to be growing then continued unconditional reassurance can cause the anxiety to grow. At these times teaching the child how to overcome their anxious feelings can provide them with tools that they may take through life which can assist in overcoming life's adversities. Cognitive behaviour therapy (CBT) has been well evidenced as the treatment of choice for both adult and childhood anxiety. It provides the skills mentioned to the child and also shows parents how to deal with their childs' anxiety in a manner that continues to reduce it over time. Individual programs run at NSW Anxiety Disorders Treatment Centre are highly effective and tailored to suit the age of the child. Children attending programs at the centre typically report their treatment to be an enjoyable and sometimes even fun experience.

What About Medication? The use of medications for anxiety and depression in adolescents and younger children is becoming more common in Australia and other Western countries. Prescription of antidepressants (which are often used for anxiety) rose in Australia for under 20 year olds from 69,325 prescriptions per month in 2002, to 78,876 per month in 2003. Despite these figures it is important to recognise that while antidepressants can sometimes be of assistance in taking the edge of severe anxiety symptoms in the short term, they are generally recognised to not provide a cure for anxiety and depression. Most doctors and psychologists recognise that medication provides, at best, short term relief from symptoms and is no substitute for well implemented CBT. Most practitioners now recommend that when possible CBT be conducted without medication, as studies have shown that CBT alone provides stronger treatment effects that are more durable than CBT and medication combined or medication alone. The side effects from medication can also, at times, be counterproductive. For example the U.S. Drug Advisory Body recently passed down a recommendation that all SSRI medications (which are the most common medications used for anxiety and depression) carry a warning label that states "use of this medication may cause suicidal thoughts or suicide in adolescents and children". Moreover, in the majority of cases recovery from unnecessary anxiety can be achieved without the need for medication. It is, however, important to always take your doctors advice when it comes to the use of medications with children and adults and to not make any changes to medication usage without first consulting your doctor.

Remember: Children will typically go through stages of anxiety as they develop and generally this is no cause for concern. If however your child is experiencing strong persistent anxiety, an assessment by a psychologist may be a good idea to avoid the problem becoming ingrained. At any time however, if an anxiety disorder has developed, an effective non-medication treatment known as CBT can be obtained from your psychologist, which teaches adaptive skills that can be carried into adulthood. Contact staff at the centre if you would like to hear more about an assessment or possible treatment options for your child.

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