Anxiety in children and teenagers occurs for a wide variety of reasons and is often benign. Kids and young adults are still trying to come to grips with the realities of life, and these realities can sometimes be frightening, whether it’s the reality that night-time makes it dark and hard to see, or the reality that beloved pets and even relatives can die.
This article will summarize the anxiety disorders seen in children and young adults and how they present, according to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition or DSM-IV, and the steps that can be taken to safely relieve their anxieties.
Treating Your Own Anxiety is Important
Many, many studies have linked childhood anxiety to anxiety in their parents, and while some of that is genetic, some of it is learned as well. If you have anxiety, make sure you take my free 7 minute anxiety test to find out how to get rid of it.
Does Childhood Anxiety Matter?
50% of all anxious children will have their anxiety cured without any extra help. But that means that 50% of those children will continue to have anxiety – a very high number. That's why it's always a good idea to take anxiety seriously, even if children may grow out of it. Take my anxiety test to learn more.
Overanxious Disorder (Pediatric GAD)
Like generalized anxiety disorder or GAD among adults, overanxious disorder is the most common of anxiety disorders among children and adolescents. It is characterized by persistent, extreme and unrealistic stress not connected to any one specific object or situation that cannot be controlled.
The anxieties they have are not limited to but often connected to fears about their own safety and the safety of members of their family, how others think of them, and bad things that could happen in the future. Because they feel unable to control their anxiety, they will often seek reassurance from friends and adults.
Their anxieties often result in conforming behavior, intense self-criticism and difficulty concentrating. Their tendency to ask for reassurances in regards to their anxieties can result in their seeming insecure and needy, which can pose problems in forming social bonds and learning to build confidence in themselves as individuals.
Separation anxiety is also common among children, and is not considered a disorder until after the child is 3 years old, and then only if it negatively affects the child’s everyday life or is deemed inappropriate for their level of development.
Separation anxiety is marked by intense uneasiness and stress resulting either from the idea or the reality of being even temporarily separated from a home or person to whom they have formed a strong emotional bond. While in instances like moving away from a home or going through a divorce this may be a normal reaction, it becomes abnormal when the child is too anxious to go to school or visit friends for the same reasons.
The anxious reactions to separation must last at least four weeks and occur before the child or adolescent is 18 years old to be classified as separation anxiety disorder (or SAD).
Pediatric Panic Disorder
Pediatric panic disorder is more common in adolescents than children, though it can occur in children, and is defined by reoccurring panic attacks that can be either unpredictable (not connected to any specific environmental trigger), situationally bound (dependant and unavoidable in the presence of the environmental trigger) or situationally predisposed (meaning that the presence of a specific environmental trigger sometimes but not always results in a full-blown panic attack).
The panic attacks themselves generally peak and begin to subside after 10 minutes, and generally involve at least four of the following symptoms:
- Rapid heart rate
- Rapid breathing
- Fear of dying
The attacks may cause behavior that resembles other anxiety disorders such as GAD and separation anxiety by interfering with interpersonal relationships and resulting in a reluctance to leave familiar spaces and people. When a panic disorder (reoccurring panic attacks) lasts for more than four weeks, it may be reevaluated as pediatric PTSD.
Pediatric Obsessive-Compulsive Disorder (OCD)
Previously thought to be very rare among children, it is now believed that OCD affects up to 2-3%. A child or adolescent with OCD will experience intrusive obsessive thoughts or images and engage in compulsive “ritual” actions as a result of them in ways that interfere with their social lives and daily functioning. It is, however, important to distinguish between OCD behaviors and the normal ritual behaviors that children engage in for comfort, such as insisting on sleeping next to a certain toy or eating food prepared a certain way.
OCD rituals are often marked by a need for orderliness and cleanliness. Actions may involve obsessively straightening, organizing, washing or counting. In addition, the compulsive actions are usually a result of negative feelings such as fear or repulsion. If interrupted, they may become disproportionally upset due to a strengthening of these negative feelings.
It is important to address this condition in childhood and in adolescence, as it can greatly interfere with social functioning, and because an estimated 10% of adolescents with OCD will attempt suicide either in their youth or as adults.
Pediatric Post-Traumatic Stress Disorder (PTSD)
PTSD, while more common in adults, is also a possible disorder in children. It can occur when a child is exposed to a situation of acute stress in which they perceive their life or the lives of significant others to be threatened, or when they or a loved one is threatened by or experiences a serious injury.
A child or adolescent with PTSD is more acutely aware of danger and dangerous situations and will experience stress related to them, as well as persistent flashbacks (either while awake, during bad dreams or both) and panic attacks. If symptoms persist for four weeks or under before going away, it is more likely to be considered a panic disorder until symptoms reemerge (which they may not). If symptoms persist for more than four weeks, the diagnosis is changed to PTSD.
Ideally, children should feel safe and protected by parents or guardians during their development into adults, and can be severely negatively affected when they feel that they are otherwise, or when they feel that their parents or guardians may be unable to protect them. If left untreated, PTSD in children can lead to the impairment of brain functionality. The most common cause of PTSD in children is witnessing or experiencing domestic violence.
How to Help
Standard medications for adult anxiety disorders such as benzodiazepines have been shown to have potentially harmful side effects for children and should generally be avoided, except in severe cases. Antihistamines are less dangerous drugs sometimes used to ease the severity of anxiety symptoms.
A drug-free route for developing minds and bodies is always preferable, and is the most widely used form of treatment for cases of pediatric anxiety. If your child is exhibiting symptoms of an anxiety disorder, it may be time to make an appointment with a counselor or child psychiatrist. Cognitive-behavioral therapy can help a child or adolescent overcome and change their irrational fears and beliefs so that they have a chance to grow into happy, healthy and functional adults.
It's also important that you work on your own anxiety, because children pick up many of their behaviors from parents. Make sure you take my free 7 minute anxiety test now to learn more about your anxiety and to find out how to stop it.
Author: Micah Abraham, BSc Psychology, last updated Sep 28, 2017.