Fears and worries in children can be common and developmentally appropriate. Infants, for example, are easily startled and, later on, develop a transient fear of strangers. Toddlers typically fear darkness, imaginary creatures, and being separated from their caretakers. School-age children tend to worry about injury, death, and natural events such as storms. Pre-adolescents and adolescents typically experience anxiety around school performance, social status, and health issues.
Developmentally appropriate fears become problematic if they do not subside with time, or if they are severe enough to impair a child’s day-to-day functioning. A clinician can help distinguish normal, developmentally appropriate anxiety or shyness from an anxiety disorder that requires further intervention and treatment.
Children and adolescents with anxiety generally voice a specific worry or fear, which they may not realize is excessive or unreasonable. They can also present with a physical complaint, such as stomachache or headache. Clinicians diagnose specific anxiety disorders by examining the context in which a child’s anxiety symptoms occur:
- Children with Generalized Anxiety Disorder experience chronic, excessive anxiety about multiple areas of their lives (e.g., family, school, social situations, health, natural disasters)
- Children with Separation Anxiety experience excessive fear of being separated from their home or caretakers
- Children with Specific Phobia fear a specific object or situation (e.g., spiders, needles, riding in elevators)
- Children with Social Phobia experience anxiety in social settings or performance situations
- Children with Panic Disorder experience unexpected, brief episodes of intense anxiety without an apparent trigger, characterized by multiple physical symptoms (e.g., shortness of breath, increased heart rate, sweating)
- Children with Obsessive-Compulsive Disorder perform repetitive mental acts or behaviors (“compulsions”) to alleviate anxiety caused by disturbing thoughts, impulses, or images (“obsessions”)
- Children with Post-Traumatic Stress Disorder experience anxiety symptoms (e.g. nightmares, feelings of detachment from others, increased startle ) following exposure to a traumatic event.
There is no single cause of anxiety disorders. The development of an anxiety disorder typically results from an interaction between certain biological and environmental risk factors that are unique to each individual. Genetics play an important role in determining who will develop an anxiety disorder, as does a child’s temperament, or innate personality style. Studies show, for example, that children who are innately cautious, quiet, and shy are more likely to develop an anxiety disorder. Environmental risk factors, such as parenting style, combine with the biological risk factors of genetics and temperament to make a child more or less predisposed toward developing an anxiety disorder.
There is not one single treatment for children and adolescents with anxiety disorders. A clinician will formulate a treatment plan that is individualized to the needs of each child and family.
Psychotherapy is the first-line treatment for anxiety disorders of mild severity. One widely used, evidence-based form of psychotherapy for anxiety disorders is Cognitive Behavioral Therapy (CBT).
When a child’s anxiety symptoms are severe, or when a child has responded only partially to psychotherapy, adding medication may be helpful. Selective Serotonin Reuptake Inhibitors (SSRIs) are the first line medications used to treat children with anxiety disorders. Parents should discuss the risks and benefits of these medications with their child’s clinician.
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