Anxiety Disorders in Children and Adolescents

It is normal for children and teens to develop some fears and anxieties as they grow. Over time, normal fears fade as children learn more about what to expect from their environment and relationships with others. When their fears do not fade and begin to interfere with their daily life and activities, an anxiety disorder may be present.  These children should get prompt evaluation by a doctor.

Examples of Normal Anxiety Triggers

7-12 MonthsStrangers, unfamiliar objects, etc.
1-5 YearsStrangers, storms, animals, dark, loud noises, monsters, insects, bodily injury
6-12 YearsBodily injury, disease, ghosts, staying alone, criticism, punishment, failure
12-18 YearsTests and exams, school performance, appearance, peer scrutiny and rejection, social embarrassment

A large, national survey of adolescent mental health reported that about 8 percent of teens aged 13-18 have an anxiety disorder, with symptoms first seen around age 6. 

There are many different anxiety disorders that affect children and teens that require clinical care by a doctor or other mental healthcare professional.

Separation anxiety is characterized by excessive anxiety or fear concerning separation from home or from those to whom the child is attached. The child may refuse to go to school or may complain of physical problems such as stomach ache or headaches. The child can feel nervous when left with daycare providers or babysitters, etc. This also frequently involves refusal to attend sleepovers or outings requiring a separation from parents. Children who have severe symptoms may also refuse to sleep in their own rooms. Sunday night and Monday morning problems are typical in these children, who may feel great on Fridays and weekends. These children have a very difficult time going back to school after holiday breaks and especially after summer vacations.

Children or adolescents with generalized anxiety disorder often worry a lot about things such as future events, past behaviors, social acceptance, family matters, their personal abilities and/or school performance resulting in significant distress. The focus of the worry and fear is not a specific stimulus as it is in other anxiety disorders such as the extreme anxiety when away from guardians in separation anxiety disorder.

Panic attacks are sudden episodes of intense fear and discomfort usually accompanied by a feeling of doom and impending danger. The child may also have a fast heart rate; sweating; trembling or shaking; shortness of breath or smothering, choking sensation; chest discomfort or pain; nausea or abdominal distress; feeling dizzy, lightheaded, faint or unsteady; feelings of unreality or being detached from oneself; fear of losing control or going crazy; fear of dying; numbness or tingling sensations; chills or hot flashes.

Panic disorder consists of recurrent panic attacks with worry about having additional attacks in the future. Panic attacks are frequently associated with the fear of open spaces such as the market place or public places and is often experienced as a fear of leaving the home.

This disorder is defined by persistent, intrusive, unwanted thoughts, images, ideas or urges (obsessions) and/or intense uncontrollable repetitive behaviors or mental acts related to the obsessions (compulsions) that are noted by the child or the parent to be unreasonable and excessive.

These obsessions and compulsions cause notable distress and difficulty with day-to-day functioning. The most common obsessions concern dirt and contamination, repeated doubts, the need to have things arranged in a specific way, fearful aggressive or murderous impulses, and disturbing sexual images or thoughts. The most frequent compulsions involve repetitive washing of hands; checking drawers, locks, windows and doors; counting rituals; repeating actions; and requesting reassurance.

Pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection (PANDAS) are a group of disorders that are believed to be the result of an autoimmune response to streptococcal infections. These disorders can present with obsessions and compulsions. The onset of OCD symptoms is typically more abrupt if associated with PANDAS.

In this disorder, a child is exposed to a traumatic event in which he or she experiences or witnesses an event that involved actual or perceived threat of death or serious bodily injury and the child's response involves intense fear, helplessness, or horror. In children, probably the most common traumatic event is abuse.

The traumatic event is continually re-experienced in the following ways: recurrent and intrusive distressing thoughts, images or nightmares about the trauma and the feeling that the traumatic event is recurring. This results in intense anxiety and distress on exposure to situations that resemble the traumatic event. In addition, the child may have difficulty falling asleep or staying asleep and may have irritability or anger outbursts.

This disorder is characterized by persistent and significant fear of one or more social situations in which a child is exposed to unfamiliar persons or scrutiny by others and feels he or she will behave in a way that will be embarrassing or humiliating.

The child usually appears extremely shy, usually has few friends, and tends to avoid group activities and reports feeling lonely. He or she is also fearful of social situations such as reading aloud in class, asking the teacher for help, eating in the cafeteria or unstructured activities with peers.

Selective mutism is the failure to speak in social situations with unfamiliar people when there is not an underlying language problem, and the child has the capacity to speak.

The child usually speaks normally in the company of familiar adults or family and familiar settings. At school or other public settings the child may be silent. The disorder is considered by some to be a very severe form of social phobia as these youth are often painfully shy.

Anxiety disorders are believed to have biological, family and environmental factors that contribute to the cause. A chemical imbalance involving two chemicals in the brain (norepinephrine and serotonin) most likely contributes to the cause of anxiety disorders.

While a child or teen may have inherited a biological tendency to be anxious, anxiety and fear can also be learned from family members and others who frequently display increased anxiety around the child. For example, a child with a parent who is afraid of thunderstorms may learn to fear thunderstorms. A traumatic experience may also trigger anxiety.

A pediatrician, a child psychiatrist, psychologist or other qualified mental health professional usually diagnoses anxiety disorders in adolescents following a comprehensive psychiatric evaluation.

Parents who note symptoms of severe anxiety in their child can seek an evaluation and treatment. Early treatment may help prevent future problems.

Specific treatment for generalized anxiety disorder will be determined by your child's clinician and will be based on:

  • Your adolescent's age, overall health and medical history
  • Extent of your child's symptoms
  • Your child's tolerance for specific medications, procedures, or therapies
  • Expectations for the course of the condition

Anxiety disorders can be effectively treated. Treatment should always be based on a comprehensive evaluation of the child and family. Treatment recommendations may include cognitive behavioral therapy for the child, with the focus being to help the adolescent learn skills to manage his/her anxiety and to help him/her master the situations that contribute to the anxiety.

Many children may also benefit from treatment with antidepressant or antianxiety medication to help them feel calmer. Parents play a vital, supportive role in any treatment process. Family therapy and consultation with the child's school may also be recommended.

Last Updated 08/2013