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Anxiety Disorders in Children and Adolescents

What Are Anxiety Disorders?

It is normal for children and teens to have some fears and anxieties as they grow. Over time, normal fears go away as children learn more about what to expect from their environment and relationships with others. When their fears start to get in the way of their daily life and activities, an anxiety disorder may be present. These children should be seen by a doctor.

Examples of Normal Anxiety Triggers

7-12 Months Strangers, unfamiliar objects
1-5 Years Strangers, storms, animals, dark, loud noises, monsters, insects, bodily injury
6-12 Years Bodily injury, disease, ghosts, staying alone, criticism, punishment, failure
12-18 Years Tests and exams, school performance, appearance, peer scrutiny and rejection, social embarrassment

A large survey of teen mental health found that about 8 percent of teens 13–18 years old have an anxiety disorder. This disorder causes a lot of problems, and gets in the way of social relationships, school and work.

There are many anxiety disorders that affect children and teens. Not all need care by a doctor or other mental health care professional, but some do.

Separation Anxiety Disorder

Separation anxiety is excessive anxiety or fear about separation from home or from those close to the child. The child may refuse to go to school. They may complain of physical problems such as a stomachache or headaches. The child may be nervous when left with daycare providers or babysitters. This also involves not wanting to go to sleepovers or outings if separated from parents. Children who have severe symptoms may not want to sleep in their own rooms. Sunday night and Monday morning problems are typical in these children. They may feel great on Fridays and weekends. These children have a very hard time going back to school after holiday breaks and summer vacation.

Generalized Anxiety Disorder (GAD)

Children or teens with generalized anxiety disorder often worry a lot about things like future events, past behaviors, social acceptance, family matters, their personal abilities and/or school performance. This can lead to significant distress. Worry or anxiety occurs most days over at least six months. The worry is extreme even when there is little or no reason to worry. The worry or anxiety results in physical symptoms such as feeling irritable, restless, easily fatigued or having trouble sleeping. The focus of the worry and fear is not a specific thing as it is in other anxiety disorders.

Panic Disorder

Panic attacks are sudden episodes of intense fear and discomfort. These episodes also come with a a feeling of doom and danger. Symptoms of a panic attack include:

  • 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 attacks usually peak within a few minutes. The attack may be unexpected. It may be in response to a known trigger such as a specific object or situation.

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. Examples may be the supermarket or public places. They often happen as a fear of leaving the home.

Phobia-related disorders

These disorders are characterized by an immediate intense fear out of proportion to any actual danger. They are brought on by an encounter with an object or situation. There is anxiety about encountering the object or situation. Steps are actively taken to avoid the object or situation. Phobias are often related to specific objects or situations. Examples are certain animals, heights, injections or blood.

Social Phobia or Social Anxiety Disorder

This disorder is a persistent and significant fear of one or more social situations in which a child is exposed to people they don’t know or scrutiny by others. The child feels they will behave in a way that will be embarrassing or humiliating.

The child appears extremely shy, usually has few friends, and tends to avoid group activities. They report feeling lonely. They are 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

Selective mutism is the failure to speak in social situations with unfamiliar people. The child can talk and there is not a language problem.

The child speaks normally with familiar adults or family and familiar settings. At school or other public settings, the child may be silent. The disorder is thought to be a very severe form of social phobia. These children are often painfully shy.

What Causes Anxiety Disorders?

The causes of anxiety disorders are not clearly understood. Anxiety disorders are thought to have genetic and environmental factors that contribute to the cause.

A child may have inherited a biological tendency to be anxious. Anxiety and fear can also be learned from family members and others who often 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.

How Are Anxiety Disorders Diagnosed?

A pediatrician, a child psychiatrist, psychologist or other mental health professional diagnose anxiety disorders in children and teens after a comprehensive psychiatric evaluation.

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

Treatment for Anxiety Disorders

A treatment plan for generalized anxiety disorder will be determined by your child's clinician. It will be based on:

  • Your child or teens age, health and medical history.
  • Your child's symptoms.
  • Your child or teens tolerance for specific medicines, procedures, or therapies.
  • Expectations for the course of the condition.

Anxiety disorders can be treated. Treatment should always be based on a comprehensive evaluation of the child or teen and family. Treatment recommendations may include cognitive behavioral therapy for the child or teen. The focus is to help the child or teen learn skills to manage their anxiety and to help them master the situations that contribute to the anxiety.

Many children and teens may benefit from treatment with antidepressant or antianxiety medicine. Parents play an important, supportive role in any treatment process. Family therapy and consultation with the child or teens school may also be recommended.

Websites for Support Organizations

Last Updated 04/2022

Reviewed By Sara Hughes, RN

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