Childhood anxiety disorders
What are childhood anxiety disorders?
Signs and symptoms of childhood anxiety / Treatment of childhood anxiety
Anxiety disorders are one of the most common mental health issues in children and adolescents. It is estimated that up to 25% of 9-17 year olds have an anxiety disorder. Common signs of anxiety disorders in children include excessive worrying about a specific object or situation (e.g. spiders) ordinary events (e.g. going to school) and physical symptoms such as palpitations, sweating, trembling, stomach-ache and/or headaches. The child will also go to great lengths to avoid the source of the anxiety, which can cause social withdrawal.
Many children will have specific fears during childhood that cause them anxiety. Some research has found that up to 90% of children between the ages of two and 12 years old have at least one specific fear. However if a child is experiencing fear or anxiety to a level that is interfering with their academic, social or family functioning, the child may be suffering from an anxiety disorder. If you are unsure whether your child’s fear is normal, or whether it is interfering in his or her life, it may be a good idea to consult with a psychologist to determine whether your child could benefit from treatment.Select Counsellors can help you find a counsellor who is the best fit for you and your child
Click on the links below to find out more about childhood anxiety disorders
Generalised anxiety disorder
In children with generalised anxiety disorder (GAD) their anxiety is ‘generalised’ to a wide range of events. These children worry excessively about all types of past, present or future events such as academic performance, sport performance, their health, the health of their family members or even the state of the world or natural disasters.
For these children, the worry over their own performance continues even when they are not being judged or when they have always performed well in the past. Children with GAD often have other physical symptoms from the worry including headaches, stomach aches, vomiting, and sleep disturbance. Often children with GAD become perfectionists and redo tasks if there are any imperfections. As such, these children need constant reassurance about their performance. GAD is a less common anxiety disorder and the rate in children is estimated to be less than 3%.
Separation anxiety disorder
Anxiety at the separation from parents, primary caregivers, home or familiar surroundings is a normal part of a child’s development click here for more information
However, in children with separation anxiety disorder, the anxiety becomes so distressful that it affects their social or academic functioning.
Separation anxiety disorder differs from normal developmental separation anxiety in several ways. Children with separation anxiety disorder:
Constantly worry that something bad will happen to their parents while they are gone
Experience dizziness, nausea and/or palpitations at the thought of being separated from their parents worry
Often experience symptoms of depression including sadness, withdrawal, apathy, and difficulty concentrating
Age of onset for separation anxiety disorder is around age 7, whereas normal developmental separation anxiety occurs when a child is 6-8 months old.
About 4% of children and young adolescents suffer from separation anxiety disorder, and it occurs slightly more commonly in girls. In some children, it can develop into panic disorder or agoraphobia in adulthood.
Many children are naturally shy, but social phobia differs from normal shyness. Children with social phobia:
Have an intense fear of being embarrassed or humiliated in social situations or doing something that will make them appear foolish or would invite ridicule from others.v
Avoid public speaking, parties and other social events, eating in public, or talking to authority figures such as teachers. Children with shyness can be uneasy around others, but they don’t go to extremes to avoid social or other situations that make them feel uncomfortable.
Social phobia also disrupts a child’s normal life, interfering with school or social relationships. Sometimes they will avoid going to school or avoid social activities with other children.
Often young children with social phobia cannot clearly articulate their fears, but may cry, have tantrums, freeze, become clingy or seem very timid in strange social situations. Social phobia is estimated to occur in less than 2% of children and has an age of onset between 10 to 13 years. Often the disorder is lifelong, but symptoms generally become less severe with age.
Specific phobias are an excessive and persistent fear of a specific object or situations such as needles, dogs, elevators or bridges. Young children often do not realise their fear is excessive and they become extremely distressed when confronted by the object or situation they fear. Young children often can’t clearly communicate their fear but may cry, have tantrums, freeze, become clingy when the object is near. Some fears are common and developmentally normal for certain ages including:
0-2 years: loud noises, strangers, separation from parents, large objects
3-6 years: imaginary figures (e.g. ghosts, monsters, supernatural beings), the dark, noises, sleeping alone, thunder, floods
7-16 years: physical injury, health, school performance, death, thunderstorms, earthquakes, floods.
Post-traumatic stress disorder
Following exposure to a traumatic event, such as witnessing death or being involved in a near death experience, some children develop posttraumatic stress disorder (PTSD). Symptoms include high levels of anxiety, difficulty sleeping, irritability or angry outbursts, excessive vigilance, a sense of foreboding and a sensitive startle response, which persist for more than a month and impacts the child’s day-to-day functioning.
The anxiety is caused by reliving the stressful events such as through dreams or exposure to similar situations (e.g. returning to where the event happened). Some children develop avoidance of situations associated with or that remind the child of the event. A child is more likely to develop PTSD following a traumatic event if:
The event was severe (e.g. witnessing the death of a parent)
The parents and family were also affected by the trauma and no ‘normalising’ family support is available
The event was recent and/or physically near
Children of any age can develop PTSD. In groups of children that have experienced a trauma, 40-80% of children will experience PTSD following the event.
Obsessive compulsive disorder
OCD is characterised by intrusive obsessive thoughts or images that are often accompanied by compulsive behaviours or actions. The obsessive thoughts cannot be stopped regardless of how hard the child tries to think about something else and are alleviated by compulsive rituals and behaviours which they repeat over and over. For example a constant obsession about dirt or being dirty, will often lead to the compulsion of hand washing. This disorder is extremely rare in children occurring in less than 1%.
Common obsessions include:
Fear of dirt or germs
Need for symmetry and order
Fixation with body waste
Lucky and unlucky numbers
Fear that something terrible will happen to a loved one
Common compulsions include:
Chronic coughing or throat clearing
Washing hands over and over again
Repetitive and lengthy teeth-brushing or showering
Repetitive checking of doors and switches
Collecting and hoarding specific items
Counting items over and over
Repeating specific words and phrases in a particular order
Rearranging things to create order and ‘balance’
Repeating actions a certain amount of times
Having a strict ritual before going to bed that has to be followed
Panic attacks are very discreet periods of sudden and highly intense anxiety and apprehension. These feeling are generally accompanied by physical symptoms such as palpitations, difficulty breathing or a choking sensation. Panic disorder is rare in children.
If you think your child may have an anxiety disorder it’s important to get some help. Select Counsellors can help you find a therapist who specialises in childhood anxiety and is the best fit for you and your child
Causes of anxiety disorders in children
Anxiety disorders can be maladaptive learned responses from previous experiences. For example a child that has a traumatic encounter with a dog, may develop a specific phobia about dogs. In some children, their natural ability to cope is under developed or lessened for some reason or there are increased internal and external stressors that overwhelm the child’s coping ability and result in extreme anxiety being experience.
Genetic and physiology
There does seem to be a genetic link with anxiety disorders. There is a higher chance of an anxiety disorder in the parents, siblings and/or children of someone with anxiety disorder. Research suggests that genetics may account for 12-50% of the level of anxiety in children. Some anxiety disorders such as panic disorder seem to have a stronger genetic link, where as GAD seems to be caused more by environmental factors.
Research on the function of brain chemicals and brain function suggests that there may be abnormal functioning of norepinephrine, serotonin and GABA or in the brain’s receptors for these brain chemicals.
Treatment of anxiety disorders in children
The most common and effective treatment for anxiety disorders in children is therapy. Cognitive and behaviour therapy (CBT) works on both the anxious thoughts and teaches the child specific skills and techniques for managing the anxiety (e.g. relaxation techniques). Modelling and exposure based treatments where the child is exposed to the situation or specific thing that makes them anxious and exposure is continued until their anxiety subsides are often an effective part of CBT.
In more severe cases, anti-anxiety medications are prescribed when therapy alone is not effective. The good news is brief CBT of eight to 12 sessions has been found to be highly effective in the treatment of childhood anxiety disorders, with follow-up finding that many children are symptom free 18 months post-treatment.
Helping your child with an anxiety disorder
If your child has an anxiety disorder, getting help is the first step in the process. A child psychologist or psychiatrist can make a diagnosis of an anxiety disorder based on a full evaluation of your child. Early identification of an anxiety disorder can also be a key factor for a successful outcome.
Did you realise research has shown that the relationship between your child and their therapist is one of the most important elements for a successful outcome? How do you know if the therapist you find will be the best fit for you and your child?
Select Counsellors provides a unique client counsellor matching service to ensure you see the right therapist for your child, first time. We have a pool of highly trained Sydney based counsellors, psychologists, psychotherapists and psychiatrists and will match you with the right therapist based on important information collected in a personalised assessment about your child and their needs. At Select Counsellors our key priority is Finding you the One. To book an assessment click here or call on 1300 123 680 to speak in person with a Select Counsellor.
Click on the links below to find out more information on child behaviour and development:
The Helpful Guide