02.Anxiety Disorders in Children and Adolescents

02.1.What Are Anxiety Disorders?

It is normal for children and teens to develop some fears and anxieties asthey grow. Over time, normal fears fade as children learn more about what toexpect from their environment and relationships with others. When their fearsdo not fade and begin to interfere with their daily life and activities, ananxiety disorder may be present. These children should get prompt evaluation bya doctor.

Examples of Normal Anxiety Triggers

7-12 Months	Strangers, unfamiliar objects,  etc.
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, national survey of teen mental health reported that about 8percent of teens aged 13–18 have an anxiety disorder causing significantproblems interfering with social interactions, school or work.

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

02.2.SeparationAnxiety Disorder

Separation anxiety is described by excessive anxiety or fear concerningseparation from home or from those to whom the child is attached. The child mayrefuse to go to school or may complain of physical problems such as stomachache or headaches. The child can feel nervous when left with daycare providersor babysitters, etc. This also frequently involves refusal to attend sleepoversor outings requiring a separation from parents. Children who have severesymptoms may also refuse to sleep in their own rooms. Sunday night and Mondaymorning problems are typical in these children, who may feel great on Fridaysand weekends. These children have a very difficult time going back to schoolafter holiday breaks and especially after summer vacations.

02.3.Generalized Anxiety Disorder (GAD)

Children or adolescents with generalized anxiety disorder often worry alot about things such as future events, past behaviors, social acceptance,family matters, their personal abilities and/or school performance resulting insignificant distress. Worry or anxiety occurs most days over a period of atleast six months. The worry is to an extreme even when there is little or noreason to worry. The worry or anxiety often results in physical symptoms suchas feeling irritable, restless, easily fatigued or sleep disturbance. The focusof the worry and fear is not a specific stimulus as it is in other anxietydisorders such as the extreme anxiety when away from guardians in separationanxiety disorder.

02.4.Panic Disorder

Panic attacks are sudden episodes of intense fear and discomfort usuallyaccompanied by a feeling of doom and impending danger. The child may also havea fast heart rate; sweating; trembling or shaking; shortness of breath orsmothering; choking sensation; chest discomfort or pain; nausea or abdominaldistress; feeling dizzy, lightheaded, faint or unsteady; feelings of unrealityor being detached from oneself; fear of losing control or going crazy; fear ofdying; numbness or tingling sensations; chills or hot flashes. Panic attacksusually peak within a few minutes. The attack may be unexpected or in responseto a known trigger such as a specific object or situation.

 Panic disorder consists of recurrent panic attacks with worry about havingadditional attacks in the future. Panic attacks are frequently associated withthe fear of open spaces such as the market place or public places and are oftenexperienced as a fear of leaving the home.

02.5.Phobia-related disorders

These disorders are characterized by an immediate intense fear out ofproportion to any actual danger brought on by an encounter with an object orsituation. There is anxiety about encountering the object or situation andsteps are actively taken to avoid the object or situation. Phobias are oftenrelated to specific objects or situations such as certain animals, heights,injections or blood.

02.6.Social Phobiaor Social Anxiety Disorder

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

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

02.7.Selective Mutism

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

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

02.8.What Causes Anxiety Disorders?

The causes of anxiety disorders are not clearly understood. Anxietydisorders are believed to have genetic and environmental factors thatcontribute to the cause.

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

02.9.How AreAnxiety Disorders Diagnosed?

A pediatrician, a child psychiatrist, psychologist or other qualifiedmental health professional usually diagnoses anxiety disorders in adolescentsfollowing a comprehensive psychiatric evaluation.

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

02.10.Treatment for Anxiety Disorders

Specific treatment for generalized anxiety disorder will be determined byyour 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 bebased on a comprehensive evaluation of the child and family. Treatmentrecommendations may include cognitive behavioral therapy for the child, withthe focus being to help the adolescent learn skills to manage his/her anxietyand to help him/her master the situations that contribute to the anxiety.

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