Anxiety Disorders In Children

Posted On: February 01, 2020

Anxiety Disorders In Children has increasingly grown all over the world in the last few decades. Many of us can remember being frightened as children. Irrational fear of things such as the dark, insects, abandonment and kidnappers are a commonplace among children. For the most part, these phobias should be no cause for concern and will dispel with age.

Adolescents also experience powerful surges of emotion as they undergo rapid physical and emotional changes.

But when should a parent be concerned? Is their child’s sudden withdrawal part of their development or might they be experiencing symptoms of anxiety?

Fearfulness and phobias are most common in early childhood and puberty. In babies, symptoms of distress are usually caused by other factors such as hunger or cold, but as children get older it can be harder to tell.

Types of anxiety disorder

Generalized Anxiety Disorder (GAD)

Children with GAD will worry constantly and about a wide variety of subjects. Their fears will include normal concerns for their age such as tests in school, but they will also worry about things that seem unexpected to their parents: such as parties, seeing friends, or other activities they would be expected to enjoy. They may also experience more catastrophic fears such as fear of death, illness, war, or the death of a loved one.

With their mind plagued by constant anxiety, children with GAD will find it difficult to concentrate. This will likely affect their performance in school and will also cause other problems such being unable to relax and enjoy themselves or fall asleep.

Some children will keep their anxiety to themselves, whereas others will be more vocal about it. If your child is always coming to you with fears that cannot be soothed by any amount of reassurance, then they may be suffering from GAD.

Anxiety disorders are also usually accompanied by physical symptoms. Your child may feel restless, have an accelerated heart rate, feel hot, sweaty, irritable, shaky or lightheaded.

Separation Anxiety Disorder (SAD)

When babies and young children are first separated from their parent it is completely normal for them to feel anxious and distressed. Generally, however, this passes as the child becomes accustomed to being without their parents.

However, when this anxiety does not pass it is known as Separation Anxiety Disorder (SAD). Children with SAD will cling to their parents and refuse to go to school or sleepovers without their parents. They may also miss days off school, claiming they are too sick to go. At home they may find it difficult to sleep if they are not in proximity to their parents. Sometimes they may even be unable to sleep in a separate room.

Social Phobia (or Social Anxiety Disorder)

Social phobia is characterized by intense fear and worry over what others will think. Children with social phobia will be constantly afraid of doing something embarrassing that makes them look weird. They will avoid raising their hand in class or otherwise being the center of attention. Giving presentations or being called upon for answers in school will cause them extreme distress and they may freeze up and be unable to answer.

As with other anxiety disorders, social anxiety disorder will often cause children to try and skip school for fear of embarrassment or ridicule.

Specific Phobias

The world of children can be frightening, and it is perfectly normal for them to express fears of the dark, monsters or other such things. Usually, however, these fears can be abated by a parent or other trusted adult. In the case of phobias, the fear will be far more extreme, intense, long-lasting and centered around something specific.

Children with specific phobias will go to great lengths to avoid the thing they are afraid of. If they are in the vicinity of it, they will experience a powerful and inconsolable sense of dread. Common phobias include animals, insects, blood, heights or flying. Children with specific phobias will also experience physical symptoms of anxiety

Selective Mutism

Selective Mutism (SM) is an extreme form of Social Phobia. Children and teenagers with selective mutism are capable of talking but in social situations, they become too afraid to talk. There are varying degrees of this condition, some may only be able to talk at home whereas others may be able to communicate through whispers to a select few close people in social situations.

Panic Disorder

Panic attacks are a rush of physical and mental symptoms that can come on suddenly and for no apparent reason. Panic attacks are very distressing and people suffering from them may feel like they are dying or going crazy. While panic attacks are not dangerous, they are extremely frightening. Children who experience regular panic attacks may suffer from panic disorder.

Causes of anxiety disorders

Physical symptoms of anxiety are triggered by what’s known as the “fight or flight” response. This response is designed to protect us from genuine threats by releasing natural chemicals in the body that affect our muscles, breathing, heart rate, and digestion. In situations of real danger, this would provide the body with extra energy for escape or combat. However, with anxiety disorders, the fight or flight response is happening in times where there is no danger.

There are multiple factors that can play a role in causing a child to have anxiety.

Within the home

Young children are especially sensitive to issues in the home. They may feel insecure and anxious if they can hear their parents rowing, especially if they hear aggressive language or talks of separation.

Children may also blame themselves for distressing events in the home, such as divorce, separation or illness. Some children may even begin to think that they should become ill or die in their parent’s place. Other traumatic events such as the loss of a loved one or abuse can also cause anxiety in children.

Children can also become anxious as a result of learned behaviours. If they grow up in a household with anxious and overprotective parents, they may mimic these fearful behaviours.

Genetics

Research has shown that anxiety can be inherited, with certain genes affecting your child’s likelihood of having the condition. Therefore, if you or a relative have an anxiety disorder then it is more likely for your child to have it. However, it is possible to have a family history of anxiety and not experience it yourself or have anxiety without a family history of it. The exact science behind the role genes play in anxiety is not yet fully understood.

How do I know if my child has an anxiety disorder?

If your child is persistently anxious and it is interfering with their everyday life then you should consult your GP. They will ask you and your child some questions to determine the nature and severity of their symptoms and an appropriate course of treatment. They may ask questions such as:

• How long has your child been experiencing these symptoms?
• What physical symptoms does your child have?
• Are there particular times when your child is more anxious?
• Does anything trigger your child’s anxiety?
• Is there a family history of mental illness?

How is anxiety treated in children?

The course of treatment will vary depending on the age of the child and the type and severity of their condition. The most common treatments for anxiety in children are talking therapies such as Counselling or CBT (Cognitive Behavioural Therapy)

Counselling

Children with anxiety may feel awkward or uncomfortable discussing their fears and emotions with parents or teachers. Counselling offers them a judgement-free environment to talk openly about their problems as well as support in confronting and rationalizing their fears. Counselling sessions are kept confidential (unless the child’s personal safety is at risk.) Counselling is sometimes provided free by the NHS or your GP. Some schools may also offer counselling services.

CBT (Cognitive Behavioural Therapy)

CBT is a more hands-on approach to dealing with negative or anxious thoughts. CBT focuses on the link between thoughts and behaviours. Sessions typically last 6-12 weeks. Your child’s therapist will provide them with “homework” throughout the week which will involve monitoring their thoughts and behaviours so as to implement strategies to improve them.

Medication

Medication is less often prescribed for children. A course of medication may be recommended if your child has not shown improvement from talking therapies. The most commonly prescribed medicines for children with anxiety belong to a class of drug called SSRI’s (Selective Serotonin Reuptake Inhibitors). These work by increasing levels of serotonin in the brain. They are non-addictive and have a relatively low side-effect profile. Examples of SSRI’s include:

• Fluoxetine (Prozac)
• Sertraline (Zoloft)
• Paroxetine (Paxil)
• Citalopram (Celexa)

In cases of acute or debilitating anxiety, your child may be prescribed a benzodiazepine. These are quite rarely prescribed as they have a high potential for addiction and more side effects than SSRI’s. They are more likely to be prescribed if your child is experiencing panic attacks or other severe symptoms that are interrupting their everyday life. If your child’s anxiety is severe enough to warrant a benzodiazepine prescription, they will most likely be prescribed Diazepam (Valium).

Other treatments such as SSRI’s and CBT do not yield immediate effects. Sometimes benzodiazepines will be prescribed short term to alleviate severe symptoms until other treatments take effect.

Benzodiazepines should not be prescribed for long periods of time. Tolerance and addiction can form, meaning that more of the drug is necessary for the desired effect and sudden cessation may result in withdrawal symptoms.

Side effects of Diazepam include:

• Sleepiness or drowsiness
• Problems with movement and co-ordination
• Confusion

Propranolol

In some cases, children may be prescribed propranolol for anxiety. Propranolol is a beta-blocker which works by slowing down the heart. It is used to address the physical symptoms of anxiety such as racing heartbeat, trembling or hot flashes. It is generally prescribed for situational anxiety, meaning that it is taken before being somewhere one is likely to be anxious (i.e. school)

How can I support my child?

There are many ways you, as a parent, can support an anxious child.

• Try to speak to them in calm, measured tones. Avoid raising your voice.
• Be sure to remain calm when your child is experiencing an anxious episode.
• Talk openly with your child about their anxiety, how it happens, and why. Children can be very frightened of their anxiety, helping them understand it can reduce this fear and also shows your child that you understand their problem.
• Be sure to recognize and praise any achievements, however small.
• Don’t punish your child for mistakes or lack of progress.
• Practice breathing exercises with your child. Have them breathe in deeply through their nose for four seconds and out through their mouth for another four seconds.
• Encourage your child to be mindful of their anxiety. You could get them to keep a diary or a box where they can write their fears and anxieties. They can then review their anxieties later to see if they were worth worrying about.
• Talk through their fears with them. Try and offer them more positive ways to look at the situation.
• Break down difficult tasks into small, achievable steps for your child.
• Don’t minimize your child’s fears.
• Lead by example. Try to express your own difficult situations in a positive or neutral light.
• Help them lead a healthy lifestyle. Regular exercise, healthy sleep patterns, balanced diet and a daily routine can all have positive impacts on your child’s mental health.

It is important to remember that anxiety disorders in a child are not a reflection of bad parenting. Having an anxious child can be stressful but it is important that you show them plenty of love and support. While there is no immediate cure, in time, and with treatment and support, anxiety can be managed and lived with.

Additional Resources:

Resources for parents

Find mental health support for young people

A-Z Mental Health Guide