Overview of Anxiety Disorders in Children, Its Types and Impact

Introduction

“Only one in five Canadians under the age of twelve with an anxiety disorder receives adequate treatment” (Butler & Pang, 2014). Anxiety disorders are one of the most common mental health conditions, with between 15% and 25% of Canadian youth experiencing a type of anxiety disorder before the age of nineteen. Some of these include separation anxiety disorder, social anxiety disorder, specific phobias, panic disorder, and obsessive compulsive disorder. However, most children who suffer from these conditions do not receive treatment due to showing different symptoms than those present in adults. When left untreated, it can heavily impact a child’s success in school and social endeavors, as well as lead to more severe cases of anxiety, depression and other mental health conditions later in life. This paper will outline the symptoms present in children with anxiety disorders, the negative impacts they can have if left untreated, and ways to recognize and provide appropriate treatment.

Anxiety Disorders in Children

“An anxiety disorder is a common mental illness defined by feelings of uneasiness, worry and fear. While anxiety occurs for everyone sometimes, a person with an anxiety disorder feels an inappropriate amount of anxiety more often than is reasonable” (Tracy, 2019). Anxiety disorders are relatively new in the medical scene, only being officially recognized by the American Psychiatric Association in 1980. Although they have been present throughout history, medical professionals typically gave a generic diagnosis to the individuals who suffered from these disorders, due to a lack of understanding around them. With the rise in media, knowledge surrounding these disorders is becoming more and more prevalent, and in return more research is being conducted as well as the search for more effective treatments. Oftentimes individuals who suffer from anxiety disorders also suffer from other mental health illnesses such as depression, which can lead to an increased risk of suicide.

Anxiety disorders are commonly present in children, however they often go unnoticed and ultimately untreated. This is possibly due to the lack of specialized training for pediatricians in youth mental health conditions. Children also typically present different symptoms than adults with anxiety disorders, making it more difficult yet again to properly recognize them. One of the biggest differences is children typically won’t report on any feelings or symptoms they may have that relate to anxiety disorders, leaving it up to professionals to recognize and provide the treatments necessary. “Therefore, early recognition of these disorders in children and adolescents can make a significant difference in outcomes through improvement in various areas of functioning” (Riedford, 2010). It is important that professionals have a good understanding of each type of anxiety disorder so that it can be correctly recognized and treated to prevent possible interferences it can have on the child later in life.

Causes

“The three main components to the development and evolution of anxiety disorders are environmental, genetic, and neurohormonal. It is important for pediatricians to recognize and explore each of these components” (Kelly, 2005). There are a number of causes for the onset of anxiety disorders in children, such as traumatic events, genetics, and an imbalance in hormones.

Traumatic situations and severe stressors can lead to a child developing an anxiety disorder, often posttraumatic stress disorder. Studies have shown that half of the children who are affected by an anxiety disorder has a family member that is affected as well. Typically this is considered and looked at when diagnosing the obsessive-compulsive disorder, panic disorder, and generalized anxiety disorder. Neurohormonal imbalances have also been looked at and considered to play a part in the development of anxiety disorders.

Types, Symptoms and Treatments

There are several types of anxiety disorders, with each having its own varying symptoms, and the recommended treatment. Children can typically experience a number of anxiety disorders, from a separation anxiety disorder, specific phobias, and generalized anxiety disorder. Each of these can be inhibiting to a child’s life, especially if left unchecked. As Bober and Martin share:

Many of these disorders share a common thread and represent a developmental condition characterized by high levels of fear and apprehension. Despite the similarities of these varied disorders, advances in neuroscience will likely continue to assist in differentiating their unique symptom profiles and associated features. (Bober & Martin, 2006)

Despite each of these conditions having shared symptoms made up of feelings of apprehension and fear, they are different from each other in the presentation of other symptoms and require their own treatments. This emphasizes the importance of understanding each form of anxiety disorder so it can be properly recognized.

Separation Anxiety Disorder

Children who experience separation anxiety disorder are often hesitant to leave those familiar to them, such as parents, and make it difficult for the caregivers to leave. Typically these children will come up with reasons not to go to school, such as waking up in the morning feeling sick despite being fine the night before.

A common treatment for separation anxiety disorder is having the child and family take part in behavior programs, which gives positive feedback and reinforcement to the child for enduring long periods of time away from their caregivers. Forms of therapy are often used as well, along with the use of Prozac for short-term treatment.

Specific Phobias

Specific phobias are classified by an extreme fear or negative reaction to a certain object or situation. The fear is typically persistent and individuals who suffer from it may not have a reason for their fear. Phobias make up a large portion of the most common anxiety disorders.

Treatment of specific phobias usually consists of gradually exposing the child to their fear or phobia; by desensitizing the child of their fear, they slowly start to become more comfortable and tolerant.

Selective Mutism

Children with selective mutism often will not speak in unfamiliar social settings, despite having no difficulties with language. These children are typically capable of speaking at home and when around familiar people, but will become silent when in a new environment and around new individuals.

Behavioral therapy is most commonly used to treat selective mutism and appears effective, while the use of Prozac is often recommended as well, proving to be somewhat effective.

Panic Disorder

Panic disorder was once thought to be uncommon in children, however studies have shown that it affects 0.5% to 5% of children in communities, and 0.2% to 10% in pediatric psychiatric clinics. Children with panic disorder will often experience panic attacks, which are described as “unexpected and repeated periods of intense fear or discomfort, along with other symptoms such as a racing heartbeat or feeling short of breath” (Child & Adolescent Psychiatry, 2013).

Specific types of medication can be used to help with the panic attacks, and psychotherapy has been shown to help children and families learn ways for the child to reduce their stress, as well as give them methods and techniques to help control their panic attacks.

Social Anxiety Disorder

Social Anxiety is the excessive fear of social situations and of having the attention of others on oneself. Around 7% of children in school have a diagnosis of social anxiety disorder. Children who suffer from this will often avoid social events and interactions, as they have the fear that they will embarrass themselves or do something wrong. As Anxiety Canada describes it, “These children constantly feel “on stage,” which can lead to a great deal of self-consciousness, distress, and avoidance” (Anxiety Canada, n.d.).

There are a range of symptoms for this disorder, including feelings of embarrassment, uneasiness, shame and fear, extreme blushing, sweating, shaking, and feeling detached from ones body. Typically these children avoid eye contact, speak lowly or mumble, avoid social situations such as declining invitations to events, staying home rather than going out with friends and not participating in new activities. Medication is typically used to treat social anxiety in both the short and long term.

Obsessive-Compulsive Disorder

Children with the obsessive-compulsive disorder will have thoughts, worries and fears that they will obsess over. These are called “obsessions”. These fears are usually unwarranted but the child will still feel great anxiety due to them. To help themselves reduce their anxiety they will start engaging in certain behaviors that are referred to as “compulsions” or “rituals”. These are often repetitive and the child feels as though they have no choice but to engage in the behaviors. For example, a child with obsessive-compulsive disorder may have a fear of being dirty and unclean; this is their “obsession”. As a result they will wash their hands meticulously and almost constantly to make sure that they are clean; this is the “ritual”.

Studies have suggested that behavioral cognitive therapy is the best form of treatment for obsessive-compulsive disorder in children.

Posttraumatic Stress Disorder/Acute Distress Disorder

Posttraumatic stress disorder and acute distress disorder are the result of experiencing an extreme and traumatic event where the result of serious injury and death to oneself or others was likely. Children affected by PTSD will often regress and lose the ability to use skills they have acquired, develop new fears or have the return of old ones, and may be extremely distracted and impulsive.

Current practices recommend that children with PTSD should be treated with psychotherapy, and should also consider psychopharmacology as well if the child has prominent symptoms of depression and panic. Some medications have recently been shown to have possible effectiveness in helping with the main symptoms of PTSD.

Although much remains to be learned, there have been important advances in understanding its risk factors and pathogenesis. Research on the management of PTSD in this age group is itself relatively young, and there is an urgent need for additional randomized controlled trials. (Kaminer, Seedat & Stein, 2005).

Most studies on the treatment of PTSD have been on adults, and as a result no definite form of treatment for children suffering from this disorder has been developed. To find the best and most effective form of treatment, more studies and research will need to be conducted to come closer to finding a way to help children suffering from PTSD.

Generalized Anxiety Disorder

Generalized anxiety disorder is the extreme fear and worry of a variety of situations, rather than one thing in particular. Boston Children’s Hospital shares that “The difference between normal feelings of anxiety and the presence of generalized anxiety disorder is that children with GAD worry more often and more intensely than other children in the same circumstances” (Boston Children’s Hospital, n.d.). Children with generalized anxiety disorder are typically not confident in themselves and are self critical, regularly seeking approval and praise from others and avoiding situations that they believe they cannot perform their best in.

Cognitive behavioral therapy, medication, and even a mixture of the two is recommended to treat children with generalized anxiety disorder. These children often respond well to treatment and therapy provided by trained mental health professionals.

Implications to the Profession

Professionals in the early childhood education field recognize children’s development and help to aid it further. They aid this development in all aspects, taking into consideration that each child learns and develops at their own pace. Therefore, it is important for these professionals to understand and recognize anxiety disorders.

Often these disorders inhibit a child’s growth and later success in school, social interactions, and later life. They can lead to more severe cases of anxiety, depression, and increase the chance of suicide. Early childhood educators can play a big role in recognizing these disorders early on and referring the children to medical professionals so they can receive appropriate treatment.

Having a core understanding of the types of anxiety disorders can help the early childhood educators to quickly recognize possible symptoms, as well as take the child’s process of recovery into consideration when preparing the classroom. By communicating with the parents as well as the medical professionals, the childcare professional can help aid the recovery of the child while they are present in the centre.

Conclusion

Anxiety disorders are prevalent in children and youth, but unfortunately, go unnoticed due to a lack of understanding around them. It is important that the population, especially those working with and close to children learn about these disorders and ways to identify them. When left untreated, these disorders can impact a child’s life in all aspects. It can lead to dangerous and risky behaviors, other mental health conditions such as depression, and in severe cases, suicide.

It is important that parents, teachers, medical professionals, and other individuals understand the impact these disorders can have on a child’s life, and work to get them the help needed so that they can grow to become successful, happy, and confident individuals who can help contribute to our world.