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Anxiety Disorders

Anxiety Disorders - Children and Adolescents

What are Anxiety Disorders?

Many children and adolescents feel anxious or stressed on the first day in a new school or when they have problems with their friends. They worry, their hearts beat faster, and they have butterfly feelings in their stomachs. These are usual anxious reactions connected to stresses in their lives; the reactions come and go with the stressful moments.

Clinical Anxiety or Anxiety Disorders are much, much stronger versions of these normal feelings, and they are not always directly connected to stress. Young people with Anxiety Disorders have intense fear and worry. They also may develop problems sleeping and have physical symptoms like headaches, stomach aches and nausea. Anxiety Disorders cannot be controlled by will power, and they often come and go in unpredictable ways. They interfere with young persons’ everyday lives and keep them from doing usual activities.

Anxiety Disorders are the most common mental illnesses in the United States; about 13 percent of American children and adolescents are affected by Anxiety Disorders each year.

There are different kinds of Anxiety Disorders that affect children and adolescents:

Separation Anxiety Disorder results in extreme distress, worry and physical symptoms when a young person is separated from the people to whom he or she is most attached. Most often the fear and worry are related to a concern that harm will come to a loved one in the child's absence. Having trouble separating from familiar people is normal for very young children, but the trouble should lessen as a child grows older.

Separation Anxiety is likely to cause the most trouble when a child or adolescent must stay in a place that they cannot easily leave and return home, such as school or camp. Young persons with Separation Anxiety can often go to friends’ homes or out shopping without getting anxious because they can go home when they choose. Separation Anxiety should not be diagnosed when children or adolescents are living in truly dangerous situations where they could really be hurt when they are away from home.

About four percent of children and adolescents have Separation Anxiety Disorder. It often develops after the child or adolescent has had a traumatic experience.

Panic Disorder causes repeated and often unexpected attacks of intense fear. These attacks come on suddenly and are usually full-blown in 10 to 15 minutes. There are accompanying physical symptoms such as:

Psychologically, a young person may feel frightened and confused and believe that he or she is dying. Children and adolescents with Panic Disorder are very worried between attacks about when the next attack will happen.

Panic Disorder is rare in young children. It is more likely to happen to adolescents. Research shows evidence that both heredity and stressful experiences may have a role in causing Panic Disorder.

Obsessive-Compulsive Disorder (also called OCD) results in repeated upsetting thoughts (called obsessions) or ritual behaviors (called compulsions) that a young person cannot control easily or stop. Common obsessive thoughts include worries about contamination, serious illness and excessive doubt. Compulsive behaviors are often done to try to control these thoughts. Common compulsions include counting, word or number repetition and attention to symmetry.

It is estimated that one to three percent of children and adolescents have Obsessive Compulsive Disorder. It is more common in boys than in girls. There is growing evidence that Obsessive Compulsive Disorder is caused by genetic and biological factors.

Post-Traumatic Stress Disorder (also called PTSD) can happen after a child or adolescent is involved in or watches a very, very frightening event like a car accident, physical or sexual abuse or other violent events. The young person may be actually hurt in the event or feel threatened with extreme harm. PTSD is a serious condition that can interfere with a young person’s ability to do everyday activities at home and at school. Common symptoms of PTSD are based on the age of the young person.

Children 5 years and younger:
  • Fear of being away from parents
  • Crying, shaking
  • Bedwetting
  • Fear of darkness
  • Trouble sleeping and nightmares

Children 6-11 years old:

  • Not wanting to be around other children
  • Irritability and fighting
  • Distractibility and trouble concentrating
  • Nightmares and difficulty sleeping
  • Refusing to go to school
  • Stomachaches or headaches
  • Flashbacks-memories of the frightening event that seem real
  • Bed wetting

Adolescents 12-17 years old:

  • Nightmares and trouble sleeping
  • Flashbacks or frightening memories that feel as if the trauma is happening again
  • Refusing to go places or do things that remind the adolescent of the trauma
  • Not getting along with friends
  • Difficulty concentrating
  • Having trouble with school work
  • Feeling sad and not wanting to be with friends

Symptoms usually begin within three months after a trauma, but can surface even months or years later.

Phobias are intense, overwhelming fears connected to specific objects or situations. Most children have fears, but they do not get in the way of their everyday life. Children and adolescents with Phobias may avoid some normal activities and miss important life experiences. There are two main kinds of Phobias in childhood and adolescence:

Generalized Anxiety Disorder is diagnosed when a child or adolescent regularly has excessive worry and tension about a number of different things for at least six months. In addition to anxiety, young people with Generalized Anxiety Disorder may have physical symptoms such as headaches, tiredness and muscle tension. Generalized Anxiety Disorder usually runs in families and can become worse when a young person is stressed.

What causes Anxiety Disorders?

Research suggests that anxiety disorders are caused by both biological and psychological factors. Stress can trigger Anxiety Disorders. Anxiety Disorders also tend to run in families. Studies have shown that children and adolescents with Anxiety Disorders have an increased physical and psychological reaction to stress. They react more quickly and more strongly even to a small perceived danger. Other physical and psychological conditions can cause the same symptoms as Anxiety Disorders. It is important to have a thorough medical examination to rule out other possible causes of anxiety symptoms.

How can Anxiety Disorders be treated?

Treatment for Anxiety Disorders often combines medications and specific types of talking therapies. Effective medications are available to treat Anxiety Disorders. Behavioral Therapy and Cognitive Behavioral Therapy are two proven talking therapies. Behavioral Therapy focuses on changing specific behaviors and uses techniques to stop unwanted behaviors. Cognitive Behavioral Therapy teaches ways to identify, understand and change the ways children and adolescents think about stressful things.

Treatment for Anxiety Disorders in children and adolescents involves a young person meeting individually with a therapist for talking therapies and also with a psychiatrist if medication is a part of treatment. Parents meet with their child’s therapist to learn ways to manage their child’s anxieties and to help reduce them. Treatment for adolescents usually involves therapist’s work with parents, but to a lesser extent.

The sections below provide links to web sites that give additional information about Anxiety Disorders in children and adolescents as well as a link to Westchester County Mental Health Services, a database which includes local service providers for the treatment of Anxiety Disorders.

Additional Information about Anxiety Disorders

Mental Health: A Report of the Surgeon General
http://www.surgeongeneral.gov/library/mentalhealth/chapter3/sec6.html
This is the first report on mental health from the United States Surgeon General. It was issued in December 1999. This site gives a clear summary of the different Anxiety Disorders in children and adolescents, including causes, symptoms and treatments.

Anxiety Disorders Association of America
http://www.adaa.org/AnxietyDisorderInfor/ChildrenAdo.cfm
This is a national organization that promotes the prevention and cure of anxiety disorders and works to improve the lives of people who have Anxiety Disorders. This site has short descriptions of the Anxiety Disorders in children and adolescents. It also has a questionnaire for parents concerned about anxiety problems in children.

National Institute for Mental Health (NIMH)
http://www.nimh.nih.gov/publicat/violence.cfm
NIMH is an agency of the United States government that does research on mental illnesses. This easy-to-read site provides detailed information on how children and adolescents react to traumatic events. It describes the symptoms and treatment of Post-Traumatic Stress Disorder in children and adolescents. It also provides information on current research findings and available resources (agency names, telephone numbers and web site addresses).

National Alliance for the Mentally Ill (NAMI)
http://www.nami.org/helpline/ocd.htm
This is a very respected grass roots family movement that began over 20 years ago. It does effective self-help and advocacy for people with mental illnesses, including Anxiety Disorders. This site gives helpful information about Obsessive Compulsive Disorder in children and adolescents.

American Academy of Child and Adolescent Psychiatry
http://www.aacap.org/clinical/Anxtysum.htm
This is an organization for physicians trained to diagnose and treat mental illnesses and emotional disturbances in children and adolescents. This site gives technical information on symptoms, diagnosis and treatment for Separation Anxiety Disorder, Generalized Anxiety Disorder, Social Phobia and Panic Disorder in children and adolescents.

http://www.aacap.org/clinical/Ptsdsum.htm
This site gives technical information on symptoms, diagnosis and treatment for Post-Traumatic Stress Disorder in children and adolescents.

http://www.aacap.org/clinical/Ocdsum.htm
This site gives technical information on symptoms, diagnosis and treatment for Obsessive Compulsive Disorder in children and adolescents.