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Anxiety Disorders in Children and Adolescents

Anxiety disorders are among the most common disorders in children and adolescents. About 10 percent of children and adolescents are affected by an anxiety disorder at some point. Anxiety is the brain’s natural response to what it perceives as a dangerous situation. It is an innate human response, and not necessarily maladaptive.  Separation anxiety is a natural phenomenon that occurs in infants less than one, emerging when a child is separated from their parents or natural caregivers. It usually peaks by 9-18 months, and decreases around 2.5 years of age, when a child develops the ability to soothe themselves and achieve an internal sense of security. However, children who display a persistent pattern of inhibition, shyness, and social withdrawal past this age are more likely to develop Separation Anxiety Disorder, as well as the other anxiety disorders of childhood, such as Generalized Anxiety Disorder, Social Phobia, and Obsessive Compulsive Disorder. An anxiety disorder, if left untreated, can lead to a pattern of avoidance and trouble making friends, participating in class and socialization, and normal development. Nevertheless, once identified and diagnosed, anxiety is highly treatable, allowing affected children to live with a greater sense of ease and accomplishment.

Causes of Anxiety Disorders in Children and Adolescents

Several biological and genetic factors seem to predispose young people to develop an anxiety disorder. Children with persistent worry are known to have elevated resting heart rates and more reactive nervous systems when confronted with tasks or activities that require high levels of concentration. Neuroimaging studies have identified that the amygdala, an area of the brain which is integral to the fight or flight response, is overactive in those prone to excessive anxiety. Females are twice as likely as males to develop an anxiety disorder, and children with at least one parent who suffers from either anxiety or depression have substantially higher rates of anxiety disorders. Twin studies suggest a genetic correlation as well. Temperamental factors, which seem to be highly influenced by genetics, can predispose to anxiety traits. The temperamental tendency to be unusually shy or to withdraw in novel situations seems to predict the development of higher rates of anxiety into adulthood.

Although biological factors may lead children to be more vulnerable to anxiety, several environmental factors contribute as well. Some studies suggest certain parenting styles, such as overprotection, authoritative parenting, and excessive parent-adolescent disagreements, contribute to anxiety disorders. Many studies have found an association between childhood adversities and the development of anxiety disorders. These include divorce, loss events, parental illness, trauma, and poverty.

In conclusion, the risk of developing an anxiety disorder might be increased by biological, genetic, and environmental factors. This list is by no means complete. It is also particularly important to note how difficult it can be to disentangle the roles of nature versus nurture.  Regardless of the cause, however, these disorders are highly treatable. If your child seems to suffer from excessive anxiety, a skillful clinician at The Midtown Practice can make recommendations to both your child and family so that they can thrive both socially and academically.

Symptoms of Anxiety in Children and Adolescents

Anxiety is a normal part of childhood, and many young people go through phases where they are more nervous, fearful, and avoid new experiences. Many children suffer from fear of the dark, or harmless phobias that diminish over time with reassurance and maturity. However, when anxiety becomes chronic and interferes with activity and normal development, it is necessary to evaluate them for a more significant condition.

The term “anxiety disorder” refers to a group of mental illnesses marked by pervasive fear and worry, generally followed by avoidant behavioral patterns. These disorders include Generalized Anxiety Disorder (GAD), Obsessive Compulsive Disorder (OCD), Panic Disorder, Post Traumatic Stress Disorder (PTSD), Separation Anxiety Disorder, Social Anxiety Disorder, and Selective Mutism. Generalized anxiety disorder is the most common anxiety disorder in childhood, and is characterized by excessive worry, occurring more days than not, for a period of at least six months. The anxiety and worry are accompanied by other symptoms such as restlessness, fatigability, irritability, muscle tension, or sleep disturbance. Affected children tend to strive for perfection, seek constant reassurance, and are often perfectionists.

Obsessive Compulsive Disorder is characterized by intrusive and unwanted thoughts and repetitive behaviors or rituals that a child feels compelled to perform in response to an obsession. Obsessions include worry about dirt, germs, contamination, fear of harm to a loved one or losing something valuable, or religious rules. Compulsions include excessive hand washing, checking and rechecking objects or information, counting, or hoarding items.

Panic Disorder is diagnosed when your child develops two or more unexpected anxiety attacks followed by at least one month of concern over having another panic attack. A panic attack includes symptoms such as feeling imminent danger, fear of going crazy, rapid heartbeat, sweating, trembling, chest pain, sense of being unreal, or tingling sensations.

Post Traumatic Stress Disorder occurs after one is exposed to an objectively traumatic event and that event is persistently reexperienced or relived by having recurring dreams, distressing recollections, and emotions triggered by internal and external cues of the event. Persistent avoidance of stimuli associated with the event and symptoms of arousal such as insomnia, anger outbursts, difficulty concentrating, and exaggerated startle response are common.

When Separation Anxiety Disorder occurs, a child has excessive fear when away from home or the primary caregiver. This might manifest as school refusal, extreme homesickness, or demanding that someone stay with them at bedtime.

Social Anxiety Disorder or Social Phobia is characterized by an intense fear of social and performance situations and activities. These children refuse to initiate conversations, have poor eye contact, often appear isolated, and are overly concerned with humiliation and embarrassment. Selective Mutism occurs when children refuse to speak where talking is expected or necessary. Although these children can be very talkative and display normal behavior in comfortable situations, they withdraw and appear emotionless or mute in unfamiliar environments or those they consider distressing.

Diagnosis of an Anxiety Disorder

Anxiety disorders  are often first  identified by a teacher, pediatrician, or concerned parent. Depending on the actual disorder, a familiar adult might observe excessive worry, rumination, trouble relaxing, restlessness, irritability, sleep issues, or social withdrawal. Several screening tests such as the GAD-7, or the Screen for Child Anxiety Related Disorders (SCARED) are available online and also might help to identify a child struggling with anxiety. If you are at all concerned, the most important step is to bring them to a skillful clinician who can assess and diagnose your child. Anxiety disorders can impact your entire family, and prevent your child from reaching their social, emotional, and academic potential. Research has shown that if left untreated, these children achieve less in school, miss out on important social experiences, and engage in substance abuse. They also might be more prone to other psychiatric disorders such as depression, eating disorders, and Attention Deficit Hyperactivity Disorders.

At The Midtown Practice, our clinicians have specific expertise in diagnosing and treating anxiety disorders. The evaluation will consist of a thorough developmental, medical, and family history, a thorough inventory of suggestive signs and symptoms, and collection of collaborative information from teachers, family members, and other professionals  when appropriate. Whether your child has been diagnosed with an anxiety disorder, or you are concerned about anxiety symptoms, the expert clinicians at The Midtown Practice are here to support your family by identifying an anxiety disorder early and addressing it with treatments that work, so you can resume normal lives.