Anxiety In Children

Anxiety disorders are the most common psychiatric problems of childhood. Parents should be aware of the different kinds of anxiety disorders and the ages at which they occur.

     Fear is a normal and protective reaction. Some forms of anxiety occur in specific age groups and represent normal development. Stranger and separation anxiety are common from 7 months of age to two years of age.  It is easy to see how toddler anxiety developed as an evolutionary advantage – toddlers have the mobility to move away from the protection of their mothers and yet have no awareness of danger, so toddlers who had no fear didn’t stay around for long.

     Preschoolers have “magical thinking”, so they can develop fears about monsters under the bed and bogymen in the closet. The original Grimm fairytales are full of fantastic (and frightening) creatures. Children of this age can also develop an obsession for order and want things done in exactly the “right way”. Parents should recognize that the fears are real, but reassure the child that things will be fine. Parents should not change routines or react as if they also hold the same fear: the night-monsters don’t result in the child sleeping with the parents; if the red socks are in the laundry, wear the blue and you can wear the red tomorrow. We teach our children that fears are normal for all of us but we are in control of how we react to those fears.

     School-aged children often have fears of physical injury to themselves or loved ones. Adolescents have anxiety about social acceptance and success.

     When anxiety impairs normal functioning, becomes obsessive or disrupts the family, it needs attention. Separation anxiety disorder can develop in children in elementary school. They worry about parents being harmed and can refuse to be separated – insisting on sleeping with the parents or refusing to go to school. These children can have significant disruption of their lives with full panic attacks if they are forced to separate from their parents. They can have absolute school refusal, selective mutism where they won’t speak outside the home and they can have physical complaints such as headaches or abdominal pains. A child with this level of impairment may need family counseling, individual therapy and/or medication.

     Adolescents can develop generalized anxiety disorder with continual worries about the future or about past actions. Another aspect of anxiety is obsessive-compulsive behavior where repetitive or ritualistic behavior can interrupt normal daily functioning.

     Any of the anxiety disorders can be related to depression.  A child who suddenly develops anxiety or depression needs to have their family and social situation examined closely for any new disruption. Anxiety and depression are so closely intertwined that the most successful medications used to treat anxiety are antidepressant medications called serotonin reuptake inhibitors or SSRIs.

     Finally, there is a belief among certain physicians that psychological problems, tics and compulsive behaviors that come on suddenly in children can be caused by an infection with streptococcus. In fighting the infection, the body makes antibodies that also attack the brain and nervous system. This diagnosis can be difficult to make and even more difficult to treat. Because some doctors don’t believe it exists, parents may find that their caregiver is reluctant to investigate this possibility.