Treating Anxiety Disorders in Children and Adolescents

Anxious feelings, worries, or fears are common among children and adolescents. Many children experience a normal amount of apprehension in certain situations, whether it's an upcoming test at school or a thunderstorm.

Some children, however, experience these types of situations with an overwhelming sense of fear and dread. Others can't seem to stop thinking about these situations and their accompanying fears. No amount of reassurance seems to help. These children may tend to get "stuck" on their worried thoughts and have a hard time doing normal daily functions like going to school, playing, falling asleep, or trying new things. This is what separates normal, fluctuating worries of childhood from an anxiety disorder that requires professional intervention.

All anxiety-related problems share four common features:

• The anxiety is often an inexplicable fear or preoccupation that interferes with the child's or adolescent's ability to enjoy life or to complete daily routines or to do the things they are expected to do
• The anxiety is often as puzzling to the child as it is to his or her parents
• The anxiety does not respond to or diminish after logical explanations, since anxiety symptoms often defy logic
• The anxiety problem can be helped

What are anxiety disorders?

There are many different types of anxiety disorders, including generalized anxiety, social anxiety, separation anxiety, obsessive-compulsive symptoms, phobias, and panic. All of these disorders cause significant distress and a reduced level of functioning and competency for children and adolescents. Some common symptoms of anxiety include:

• Feeling nervous or "on edge"
• Unfounded or unrealistic fears
• Trouble separating from parents
• Sleep disturbance
• Obsessive thoughts and/or compulsive behaviors
• Trembling, sweating, shortness of breath, and other physical symptoms associated with anxious feelings

Often, the child or adolescent feels these symptoms are beyond his/her control, which only adds to their concerns.

Types of Anxiety Disorders

Generalized anxiety disorder is an excessive worry and/or apprehension about a number of events or activities. These feelings occur almost all the time and are not triggered by any one specific thing. Rather, the worry seems to float from one topic to the next. Some examples include: fear of failure or poor performance, worries about what others will think of them, and apprehension about new situations or meeting new people.

Phobias are highly specific and exclusive fears. The child or adolescent functions normally until confronted by the dreaded object, event, or situation. Some examples include fears of bugs, fears of heights, or fear of flying in an airplane.

Separation anxiety disorder is the child's or adolescent's excessive worry and apprehension about being away from their parents. Children with separation anxiety disorder often fear that their parents will be harmed in some way or will not return to them as promised. Separation anxiety disorder is often seen in preschoolers, but it is also seen in older children and adolescents in response to stressful life events.

Obsessive-compulsive disorder is a condition involving obsessions and compulsions. Obsessions are recurrent thoughts, impulses, or images that are difficult to control and cause significant distress. Some examples of obsessions are excessive concerns about germs or lucky/unlucky numbers.

Compulsions are recurrent behaviors that are difficult to control and cause significant distress. Some examples of compulsions include excessive hand washing or needs for cleanliness and orderliness.

Panic disorder is characterized by discrete and intense periods of anxiety that occur unexpectedly, without warning, and are not always linked to a specific place or situation. With panic disorder, there is often no warning, and therefore it is harder to predict when it may occur.

Post-traumatic stress disorder is an intense re-experiencing of a traumatic event by distressing recollections, dreams, and/or associations (such as things or situations that remind the child or adolescent of the traumatic event). Some examples include witnessing or experiencing a natural disaster, being in a serious automobile accident, or witnessing a violent crime.

What causes anxiety disorders?

Anxiety disorders are caused by a combination of life events, heredity, temperament, and biochemical factors.

In some ways, anxiety disorders are like allergies: We can identify the problem easily enough, but only through a careful evaluation can the causes and circumstances that cause anxiety disorders be identified and effectively treated.

Can anxiety disorders be helped?

Yes. Anxiety disorders can be helped by a combined treatment approach using behavioral treatment, family intervention and/or medication based on the individual needs of the child or adolescent. Often, children and adolescents do not initiate the help-seeking process and need the support and direction of their families.

What are the risks if I don't seek help for my child?

Not obtaining treatment can have serious negative consequences on your child's development and self esteem. Untreated anxiety disorders can strain family relationships, impact school performance and social functioning, and lead to more serious mental and physical health problems for the child.

What is the typical approach to treatment?

Assessment: The first step to successful treatment begins with a comprehensive evaluation of your child. This evaluation would include:

• A review of current symptoms and concerns, their duration and level of intensity
• A thorough review of your child's development and background
• Past medical and psychiatric history
• Important family background
• A mental status exam

Parents and guardians are included in the evaluation process to obtain background information and history as well as to participate in treatment planning.

Treatment: As part of the evaluation, the psychiatrist or psychologist will discuss an individualized treatment plan for your child. The treatment plan may include a combination of the following:

• Cognitive behavioral therapy for your child
• Medication
• Family therapy
• Parent education and support

The role of parents and guardians in their child's treatment is essential.

Obtaining help for your child

Please consult with a health care provider about your child's situation. If you're uncertain about whether or not an assessment is appropriate, a health care professional can talk to you about your concerns and help you decide what to do.

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