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
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
- 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
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
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
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
- 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
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
- Family therapy
- Parent education and support
The role of parents and guardians in their child's treatment is
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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