Anxiety Disorders

Defining Anxiety
There are many definitions of anxiety, but a useful one is apprehension or excessive fear about real or imagined circumstances. The central characteristic of anxiety is worry, which is excessive concern about situations with uncertain outcomes. Excessive worry is unproductive, because it may interfere with the ability to take action to solve a problem. Symptoms of anxiety may be reflected in thinking, behaviour, or physical reactions.

Anxiety Disorders
When anxiety becomes excessive beyond what is expected for the circumstances and the child’s developmental level, problems in social, personal, and academic functioning may occur, resulting in an anxiety disorder. The signs of anxiety disorders are similar in children and adults, although children may show more signs of irritability and inattention. The frequency of anxiety disorders ranges from about 2 to 15% of children and occurs somewhat more often in females. There are many types of anxiety disorders, but the most common ones in children are Separation and Generalized Anxiety. Typical symptoms are listed below but many times there are some symptoms from both that overlap.

Separation Anxiety DisorderThis pattern is characterized by excessive clinging to adult caretakers and reluctance to separate from them that is inappropriate for the child’s age.

Typical Symptoms:
Unrealistic and persistent worry about possible harm to parents, self or other family members
Unrealistic and persistent worry that a terrible event will separate the child from parents or other family members
Persistent school refusal
Persistent refusal to sleep alone
Persistent avoidance of being alone
Recurrent nightmares re: separation
Complains of illness (stomach aches, headaches)
Excessive distress in anticipation of separation from parents or family members
Excessive distress when separated parents/family members

Generalized Anxiety Disorder. This pattern is characterized by excessive worry and anxiety across a variety of situations that does not seem to be the result of identified causes.

Typical Symptoms:
Excessive anxiety or worry about future events (school performance, not having friends)
Excessive worry about death or dying or that some natural disaster or other event will cause harm
Unrealistic concern about the appropriateness of past behaviours
Unrealistic concern about competence (school/social situations, sports)
Frequently complains about being ill (headaches, stomach aches)
Very self-conscious or sensitive
Excessive need for reassurance
Has difficulty relaxing
Sleep disturbance (difficulty falling or staying asleep or restless sleep)
Touchy or easily annoyed
Becomes tired easily

Obsessive-Compulsive Disorder. Characteristics include repetitive thoughts that are difficult to control (Obsessions) as well as some uncontrollable need to repeat specific acts, such as arranging, cleaning, hand washing or placing objects in the same arrangement (compulsions). The person with OCD usually knows the thoughts and behaviours are excessive and feels distress at not being able to control them.

Relationship to Other Problems

Depression. Anxiety and depression can occur together. When they do anxiety most often precedes depression, rather than the opposite.
Anger Control. Anxious children can sometimes be very irritable and get frustrated easily. Thinking about anxiety provoking events that they may be trying to avoid can cause the child to become uncooperative and refuse to comply. Tantrums may sometimes occur in younger children.
Attention Deficit Hyperactivity Disorder. Some children can present with both ADHD and Anxiety. There is sometimes a complex interplay between ADHD and anxiety as well as other mood control problems such as managing anger. In some cases much of the child’s anxiety may be caused by distress that they have so much difficulty with attention and concentration or vice versa. A thorough psychological and educational evaluation by a qualified professional will help to determine what is the primary cause and priority for treatment.
School performance. Children with anxiety may not have any difficulty with school performance. They are “pleasers” who really try to do their best. However, they may be too much of a perfectionist and not be satisfied with their work if it does not meet high personal standards or they may worry excessively about their school performance and this results in underperformance and difficulty concentrating.

Does My Child Need Professional Help?
Read the symptom checklist above and if you see a lot of these behaviours and they cause problems to the child’s functioning within the family, at school or with their socialization, it is usually best to consult with a Psychologist.

Some questions to consider:

  • Is the anxiety typical for a child this age?
  • Does the anxiety seem excessive no matter what you do to help?
  • Is the problem long term and doesn’t seem to improve?
  • How is the child responding to the parent’s attempts to help?

A counselling approach that utilizes techniques from Cognitive Behavioural Therapy (CBT) has been shown to be one of the best approaches to deal with anxiety disorders in children. Parents are usually involved in counselling to some degree especially with younger children. In some cases, a Physician may recommend medication.

How Can I Help My Child?
Although professional assessment and intervention may be necessary, the following list may be helpful to parents in working with the child at home:

  • Remember that anxiety is not wilful misbehaviour, but reflects an inability to control it. Therefore, be patient and be prepared to listen. Being overly critical, disparaging, impatient, or cynical likely will only make the problem worse.
  • Try not to reinforce anxious behaviour when it occurs. Help the child identify that it is excessive and unproductive. Point out to them occasions when they have faced a situation and managed it appropriately. Help the child learn some relaxation techniques. Praise the child’s efforts to manage it.
  • Maintain realist, attainable goals and expectations for your child. Do not communicate that perfection is expected or acceptable. Often, anxious children try to please adults, and will try to be perfect if they believe it is expected of them.
  • Maintain a consistent, but flexible, routine for homework, chores, and activities.
  • Accept mistakes as a normal part of growing up and that one is expected to do everything equally well. Praise and reinforce effort, even if success is less than expected. There is nothing wrong with reinforcing and recognizing success, as long as it does not create unrealistic expectations and result in unreasonable standards.
  • It is not realistic to expect that all anxiety will be removed; rather, the goal should be to get the anxiety to a level that is manageable.
  • Teach your child simple strategies to help with anxiety, such as organizing materials and time, developing small scripts of what to do and say , either externally or internally, when anxiety increases, and learning how to relax under stressful conditions.
  • You may find that reasoning about the problem does not work. At times, children may realize that their anxiety does not make sense, but are unable to do anything about it without help.
  • Do not assume that your child is being difficult or that the problem will go away. Seek help if the problem persists and continues to interfere with daily activities.

Conclusion
Untreated anxiety may get worse if it is not properly addressed and lead to other problems. However, anxiety problems can be treated effectively, especially if detected early. Teaching the child and parent to cope and manage is the goal of any intervention.
Website
Anxiety Disorders Association of America – www.aada.org
National Mental Health Association – www.nmha.org