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Just how many anxiety disorders affect children?
The major anxiety disorders identified in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders include separation anxiety disorder, generalized anxiety disorder, social phobia, specific phobia, panic disorder with or without agoraphobia, agoraphobia without panic disorder, posttraumatic stress disorder and obsessive compulsive disorder.
Separation anxiety disorder features excessive anxiety about separation from a major attachment figure that may reach a panic level and lead to school refusal (Corcoran & Walsh, 2006). Separation anxiety causes the child to fear for the safety and return of the person with whom they are attached. The worry experienced by children with generalized anxiety disorder is not limited to a specific object or situation and is present most of the time (Connolly et. al., 2006). Social phobia is a marked and persistent fear of social or performance situations in which embarrassment may occur. Children with social phobia may not be able to identify the source of their anxiety, but behaviorally may exhibit crying, tantrums, clinging or staying close to a familiar person and inhibited interactions possibly including mutism (DSM-IV-TR).
Children who unreasonably fear a certain object or situation may be experiencing a specific phobia. Again, as with all of these disorders, the interference in daily functioning must be extreme and result in adverse effects. For example, a child may avoid a school bus if their anxiety revolves around an obsession with the possibility of a school bus crash. He or she may miss school repeatedly and will fail to recognize their fears as irrational.
Connolly and authors (2006) defined panic disorder as recurrent episodes of intense fear that occur unexpectedly and involve physical symptoms including, but not limited to, pounding heart, sweating, shaking, difficulty breathing and nausea.
Agoraphobia features anxiety about being in places or situations from which escape may be difficult or embarrassing or in which help may not be available if panic like symptoms arise (DSM-IV-TR). Agoraphobia may or may not be present when a child experiences a panic disorder.
Post traumatic stress disorder is an anxiety disorder that follows the exposure to an extreme traumatic stressor that involved physical harm or the threat of physical harm (NIMH). Children may seem hypersensitive, emotionally numb, distant, irritable, aggressive, and possibly violent as a result of this anxiety disorder.
Obsessive compulsive disorder includes anxiety aroused by repetitive, intrusive thoughts, images or impulses, often leading to compulsive ritual behaviors (Papalia et. al., 2004). Obsessions and compulsions create anxiety due to the perceived need to complete rituals.
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How do anxiety disorders develop?
The development of anxiety disorders in children depends on the interplay between risk and protective factors that include biological and social components. Connolly and authors (2006) said risk factors include genetics, child temperament and parental anxiety. Genetics and temperament are biological risk factors, while parental anxiety presents as an environmental risk factor.
Other parenting attributes can also contribute to the development of anxiety disorders. According to Connolly and colleagues (2006), “Overprotective, overcontrolling, and overly critical parenting styles that limit the development of autonomy and mastery may also contribute to the development of anxiety disorders in children with temperamental vulnerability.” These parenting styles can inhibit the development of a healthy attachment between a child and parent which may contribute to the occurrence of an anxiety disorder.
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Help is available
Treatment for children with an anxiety disorder may include medication, psychotherapy or a combination of both. Antidepressants, also known as selective serotonin reuptake inhibitors (SSRIs) are often preferred in the treatment of pediatric anxiety. Medication may be necessary and helpful when anxiety disorder symptoms interfere with participation in psychotherapy or reduce the effectiveness of psychotherapy. Connolly and authors (2006) recommend including consultation with school personnel and primary care physicians, cognitive-behavioral interventions, psychodynamic psychotherapy, family therapy, and pharmacotherapy.
Cognitive behavioral therapy teaches a child how to develop and practice coping skills to alleviate or reduce anxious symptoms. When a child learns how to control their anxiety they will experience less distress and have greater confidence in managing symptoms.
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American Psychiatric Association (2000). Diagnostic and statistical manual of mental disorders, 4th edition, (DSM-IV-TR). Washington, DC: American Psychiatric Association.
Connolly, S. D. et al. (2006). Practice Parameter for the Assessment and Treatment of Children and Adolescents with Anxiety Disorders. Journal of American Academy of Child Adolescent Psychiatry.
Corcoran, J. & Walsh, J. (2006). Clinical assessment and diagnosis in social work practice. New York: Oxford University Press.
National Institute of Mental Health. Anxiety Disorders. U. S. Department of Health and Human Services. (http://www.nimh.nih.gov)
Papalia, D. E., Olds, S. W., & Feldman, R. D. (2004). A child’s world: Infancy through adolescence. (9th ed.). Boston, MA: McGraw Hill.