Children and Anxiety Disorders

Anxiety disorders are the most common psychiatric conditions in children and adolescents, affecting nearly 1 in 12 children and 1 in 4 adolescents. Anxiety disorders include specific phobias, social anxiety disorder, separation anxiety disorder, agoraphobia, panic disorder, and generalized anxiety disorder. Risk factors include parental history of anxiety, socioeconomic stressors, exposure to violence, and trauma. The U.S. Preventive Services Task Force recommends screening for anxiety in children eight years and older.

Symptoms include excessive anxiety, fear, or worry that is out of proportion to the situation, event, person, object, or threat. Physical symptoms of anxiety disorders in children and adolescents manifest as autonomic nervous system activation, including excessive sweating, palpitations, chest tightness, nausea, faintness, chills, and muscle tightness. Peak autonomic nervous system activation is seen in panic attacks, which can occur with any anxiety disorder. Additional behavioral responses indicative of an anxiety disorder include avoidance of or reluctance to engage in certain activities or with certain objects or individuals. Children can display behaviors such as crying, tantrums, or clinging when confronting or anticipating engagement with a situation, event, person, object, or threat. Anxiety disorder symptoms persist over time and negatively impact functioning in one or more domains, such as education and social and interpersonal performance

Care should be taken to distinguish symptoms of a disorder from normal developmental fears and behaviors, such as separation anxiety in infants and toddlers. Several validated screening measures are useful for initial assessment and ongoing monitoring. Cognitive behavior therapy and selective serotonin reuptake inhibitors are the mainstay of treatment and may be used as monotherapies or in combination. Prognosis is improved with early intervention, caretaker support, and professional collaboration.

Childhood anxiety is a common psychiatric disorder. It is estimated that more than 7% of adolescents 13 to 17 years of age have been diagnosed with anxiety, and more than 36% of children with behavioral problems have been diagnosed with anxiety disorders. A systematic review of studies conducted in 27 countries estimates that the worldwide prevalence of anxiety disorders in children is 6.5%. In the United States, nearly 1 in 12 children 3 to 17 years of age have anxiety. The National Institute of Mental Health estimates that the prevalence of anxiety disorders in adolescents 13 to 18 years of age is 1 in 4, and the prevalence of severe anxiety is about 1 in 17. Prevalence rates are approximately 20% for specific phobias, 9% for social anxiety disorder, 8% for separation anxiety disorder, and 2% each for agoraphobia, panic disorder, and generalized anxiety disorder.

Allison Green
Boston Tutoring Services