Anxiety in Children

Fear is the emotional response to real or perceived imminent threat, whereas anxiety is anticipation of future threat. Obviously, these two states overlap, but they also differ, with fear more often associated with surges of autonomic arousal necessary for fight or flight, thoughts of immediate danger, and escape behaviors, and anxiety more often associated with muscle tension and vigilance in preparation for future danger and cautious or avoidant behaviors. (APA 2013)

• Anxiety disorders in children and young people are common and can have a significant impact on mental health and well-being. Anxiety disorders can affect family, school and social life, leisure activities and educational achievement and they often occur alongside other mental health problems. They are particularly prevalent in children with autism spectrum disorder and ADHD.
• There are seven main anxiety disorders, including phobias, panic disorder, separation anxiety disorder and generalised anxiety disorder.
• Children and young people with an anxiety disorder may be tired and irritable, have problems sleeping and find it hard to concentrate. Anxiety may also show itself as physical symptoms such as headache and muscle tension, or as dysregulated behaviour including tantrums, crying and ‘freezing’ with fear.
• There is no single cause of anxiety disorders, but instead multifactorial risk factors, such as family history, adverse life events and parenting behaviours.
• The main treatment for anxiety disorders is cognitive behavioural therapy (CBT), which is effective in children and young people. It can be delivered in various ways, including as parent-guided therapy, computer based programmes and face to face sessions. Medication can also be used, but is not routinely prescribed.

Anxiety disorders in children and young people are very common, and are often associated with long-term mental health problems which persist into adulthood (Creswell et al, 2014). Anxiety is a part of life for everyone and some anxiety is essential because it helps us to act to protect ourselves and ensure our safety. However, anxiety can become overwhelming, and the symptoms that arise as a result can persist long after the anxiety provoking situation has ended. When this happens, it can cause distress and have a significant impact on the mental health of children and young people.

Anxiety disorders are characterised by excessive fear, anxiety and worry about events or activities and this happens more often than not for a child and continues for at least six months (APA 2013). The anxiety or worry, or physical symptoms that arise as a result, can cause significant distress to a child or young person and affect their quality of life and ability to function day to day (APA 2013).

Children and young people with a generalised anxiety disorder can feel restless and on edge much of the time. They may be tired and irritable, have problems sleeping, find it hard to concentrate and be unable to control of deal effectively with their worries (APA 2013). In young children the anxiety may be more likely to show itself as physical symptoms, such as muscle tension, headache or stomach ache (James 2015).  Angry outbursts, tantrums, crying and ‘freezing’ with fear are also common symptoms in children.

The Diagnostic and Statistical Manual of Mental Disorders lists seven anxiety disorders (APA, 2013):

• Separation anxiety disorder. This is an inappropriate and extreme anxiety about being separated from home or from a major attachment figure (such as a parent), which causes significant distress to a child (Evans 2012). Children can become reluctant to take part in activities that mean they must be separated from a key attachment figure and this can affect their attendance at school (Evans 2012).
• Selective mutism. This is when a child consistently fails to speak in situations in which they are expected to speak, such as at school (APA 2013). Selective mutism isn’t a communication disorder and it’s also not the child being uncomfortable with speaking in those situations, or not knowing what to say (APA 2013).
• Specific phobia. This is an extreme or unreasonable feeling of fear or anxiety linked to a specific animal, object, activity, or situation (Evans 2012). This fear causes extreme distress and can stop children taking part in normal day to day activities (Evans 2012).
• Social phobia. This is a persistent fear of social or performance situations with unfamiliar people, where a child or young person feels like they are being scrutinised (APA 2013). Children can worry that they will act in a way that is embarrassing and humiliating, and this can lead to a panic attack (APA 2013). Children will either avoid the situations that cause this distress, or will take part in them but with intense anxiety and distress (APA 2013).
• Panic disorder. This often starts in older children and young adults (Evans 2012). It’s the repeated fear of impending doom or danger which develops after unprovoked physical symptoms, such as rapid heart rate, shortness of breath, choking sensations, and sweating (Evans 2012).
• This is fear or severe anxiety about multiple situations in which escape might be difficult or panic-like symptoms might develop (Cornacchio et al, 2015). If it’s not treated, agoraphobia can lead to more serious mental health problems such as depression, substance misuse, and lead to suicide (Cornacchio et al, 2015).
• Generalized anxiety disorder. This is excessive anxiety and worry (apprehensive expectation) about several events or activities (such as work or school performance) (APA, 2013).

Useful links for families and carers.  

Anxiety UK 08444 775774 www.anxiety.org.uk

No panic 0844 967 4848 www.nopanic.org.uk

OCD Action 0845 390 6232 www.ocdaction.org.uk

OCD-UK www.ocduk.org.uk

CBT Online www.getselfhelp.co.uk