Anxiety in Children

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Anxiety is a normal part of everyday life for adults and children. Some children may become anxious when starting something new like school. Others may go through phases when they have nightmares about monsters under the bed. When children are experiencing anxiety related to a specific event they can usually be reassured and comforted by their parents or caretaker.

The difference between normal event-related anxiety, going through phases of being anxious and an anxiety disorder is that the event-related anxiety or phase is usually harmless and temporary. When a child suffers from an anxiety disorder he/she will experience fear, nervousness, shyness, and avoidance of places and activities that persists despite the helpful efforts of parents, caretakers, and teachers. An anxiety disorder is likely to be present when a child experiences excessive worry, concern, or fear while involved in developmentally appropriate tasks, ordinary interactions, and everyday routines.

Anxiety disorders tend to become protracted and interfere with how the child functions at home or at school to the point that the child becomes distressed and uncomfortable and starts avoiding activities or people. Unlike a temporary phase of fear, such as seeing a scary movie and then having trouble falling asleep, reassurance and comfort is not enough to help a child with an anxiety disorder get past his or her fear and anxiety.

Children with anxiety disorders usually exhibit an excessive level of fear toward normal challenges and/or when learning new skills. Infants may display anxiety by crying inconsolably or screaming; sleeping and eating disturbances may also indicate a higher level of anxiety. Toddlers and preschoolers experiencing an anxiety disorder may exhibit recklessness and aggression directed toward themselves or others. For example, a toddler may be so afraid of the dark that the lights being turned down at nap time cause him to aggressively run from the room, or a child may become aggressive and run reckless when confronted with a new but developmentally appropriate activity such as finger painting. It is also common for children to react with somatic complaints such as stomachaches or headaches.

Anxiety in Children : Symptoms

  • Multiple fears
  • Specific fears
  • Limited play repertory
  • Difficulty with transitions between activities
  • Reckless and defiant behaviour
  • Excessive stranger anxiety
  • Excessive separation anxiety
  • Excessive inhibition due to anxiety
  • Lack of impulse control

Children can develop any of the anxiety disorders as adults do. However the disorders listed in the following tabs occur more commonly during childhood.

Separation Anxiety Disorder

Separation from the caregiver causes the child excessive anxiety and distress that has intensity and duration beyond that of typical development and lasts more than one month. Children experiencing this disorder often refuse to be held or comforted by a substitute caregiver. These children are also often preoccupied with fears that their primary caregiver will have an accident or become sick, or the child may also fear that they might have an accident or illness while separated from their primary caregiver. Children may also worry about getting lost or kidnapped. Physical complaints such as headaches, stomach-aches, nausea, or vomiting are also common when separation from the caregiver occurs or is anticipated.

Social Anxiety Disorder

A child will have a persistent fear of social or performance situations that include people unfamiliar to the child or where the child will be in a situation in which they are under the scrutiny of others. This typically includes such things as play dates, large family gatherings, birthday parties, religious ceremonies, and/or collective sharing times at childcare or preschool; the fear must last at least four months. These situations may cause reactions such as crying, having a tantrum, becoming immobile, becoming “clingy”, or strongly resisting being involved in social situations. The child will avoid the feared social situation and may have anticipatory anxiety that interferes with their normal functioning and development.

Specific Phobias

Children experience excessive fear when they are in the presence of specific objects or exposed to certain situations; the fear may even occur when the child is just anticipating such experiences. The fear must last at least four months. Exposure to the object or situation will cause an immediate reaction by the child—usually crying, a tantrum, becoming immobile, or becoming “clingy.” The child will attempt to severely limit their own activities and their family’s activities to avoid possible exposure to the feared object or situation.

Helpful Strategies for Parents and Caregivers

Avoid belittling the fear or anxiety; instead, validate the concern without confirming that the fear is real. For example, “You are worried about your dad leaving—that can be scary to think about.”

Use and teach positive self-talk; listen to what the child says and help them to replace negative thoughts with positive ones. For example, if your child says “I can’t go outside because their might be a dog and dogs are scary,” you can say “Some dogs outside are mean and may be scary, but not all dogs are. I’ll help you figure out which ones aren’t mean so you can feel okay outside.”

If the anxiety relates to learning or mastering new skills, teach building-block skills. For example, if a child seems overwhelmed at the thought of getting dressed by themselves, teach them to zipper or button first, then work toward the goal of independent dressing over time.

For separation anxiety, try using a transitional object—something the child receives from their caregiver to hold while the caregiver is gone.

Help the child verbalise their feelings and fears. With young children, help them to distinguish between a little bit scared and a lot scared.

Teach relaxation and deep-breathing exercises to children who are able to understand and participate in these activities. Blowing bubbles and pretending to blow bubbles, learning to whistle, or actively trying to move their bellies in and out are all fun ways for children to learn deep breathing.

If the anxiety remains you may need to seek professional assistance. Before you speak to your GP or psychologist it is helpful to document, with as much detail as you can gather, your child’s emotional reactions and behaviours. When documenting behaviour, be as specific as possible. Avoid generalisations such as “Michael looked anxious.” Instead, record specific behaviours you are seeing or not seeing and provide as much detail as seems relevant. Also include the context in which the behaviour occurred. For example, noting that “Michael held his blanket tight and got teary-eyed as the children lined up to go outside” is more informative than “Michael wouldn’t line up to go outside.”