Anxiety and Anxiety Disorders in Children

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Anxiety is one of the most common experiences of children and adults. It is a normal, adaptive reaction, as it creates a level of arousal and alertness to danger. The primary characteristic of anxiety is worry, which is fear that future events will have negative outcomes. Anxious children are much more likely than their peers to see minor events as potentially threatening. For example, giving a brief oral report might be slightly anxietyproducing for most children, but the anxious child is much more likely to believe that his or her performance will be a complete disaster.

Anxious children are likely to engage in a variety of avoidance behaviors to reduce exposure to threat. In the classroom, they may be withdrawn, not initiate interactions, select easy over difficult tasks, and avoid situations where they anticipate increased risk for failure. Socially, they may feel uncomfortable in new situations, not initiate conversations, or avoid group interactions. They worry about being evaluated socially and fear that others will view them negatively. Although there may be some basis for worry, it is usually out of proportion to the situation and is unrealistic. Either a real or imagined threat may be enough to trigger an anxiety reaction.

DEVELOPMENT OF ANXIETY

From early childhood through adolescence, anxiety can be a normal reaction to stressful situations.

Infancy and preschool. Anxiety first appears at about 7-8 months of age as stranger anxiety, when an infant becomes distressed in the presence of strangers. At about 12-15 months of age, toddlers show separation anxiety when parents are not nearby. Both of these reactions are typical and indicate that development is progressing as expected. In general, severe stranger and separation anxiety dissipate by the end of the second year of life. Anxiety at this age is primarily associated with fears of strangers, new situations, animals, the dark, loud noises, falling, and injury.

School age. Up to about age 8, many causes of anxiety continue from preschool levels with a focus on specific, identifiable events. With age, sources of anxiety become more social and abstract, such as worrying about friends, social acceptance, the future, and coping with a move to a new school. Adolescents tend to become more worried about sexual, religious, and moral issues as they continue to develop. In the vast majority of cases, children and adolescents cope well with these situations and severe or chronic anxiety is not common.

SIGNSOFANXIETY

Table 1 summarizes the major thinking/learning, behavioral, and physical signs of anxiety. Not all children will show all signs or show the same signs to the same degree, but a stable pattern that interferes with performance may be cause for concern.

The usual signs of anxiety differ between the anxious and nonanxious child primarily in degree, and may be shown in one or more of the following ways:

Excessive or atypical for age or developmental level

Inappropriate or excessive for the situation on a frequent basis

Have persisted for several weeks or months

ANXIETY DISORDERS

A child or adolescent may have an anxiety disorder if anxiety is a pattern causing persistent problems. Several types of anxiety disorders exist, impairing social, personal, or academic functioning. The frequency of anxiety disorders ranges from about 3% up to 20% of children and adolescents. In infancy and preschool children, anxiety disorders are infrequent. They most often start to emerge in early childhood and may persist into adulthood. The frequency of anxiety disorders in boys and girls is about the same during elementary school years, but differences between them emerge in adolescence, with girls being two to three times more likely to develop anxiety disorders. …