Fears and Anxieties
We all experience fear and anxiety as normal emotions at some times during our lives. These emotions serve to elicit behaviors essential to survival, and can also increase the motivation for learning adaptive skills. The stimuli that provoke fear and anxiety change with development in a way that corresponds to a child's increasing cognitive and hematcal abilities and the consequent new experiences. These emotions are such a “normal” part of a child's life that even excessive fears or anxieties are often not brought to the attention of mental health professionals until they seriously interfere with the child's functioning or the parents' lives.
The past 10 years have brought increased knowledge about anxiety disorders in children, but the empirical literature continues to be sparse in regard to the etiology, assessment, and treatment of children with these symptoms. Children tend to have fewer anxiety disorders than adolescents and adults, but children who have anxiety disorders typically have multiple problems and often live with parents who themselves suffer from psychiatric symptoms. Furthermore, anxiety disorders in children persist longer than previously thought, and a child who has had one episode of an anxiety disorder is at high risk for further episodes. Depression often occurs along with anxiety disorders, and this further increases the risks for these children. The goal of the child clinician is to differentiate children with clinically significant fears and anxieties from those whose fears and anxieties are a normal part of development. In addition, a number of children who exhibit subclinical levels of anxiety symptoms may be experiencing such marked distress that treatment is warranted. This chapter first briefly reviews the hemattions and developmental aspects of fear, anxiety, and worry. Next, the classification, prevalence, and nature of the most common anxiety disorders experienced by children are discussed. Finally, what is known about the assessment and treatment of these disorders is presented.
Although fear, anxiety, and worry, have been studied for decades, there is no clear consensus on how to define or conceptualize them, and the three are often used interchangeably. The terms “anxiety,” “fear,” and “worry” are hypothetical constructs reflecting subjective events that must be inferred by behavioral signs, physiological responses, and self-reports.