Kids And Anxiety

Pediatrics for Parents - January 22, 2008

According to the Anxiety Disorders Association of America (ADAA), children can suffer from anxiety in much the same way adults do. The ADAA's current research shows that if left untreated, anxiety disorder may cause a child to perform poorly in school, have undeveloped social skills and be vulnerable to substance abuse. But anxiety can sometimes be tricky to recognize, and not all forms of anxiety lead to serious problems.

The Beginnings of Anxiety

"There are many causes of anxiety and fear in children," says Frank Farley, PhD, a renowned child psychologist who teaches at Temple University and has often been consulted on issues of children and terror. Among the most common causes are school issues such as bullying, fitting in and peer pressure, concerns about terror and their future, and stress at home.

"One thing that can lead to anxiety is [any kind of] transition," Farley says. "The most basic anxieties are probably vague memories of helplessness related to conditions which threaten the very existence of the human infant - being attacked, dropped, annihilated, abandoned, overwhelmed or destroyed. These very basic dreads appear in everyone's dreams, sometimes as confused and overpowering nightmares," says Elizabeth Berger, MD, a child psychiatrist from Elkins Park, PA, and the author of Raising Kids with Character. "As children grow, they experience more sophisticated kinds of anxieties," she says.

Allen H. Weg, EdD, a psychologist, founder and director of Stress and Anxiety Services of New Jersey, and a cognitive behavioral therapist in East Brunswick, NJ, agrees that the causes of anxiety in a child vary by age. "Younger children tend to focus on fears of separation or loss of parents, for instance. Pre teens and teens are more focused on fear of peer rejection or school failure." Although research is ongoing, Farley says there seems to be both genetic and environmental links to anxiety in kids. "A family history of anxiety and depression can sometimes have an effect," he says. "Parents have an enormous impact on kids. If you have a parent who is anxious, [he] will communicate that fearfulness to the child."

Signs that a kid is struggling with anxiety, Farley says, include constant and unrelenting worrying about everyday activities, constantly checking and rechecking actions (such as a door lock or a packed school bag) and unrealistic fears that appear for no reason.

Coping with Anxiety

Weg says that one of the best ways to cope with anxiety in kids is to talk with them. "Reflect your understanding of their fear ("I know it feels very scary when Mommy drops you off at nursery and you are afraid."); provide comforting statements ("Do you remember feeling afraid yesterday? What ended up happening? Didn't you end up having a fun day? Didn't Mommy come back for you at the end of the day?"); provide a grounding or transitional object, like a stuffed animal that the child likes, or a charm that belongs to the parent; reinforce any attempt on the part of the child[ren] to combat their fears, even if unsuccessful."

Farley says that older kids especially need to talk, although they may not necessarily initiate a conversation about their fears. "I am a big fan of talking with your kids," he says. "Kids sometimes just want comfort. The more you reason with them [about their fears], the more effective it becomes."

"In general, the best defense against anxiety is human relationships," Berger says. "Parents (always anxious to do a good job) sometimes feel obligated to solve their children's anxieties on the spot, but what is called for is simply empathic listening, open-mindedness, and devotion to the child's best interest. Parents can offer suggestions - should an especially useful one leap to mind - but in the end the greatest reassurance is simply that one is loved and appreciated." A loving family relationship, Berger says, will provide an inner stability and allow children to learn to soothe themselves against life's fears.

When Anxiety Becomes Serious

Excessive anxiety can be a sign of a serious problem, Berger says, especially if the anxiety seems to interfere with the child's sleep, schoolwork and relationships. She recommends talking with your pediatrician "if a child shows persistent symptoms for more than two weeks, if there is a 'change in personality,' if there is an expression of hopelessness [or thoughts of suicide] by the child, or if there is any suspicion of substance use."

Your child's doctor may refer you to a healthcare professional who can diagnose and treat a serious disorder. While "run of the mill" anxiety, such as concerns about school, parental divorce and arguments with peers, can be stressful, there are many chronic anxiety disorders that can seriously impact the child's day-to-day functioning, says Weg. These include:

* Obsessive-compulsive disorder - washing, ordering, checking, counting, repeating and cleaning are just a few

* Specific phobia - fear of heights, dogs, bees, etc.

* Social phobia - intense shyness

* Panic disorder - very intense, physiological arousal symptoms that are scary, like heart racing, shortness of breath, dizziness

* PTSD (Post Traumatic Stress Disorder) - following a trauma, where the symptoms involve hypervigilance, nightmares, strong startle response and more;

* Generalized Anxiety Disorder - where the child seems to have multiple worries about almost everything, always thinking the worst

Weg encourages parents to be advocates for their child's mental health by seeking out a professional who has experience with the particular type of disorder your child may be experiencing. "Do not be afraid to ask the therapist about his/her experience," he says.

And is there a link between anxiety and depression? "Anxiety disorders and depression disorders can sometimes co-occur," Farley says. "There are a lot of ongoing research and treatment options out there."

Back to News