Pediatrics: Anxiety Disorders
The anxiety disorders (AD) are mental health problems found in children and adolescents, characterized by disabling scared or worried feelings. These disorders are common, with 10 to 15 of 100 youths estimated to have one of these disorders. These occur more commonly in girls. ADs are caused by a difference in the structure or function of the brain that controls worries and fears. Vulnerability to the development of anxiety disorders can be genetically transmitted. Parents who are overprotective or overcontrolling appear more likely to have anxious children, and children also can learn to be anxious from parents who are anxious. Sometimes environmental events can trigger an anxiety disorder. For example, separation anxiety disorder can be caused by exposure to frightening events, such as domestic violence.
Generalized Anxiety Disorder. Generalized anxiety disorder is characterized by excessive worry/angst occurring on more days than not about a variety of areas, such as schoolwork, friendships, family, health/ safety, and world events. The worry is accompanied by feeling tired, tense, restless or irritable; having difficulty focusing; and having trouble falling or staying asleep. Sometimes these youngsters have associated physical symptoms, including muscle aches, stomach cramps, or nausea. The youth finds it difficult to control the worry. To meet the diagnosis, the problems must be present for at least 6 months, and must cause distress and/or impair the youth’s function at home, at school, or with peers.
Separation Anxiety Disorder. Separation anxiety dis- order is characterized by excessive worry about being separated from the home or from parents. The child may feel very upset about leaving home to go to school, about being separated from the parent, about sleeping alone in his or her own bedroom, about something bad happening to the parent, or something bad happening to the child that will separate him or her from the parent. These children may refuse to go to school or may develop physical problems (headaches, nausea) before going to school or when at school. Some youngsters may experience bad dreams about being separated from the parent. To meet the diagnostic criteria, these problems must be at least a 1-month duration, causing distress and/or impairing the youth’s function at home, at school, or with peers.
Social Anxiety Disorder. Social anxiety disorder is characterized by excessive worry about social or performance situations where embarrassment may occur. This angst can arise when meeting new people or performing in front of others (i.e., speaking up in the classroom or performing musically or athletically). When this becomes so severe that it causes panic, a pattern develops, leading to the youth avoiding social or performance situations. To meet the diagnosis, the problems must have been present for at least 6 months, causing distress and/or impairing the youth’s function at home, at school, or with peers.
Diagnosis. Qualified mental health professionals experienced with children (child and adolescent psychiatrists, child psychologists, child-trained social workers, counselors, and clinical nurse specialists) are best trained to accurately diagnose the various anxiety disorders. The evaluation for these diagnoses typically takes several hours and requires input from multiple people who know the child very well. The diagnosis is based upon the findings from parent and child inter- views, questionnaires, and a mental status examination. In contrast to disruptive disorders, anxiety disorders often cause more distress in the child than the parents, and children tend to report their anxiety symptoms more accurately than their parents who may not even be aware of the child’s symptoms. There are no imaging studies, blood tests, or other medical tests to diagnose these disorders.
Treatment. Psychotherapy to help the youth to learn how to cope with worry and fear is the best treatment. These coping strategies include learning how to identify and talk about feelings, how to stop thinking automatic negative thoughts, and how to relax the mind and body. When a child’s anxiety disorder does not respond to traditional therapy, then antianxiety medication may be considered. Antianxiety medication may help the youth feel more relaxed when working on coping skills in therapy.
Course. The anxiety disorders respond well to the above treatments when delivered by qualified mental health professionals. If left untreated, the anxiety disorders can cause long-standing distress and problems with social relationships and school performance.