Anxiety Disorders in Children and Adolescents

What are anxiety disorders?

Children and adolescents with anxiety disorders typically experience intense fear, worry, or uneasiness that can last for long periods of time and significantly affect their lives. If not treated early, anxiety disorders can lead to:

• Repeated school absences or an inability to finish school;
• Impaired relations with peers;
• Low self-esteem;
• Alcohol or other drug use;
• Problems adjusting to work situations; and
• Anxiety disorder in adulthood.

What are the types and signs of anxiety disorders?

Many different anxiety disorders affect children and adolescents. Several disorders and their signs are described below:

Generalized Anxiety Disorder: Children and adolescents with generalized anxiety disorder engage in extreme, unrealistic worry about everyday life activities. They worry unduly about their academic performance, sporting activities, or even about being on time. Typically, these young people are very self-conscious, feel tense, and have a strong need for reassurance. They may complain about stomachaches or other discomforts that do not appear to have any physical cause.

Separation Anxiety Disorder: Children with separation anxiety disorder often have difficulty leaving their parents to attend school or camp, stay at a friend's house, or be alone. Often, they "cling" to parents and have trouble falling asleep. Separation anxiety disorder may be accompanied by depression, sadness, withdrawal, or fear that a family member might die. About one in every 25 children experiences separation anxiety disorder.1

Phobias: Children and adolescents with phobias have unrealistic and excessive fears of certain situations or objects. Many phobias have specific names, and the disorder usually centers on animals, storms, water, heights, or situations, such as being in an enclosed space. Children and adolescents with social phobias are terrified of being criticized or judged harshly by others. Young people with phobias will try to avoid the objects and situations they fear, so the disorder can greatly restrict their lives.

Panic Disorder: Repeated "panic attacks" in children and adolescents without an apparent cause are signs of a panic disorder. Panic attacks are periods of intense fear accompanied by a pounding heartbeat, sweating, dizziness, nausea, or a feeling of imminent death. The experience is so scary that young people live in dread of another attack. Children and adolescents with the disorder may go to great lengths to avoid situations that may bring on a panic attack. They also may not want to go to school or to be separated from their parents.

Obsessive-Compulsive Disorder: Children and adolescents with obsessive-compulsive disorder, sometimes called OCD, become trapped in a pattern of repetitive thoughts and behaviors. Even though they may recognize that the thoughts or behaviors appear senseless and distressing, the pattern is very hard to stop. Compulsive behaviors may include repeated hand washing, counting, or arranging and rearranging objects. About two in every 100 adolescents experience obsessive-compulsive disorder (U.S. Department of Health and Human Services, 1999).

Post-traumatic Stress Disorder: Children and adolescents can develop post-traumatic stress disorder after they experience a very stressful event. Such events may include experiencing physical or sexual abuse; being a victim of or witnessing violence; or living through a disaster, such as a bombing or hurricane. Young people with post-traumatic stress disorder experience the event over and over through strong memories, flashbacks, or other kinds of troublesome thoughts. As a result, they may try to avoid anything associated with the trauma. They also may overreact when startled or have difficulty sleeping.

How common are anxiety disorders?

Anxiety disorders are among the most common mental, emotional, and behavioral problems to occur during childhood and adolescence. About 13 of every 100 children and adolescents ages 9 to 17 experience some kind of anxiety disorder; girls are affected more than boys.1 About half of children and adolescents with anxiety disorders have a second anxiety disorder or other mental or behavioral disorder, such as depression. In addition, anxiety disorders may coexist with physical health conditions requiring treatment.

Who is at risk?

Researchers have found that the basic temperament of young people may play a role in some childhood and adolescent anxiety disorders. For example, some children tend to be very shy and restrained in unfamiliar situations, a possible sign that they are at risk for developing an anxiety disorder. Research in this area is very complex, because children's fears often change as they age.

Researchers also suggest watching for signs of anxiety disorders when children are between the ages of 6 and 8. During this time, children generally grow less afraid of the dark and imaginary creatures and become more anxious about school performance and social relationships. An excessive amount of anxiety in children this age may be a warning sign for the development of anxiety disorders later in life.

Studies suggest that children or adolescents are more likely to have an anxiety disorder if they have a parent with anxiety disorders. However, the studies do not prove whether the disorders are caused by biology, environment, or both. More data are needed to clarify whether anxiety disorders can be inherited.

What help is available for young people with anxiety disorders?

Children and adolescents with anxiety disorders can benefit from a variety of treatments and services. Following an accurate diagnosis, possible treatments include:

• Cognitive-behavioral treatment, in which young people learn to deal with fears by modifying the ways they think and behave;
• Relaxation techniques;
• Biofeedback (to control stress and muscle tension);
• Family therapy;
• Parent training; and
• Medication.

While cognitive-behavioral approaches are effective in treating some anxiety disorders, medications work well with others. Some people with anxiety disorders benefit from a combination of these treatments. More research is needed to determine what treatments work best for the various types of anxiety disorders.

What can parents do?

If parents or other caregivers notice repeated symptoms of an anxiety disorder in their child or adolescent, they should:

• Talk with the child's health care provider. He or she can help to determine whether the symptoms are caused by an anxiety disorder or by some other condition and can also provide a referral to a mental health professional.
• Look for a mental health professional trained in working with children and adolescents, who has used cognitive-behavioral or behavior therapy and has prescribed medications for this disorder, or has cooperated with a physician who does.
• Get accurate information from libraries, hotlines, or other sources.
• Ask questions about treatments and services.
• Talk with other families in their communities.
• Find family network organizations.
• People who are not satisfied with the mental health care they receive should discuss their concerns with the provider, ask for information, and/or seek help from other sources.

This is one of many fact sheets in a series on children's mental health disorders. All the fact sheets listed below are written in an easy-to-read style. Families, caretakers, and media professionals may find them helpful when researching particular mental health disorders. To obtain free copies, call 1-800-789-2647 or visit http://www.mentalhealth.samhsa.gov/child.

Important Messages About Children's and Adolescents' Mental Health

• Every child's mental health is important.
• Many children have mental health problems.
• These problems are real and painful and can be severe.
• Mental health problems can be recognized and treated.
• Caring families and communities working together can help.

Mental Health Resources on the Internet

Centers for Disease Control and Prevention
www.cdc.gov

ClinicalTrials.gov, National Institutes of Health
http://clinicaltrials.gov/

Substance Abuse and Mental Health Services Administration
http://www.mentalhealth.samhsa.gov

National Institute of Mental Health
www.nimh.nih.gov

For information about children's mental health, contact SAMHSA's National Mental Health Information Center:

Toll-free: 800-789-2647
Fax: 240-747-5470
TDD: 866-889-2647

Systems of Care

Individual help is available for children diagnosed with severe anxiety through community-based systems of care. Systems of care help children with serious emotional disturbances and their families overcome obstacles associated with difficult mental health, emotional, and behavioral problems. To learn more about systems of care, call 301-443-1333, or to request a free fact sheet on systems of care, call 1-800-789-2647.

Endnotes

U.S. Department of Health and Human Services. (1999). Mental Health: A Report of the Surgeon General. Rockville, MD: U.S. Department of Health and Human Services.

SAMHSA
CA-0007
04/2003