Introduction

All children experience anxiety. Anxiety in children is expected and normal at specific times in development. For example, from approximately age 8 months through the preschool years, healthy youngsters may show intense distress (anxiety) at times of separation from their parents or other persons with whom they are close. Anxious children are often overly tense or uptight. Some may seek a lot of reassurance, and their worries may interfere with activities. Parents should not discount a child’s fears. Because anxious children may also be quiet, compliant and eager to please, their difficulties may be missed. Parents should be alert to the signs of severe anxiety so they can intervene early to prevent complications. There are different types of anxiety in children.

Overview and Facts

Around 5% of children and adolescents meet criteria for an anxiety disorder during a given period of time in Western populations.
Anxiety disorders are more common in females than males in the general population. Most population studies estimate around 1.5-2 times as many females compared to males for most anxiety disorders. Anxiety disorders are among some of the earliest disorders to appear and most commonly begin by middle childhood to mid adolescence. It is common for anxiety disorders to appear within a context of temperamental inhibition and fearfulness.

Symptoms

Symptoms of anxious children include:

• A tendency to worry about a wide range of negative possibilities, that something bad will happen
• Repeated and extensive worry about several areas such as family finances, friendships, schoolwork, sports performance, self and family health, and minor, daily issues.
• Tendency to repeatedly seek reassurance from parents or others about fears.
• Avoidance of novelty, negative news, uncertain situations, and making mistakes.
• Physical symptoms, sleeplessness and irritability when worried

Causes and Risk Factors

Anxiety runs in families. First degree relatives of people with anxiety disorders are at significantly increased risk to also have anxiety as well as mood disorders. The same is true more specifically for anxiety in children and adolescents. Anxious children are considerably more likely to have parents with anxiety disorders and adults with anxiety disorders are more likely to have anxious children.

There is little doubt that anxiety disorders are heritable. Best estimates suggest that around 40% of the variance in anxiety symptoms and in diagnoses of anxiety disorder is mediated by genetic factors.
Temperamental risk for anxiety is probably the best studied and most clearly established risk factor. A variety of similar temperaments have been associated with child anxiety including: behavioural inhibition, withdrawal, shyness and fearfulness.

One specific form of life event that has received particular attention is bullying and teasing. There is considerable evidence that anxious children are more likely to be teased and bullied than non-anxious children and that they are often neglected or even rejected by their peers. Once again the direction of causation is unknown but it is very likely that anxious children elicit teasing from others due to their behaviours; in turn, it is likely that teasing will further enhance their anxiety.

Anxious children report heightened threat beliefs and expectations. To some extent this is a reflection of the diagnosis, but it is also argued to represent a core maintaining feature. Although there is considerable overlap, to some extent the threat expectancies are specific. That is, socially phobic children are more likely to have increased expectancies for social threat (e.g., “other kids won't like me”), children with separation anxiety will have increased expectancies for physical threat (e.g., “my parents will get hurt”), and so on. Evidence suggests that these threat beliefs are greater among anxious children than among children with other psychopathology and that they decrease with successful treatment.

Tests and Diagnosis

Clinical evaluation generally includes a combination of questionnaires, diagnostic interview and behavioural observation. Several structured diagnostic interviews exist to assist in determining either DSM or ICD criteria for childhood disorders including anxiety. Most interviews include a large number of questions aimed to tap each of the relevant diagnostic criteria and generally differ in their degree of structure.

Treatment

Pharmacological management of anxiety in children has typically focused on the use of selective serotonin reuptake inhibitors (SSRIs).
Several studies have demonstrated significant efficacy of SSRIs in the management of broad-based anxiety disorders. Outcome results indicate that 50% to 60% of children are considered treatment responders at the end of treatment compared with around 30% of those on placebo.
Skills-based programs
Most evidence-based psychological treatment for childhood anxiety falls under the broad category of cognitive-behavioural or skills-based treatment. The fundamental basis is teaching the child (and sometimes the parents) specific skills to help manage the child's anxiety. Treatment programs typically last 8-15 weeks.

Sources and Links

http://www.aacap.org
http://www.iacapap.org