
Anxiety is not just an adult issue.
Looking back at our childhood, some of us might remember experiences of intense worry or fear.
Not all children develop an anxiety disorder, but all children, like adults, have experienced moments of fear and concern.
Anxiety Disorders in Children
Anxiety disorders are the most common psychiatric condition in childhood.
Many studies show that childhood anxiety disorders are associated with anxiety disorders in adolescence and adulthood, depression, and substance use.
The debate in literature about the role of environmental versus genetic factors in the development of anxiety disorders is particularly heated.
The most influential environmental factors on children are related to the family environment (including extended family, such as grandparents, and other significant figures for the child) and the school environment.
Symptoms of Anxiety Disorders in Children
Anxiety disorders in childhood and adolescence are increasingly widespread, and more children are seeking help from child psychology and child neuropsychiatry services. Anxiety also affects the entire family.
An excessive load of anxiety can interfere with many, if not all, aspects of a child's life, from making new friends to academic performance and family well-being.
Like adults, anxiety in children is characterized by specific thoughts, such as the fear that ābad thingsā may happen to loved ones or the fear of failure.
Anxiety in children can also manifest through somatic symptoms such as headaches, vomiting, abdominal pain, or pain in the limbs.
Behaviorally, a reduction in attention, distraction, and laziness may be observed.
In children and adolescents, anxiety is often manifested through worries about school responsibilities, sports, and social engagements, and performance in general.
There may be a tendency towards perfectionism, creating tension that can result in either excessive effort or avoidance behaviors.
An anxious child may experience a sense of oppression, a weight associated with the anticipation of an event.
DSM-5 Diagnosis of Anxiety Disorders
The DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) categorizes anxiety disorders along the life cycle, with similar diagnostic criteria for both children and adults. Below are the symptoms of the most common anxiety disorders during childhood.
SOCIAL ANXIETY
The typical symptoms of social anxiety disorder, for both children and adults, include marked fear or anxiety in one or more social situations in which the child is exposed to the possible judgment of others, such as being observed or performing in front of an audience.
SPECIFIC PHOBIA
Marked fear or anxiety about a specific object or situation (e.g., heights, animals) may be expressed through crying, temper tantrums, freezing, or what is called āclinging,ā when the child āclingsā to a parent, often hiding behind their legs.
The situation or object causing the phobia almost always triggers an immediate reaction and is actively avoided or endured with intense fear or anxiety.
SELECTIVE MUTISM
Selective mutism is the consistent inability to speak in specific social situations where speaking is expected (e.g., at school) despite being able to speak in other situations. This condition clearly interferes with school performance or social communication.
SEPARATION ANXIETY
Separation anxiety is a common phenomenon during childhood neuropsychological development, typically decreasing after the age of 2 and disappearing before puberty. However, after the age of six, persistent separation anxiety from significant figures should be addressed.
Separation anxiety involves persistent difficulty leaving parents or the home, a constant fear that something tragic could happen, or that the child could be harmed or kidnapped while alone.
Repeated nightmares of separation or losing oneself in an unknown place are common.
Cognitive Behavioral Therapy for Anxiety Disorders in Children
Cognitive-behavioral therapy (CBT) for anxiety disorders in children follows several stages.
First, the child (and the parents) are introduced to the concept of the connection between situations, thoughts, and emotions.
The child is taught to monitor and identify anxious thoughts, explaining the effects of cognitive distortions typical of anxious thinking while also learning to follow a thought that challenges their negative predictions.
By identifying and questioning the consequences of feared events, the child is gradually exposed to the anxiety-inducing situation and experiences a reduction in avoidance behaviors.
Relaxation techniques suitable for younger children can also be taught.
Conclusions
Early recognition of anxiety problems and proper management can reduce the risk of more severe issues in the future or prevent the development of other disorders.
If a parent notices signs of anxiety in their child, itās important to help them understand their emotions, analyze them together, and encourage them not to avoid anxiety-provoking situations. By fostering realistic thinking about their fears and rewarding the childās courage and small steps, improvement is possible.
If the anxiety persists, professional intervention could prevent recurrence and worsening of symptoms.
Written by
Dr Elizabeth Moore, Psychologist
(consultation only in Italian)
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Bibliography
DSM-5. Manuale diagnostico e statistico dei disturbi mentali, Raffaello Cortina Editore, Milano 2014
F. Muratori, L. Picchi, M.G. Patarnello, F. Palacio Espada, Manuale di psicoterapia breve per i disturbi emozionali nei bambini, Giovanni Fiori Ed
M. Pontillo, S. Vicari, L'ansia nei bambini e engli adolescenti, Il Mulino Ed.
Berg, C., Rapoport, J., Whitaker, A., Davies, M., Leonard, H., Swedo, S., et al.,Childhood obsessive compulsive disorder : a two-years prospective fol- lowup of a community sample. Journal of the American Academy of Child and Adolescent Psychiatry, 1989.
Hallett, V., Ronald, A., Rijsdijk, F., & Eley, T. C., Phenotypic and genetic differentiation of anxiety-related behaviours in middle childhood. Depression and Anxiety, 2009.
Feehan, M., McGee, R., & Williams, S.M., Mental health disorders from age 15 to age 18 years, Journal of the American Academy of Child and Adolescent Psychiatry,1993.
External resources
If you wish to explore the topic of psychological manipulation further and find relevant articles and studies, consider these important academic and institutional resources
American Academy of Child & Adolescent Psychiatry.Link: AmericanĀ AcademyĀ ofĀ ChildĀ & AdolescentĀ Psychiatry
Child Mind InstituteLink: ChildĀ MindĀ Institute
National Institute of Mental HealthLink: NationalĀ InstituteĀ ofĀ MentalĀ Health