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Anxiety is a natural human emotion; everyone feels anxious or worried at times. We are all familiar with preschoolers who are
frightened by the dark, have a variety of bedtime rituals and can get anxious at times of separation from a parent. However, a
child who experiences anxiety more strongly and easily than others and worries excessively to a degree that interferes with his
or her life may have an Anxiety Disorder. Anxiety in children and teenagers can arise because of separation, fears, something
tragic happening, being judged, worrying about things before they happen, getting a perfect score on a test, being in school or in
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. About half
of children and adolescents with one anxiety disorder 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.
Anxiety disorders can strike at any age and some disorders are more common in younger children while others tend to first
develop in adolescence. Researchers 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. Panic Disorder tends to begin in adolescence. Girls are affected more than boys.
Anxiety is a complex emotion, and its signs and symptoms may be apparent in different ways. Following are brief descriptions
of the forms of anxiety that may occur in children and teenagers.
Separation Anxiety Disorder - Children with separation anxiety disorder (SAD) have intense anxiety about being away from
home or caregivers that affects their ability to function socially and in school. The child may cling to parents, refuse to go to
school, or be afraid to sleep alone
Generalized Anxiety Disorder - Children with generalized anxiety disorder (GAD) have recurring fears and worries that they
find difficult to control. They worry about almost everything—school, sports, being on time, even natural disasters. They may
be restless, irritable, tense, or easily tired, and they may have trouble concentrating or sleeping. Children with GAD are usually
eager to please others and may be “perfectionists,” dissatisfied with their own less-than-perfect performance.
Social Phobia - Young people with this disorder are extremely shy and have a constant fear of social or performance situations
such as speaking in class or eating in public. They respond to these feelings by avoiding the feared situation. This fear is often
accompanied by physical symptoms such as sweating, blushing, heart palpitations, shortness of breath, or muscle tenseness.
Young people with social phobia are often overly sensitive to criticism, have trouble being assertive, and suffer from low self-
esteem. Social phobia can be limited to specific situations, so the teenager may fear dating and recreational events but be
confident in academic and work situations.
Obsessive-Compulsive Disorder - Children with OCD have frequent and uncontrollable thoughts (called “obsessions”) and
may perform routines or rituals (called “compulsions”) in an attempt to eliminate the thoughts. These children and teenagers
often repeat behaviors to avoid some imagined consequence. For example, a common compulsion is excessive hand washing
due to a fear of germs. Other common compulsions include counting, repeating words silently, and rechecking completed tasks.
In the case of OCD, these obsessions and compulsions take up so much time that they interfere with daily living and cause a
great deal of anxiety.
Post-Traumatic Stress Disorder - Children who experience a physical or emotional trauma such as witnessing a shooting or
disaster, surviving physical or sexual abuse, or being in a car accident may develop post-traumatic stress disorder (PTSD). A
child may “re-experience” the trauma through nightmares, constant thoughts about what happened, or reenacting the event
while playing. A child with PTSD may experience symptoms of general anxiety, including irritability or trouble sleeping and
Acute Stress Disorder - this disorder refers to the immediate reaction of intense fear, helplessness, or horror of a person
exposed to a traumatic event, during which the person experienced, witnessed or was confronted with a situation involving
actual or threatened death or serious injury. Examples are rape, mugging.
Panic Disorder (with or without Agoraphobia) - is characterized by recurrent, unexpected panic attacks that may include
trouble breathing, lightheadedness, rapid heart rate, shortness of breath. As a result a person with this disorder feels intense fear
when in certain situations or places. May or may not accompany agoraphobia.
Agoraphobia - involves intense fear and avoidance of any place or situation where escape might be difficult or help unavailable
if the individual should develop sudden panic-like symptoms. Examples include being in a car or being in crowds.
Specific Phobia - refers to an intense, unreasonable fear of a specific object or situation. Some common phobias are animals,
Selective Mutism - anxiety regarding speaking in some environments. Typically, children will speak at home within the family,
but not in school or in unfamiliar situations.
School Refusal Behavior - refers to children who are entirely absent or truant from school or leave during the day. Although
not a disorder listed in the Diagnostic and Statistical Manual of Mental Disorders - IV (DSM-IV), it can be associated with
Social Anxiety Disorder, Separation Anxiety Disorder, Social Phobia, and Conduct Disorder.
Genetics of Anxiety Disorders
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.
Anxiety Disorders result from a combination of family and biological influences. Some research suggests that anxiety may be
caused by a chemical imbalance involving norepinephrine and serotonin. Other research implicates specific brain mechanisms,
involving hormones and respiratory functions, as potential pathways to anxiety. Anxiety Disorders tend to run in families, but
the complex relationship between genes, biological systems, and anxiety is not yet well understood. Moreover, evidence
suggests that anxiety and phobic reactions can be learned, either through direct experience or observations of others.
In order to decide if a child or adolescent has an Anxiety Disorder, professionals will need information as to how often the child
has been anxious and if it has continued despite steps taken to alleviate it. They will decide if the fears are normal for the child's
age and will evaluate the degree to which the anxiety interferes with the child's life. A professional will also take a close look at
people or situations that may be unwittingly reinforcing the child's anxious behaviors. Some children and adolescents with
anxiety disorders benefit from a combination of treatments.
Cognitive-behavioral treatment (CBT), in which children learn to deal with anxiety by modifying the ways they think and behave,
is effective in assisting a child or teenager with controlling anxiety and regaining a normal life. CBT involves education about the
nature of anxiety, helps the child identify unhealthy, negative beliefs and behaviors and replace them with positive ones, along
with teaching specific skills for managing the physical sensations, negative thoughts, and problematic behaviors that accompany
the anxiety. Through CBT a child learns, in a step–by–step fashion, to master the situations that cause anxiety.
Exposure and Response Prevention (ERP)
The "exposure" part of this treatment involves direct or imagined controlled exposure to objects or situations that trigger anxiety
which over time leads to less and less anxiety, and eventually arouses little anxiety at all. The "response" in "response prevention"
refers to the ritual responses that people engage in to reduce anxiety. In ERP treatment, patients learn to resist the compulsion to
perform rituals and are eventually able to stop engaging in these behaviors.
• Habit Reversal Training (HRT)
• Relaxation techniques
• Biofeedback (to control stress and muscle tension)
• Family therapy
• Parent training
• Medication that works directly on the central nervous system and brain may be prescribed to help children feel calmer as
they work toward healthier everyday functioning