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 eating.
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,
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 - 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, flying, lightening.
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