Childhood Anxiety


The following information was taken from 'Keep Kids Healthy.com' (http://www.keepkidshealthy.com/)

Anxiety symptoms and disorders are the number one health problem in America, ranging from a simple Adjustment Disorder to more difficult and debilitating disorders such as Panic Disorder and Posttraumatic Stress Disorder. According to the most recent data, the lifetime prevalence for anxiety disorders as a whole in adults is about 25%; the frequency in children is unknown, but felt to be significantly underreported and under-diagnosed. More specifically Social Anxiety Disorder has a lifetime risk of 17%, while Panic Disorder occurs in approximately 1-3% of the adult population.

Although quite common, Anxiety Disorders in children often are overlooked or misjudged, despite them being very treatable conditions with good, persistent medical care. What does seem to be developing in the medical literature is the consensus that many “adult” psychiatric disorders likely have their first (although perhaps subtle or ignored) manifestations in childhood, and that if left untreated these anxiety disorders in children likely progress to adult versions.

Symptoms of Anxiety Disorders

Anxiety is a subjective sense of worry, apprehension, fear and distress. Often it is normal to have these sensations on occasion, and so it is important to distinguish between normal levels of anxiety and unhealthy or pathologic levels of anxiety. The subjective experience of anxiety typically has two components: physical sensations (e.g., headache, nausea, sweating) and the emotions of nervousness and fear. Anxiety disorders, when severe, can affect a child's thinking, decision-making ability, perceptions of the environment, learning and concentration. It raises blood pressure and heart rate, and can cause a multitude of bodily complaints, such as nausea, vomiting, stomach pain, ulcers, diarrhea, tingling, weakness, and shortness of breath, among other things.

Types of Anxiety Disorders

Diagnosis of normal versus abnormal anxiety depends largely upon the degree of distress and its effect on a child's functioning in life. The degree of abnormality must be gauged within the context of the child's age and developmental level. The specific anxiety disorder is diagnosed by the pattern and quality of symptoms as follows:

Generalized Anxiety Disorder

Defined as excessive worry, apprehension, and anxiety occurring most days for a period of 6 months or more that involves concern over a number of activities or events. The person has difficulty controlling the anxiety, which is associated with the following: restlessness, feeling “keyed up” or on edge; being easily fatigued; difficulty concentrating or having the mind go blank; irritability; muscle tension; difficulty falling asleep or staying asleep, or restless sleep. The anxiety causes significant distress and problems functioning.

Panic Disorder

Panic Disorder is different from Panic Attacks; panic attacks are defined as sudden, discrete episodes of intense fear and/or discomfort accompanied by 4 out of 13 bodily or cognitive symptoms, often manifesting with an intense desire to escape, feeling of doom or dread, and impending danger. These symptoms peak within 10 minutes, and often subside within 20-30 minutes. The 13 symptoms are: heart palpitations or fast heart rate; sweating; trembling or shaking; shortness of breath or smothering; choking sensation; chest discomfort or pain; nausea or abdominal distress; feeling dizzy, lightheaded, faint or unsteady; feelings of unreality or being detached from oneself; fear of losing control or going crazy; fear of dying; numbness or tingling sensations; chills or hot flashes. Panic Disorder consists of recurrent unexpected panic attacks with inter-episode worry about having others; the panic attacks lead to marked changes in behavior related to the attacks. Panic attacks are frequently associated with Agoraphobia (anxiety and avoidance of situations from which escape might be difficult or help might not be available).

Obsessive-Compulsive Disorder

Defined by persistent Obsessions (intrusive, unwanted thoughts, images, ideas or urges) and/or Compulsions (intense uncontrollable repetitive behaviors or mental acts related to the obsessions) that are noted to be unreasonable and excessive. These obsessions and compulsions cause notable distress and impairment and are time consuming (more than one hour a day). The most common obsessions concern dirt and contamination, repeated doubts, need to have things arranged in a specific way, fearful aggressive or murderous impulses, and disturbing sexual imagery. The most frequent compulsions involve repetitive washing of hands or using handkerchief/tissue to touch things; checking drawers, locks, windows, and doors; counting rituals; repeating actions; and requesting reassurance.

Posttraumatic Stress Disorder

A person is exposed to a traumatic event in which he or she experiences, witnesses, or is confronted by an event
or events that involved actual or perceived threat of death or serious bodily injury, and the person’s response involves intense fear, helplessness, or horror. The traumatic event is continually re-experienced in the following ways: recurrent and intrusive distressing remembrances of the event involving images, thoughts, or perceptions; distressing dreams of the event; acting or believing that the traumatic event is recurring; intense anxiety and distress to exposure to situations that resemble the traumatic event; bodily reactivity on exposure situations that resemble the traumatic event. The person avoids situations associated with and remind him of the traumatic event, leading to avoidance of thoughts, feelings or conversations associated with the trauma; activities, places, or people that remind him of the traumatic event; inability to remember details of the event; markedly diminished participation and interest in usual activities; feeling detached and estranged from others; restricted range of emotional expression; sense of a foreshortened future or lifespan; persistent signs of physiologic arousal, such as difficulty falling asleep or staying asleep, irritability or anger outbursts, difficulty concentrating, excessive vigilance, and exaggerated startle response. The above symptoms persist for more than one month and cause significant distress and impairment of functioning.

Acute Stress Disorder

A person is exposed to a traumatic event in which he or she experiences, witnesses, or is confronted by an event or events that involved actual or perceived threat of death or serious bodily injury, and the person’s response involves intense fear, helplessness, or horror. The traumatic event is continually re-experienced in the following ways: recurrent and intrusive distressing remembrances of the event involving images, thoughts, or perceptions; distressing dreams of the event; acting or believing that the traumatic event is recurring; intense anxiety and distress to exposure to situations that resemble the traumatic event; bodily reactivity on exposure situations that resemble the traumatic event. The person avoids situations associated with and remind him of the traumatic event, leading to avoidance of thoughts, feelings or conversations associated with the trauma; activities, places, or people that remind him of the traumatic event; inability to remember details of the event; markedly diminished participation and interest in usual activities; feeling detached and estranged from others; restricted range of emotional expression; sense of a foreshortened future or lifespan; persistent signs of physiologic arousal, such as difficulty falling asleep or staying asleep, irritability or anger outbursts, difficulty concentrating, excessive vigilance, and exaggerated startle response. The above symptoms persist for less than one month and cause significant distress and impairment of functioning.

Social Phobia

Persistent and significant fear of one of more social situations in which a person is exposed to unfamiliar persons or scrutiny by others and feels he or she will behave in a way that will be embarrassing or humiliating. Exposure to the feared social situations almost always causes significant anxiety, even a panic attack despite the fact that the anxiety is seen as excessive and unreasonable. This belief may lead to avoidance of such situations or endurance under extreme distress, leading to marked interference in the person’s functioning and routine.

Specific Phobia

Persistent and significant fear that is recognized as unreasonable and excessive that is triggered by the presence or perception of a specific feared situation or object; exposure to this situation or object immediately provokes an anxiety reaction. The distress, avoidance, and anxious anticipation of the feared situation or object significantly interfere with a person’s normal functioning or routine. Animal Type: animals or insects; Natural Environmental Type: storms, heights, water, etc.; Blood-Injection-Injury Type: getting injections, seeing blood, seeing injuries, watching or having invasive medical procedures; Situational Type: elevators, flying, driving, bridges, escalators, trains, tunnels, closets, etc.

Adjustment Disorder with Anxiety (with or without depressed mood)

When the development of emotional and/or behavioral symptoms occur within 3 months in response to an identifiable stressor. These symptoms and behaviors cause marked distress in excess of that which could be expected and results in significant occupational, social, or academic performance. Once the initiating stressor has ceased, the disturbance does not last longer than 6 months.

Anxiety Disorder Due to a General Medical Condition

When the physiologic consequences of a distinct medical condition is judged to be the cause of prominent anxiety symptoms.

Drug-Induced Anxiety Disorder

When the physiologic consequences of the use of a drug or medication is judged to be the cause of prominent anxiety symptoms.

Anxiety Disorder Not Otherwise Specified

When the prominent symptoms of anxiety and avoidance exist but do not fully meet the above diagnostic criteria.

Great Site-The Child Anxiety Network