Anxiety is a mental disorder characterized by feelings of anxiety and worry, usually about future events. Anxiety disorders can range from mild to severe, and typically cause distress or problems functioning in everyday life. Mental disorders in any form can compromise an individual's productivity and quality of life. Their management and treatment id essential to ensure the health and well-being of an individual. According to WHO, 2021
Anxiety is a common mental health condition, that can affect children and grown-ups equally. Children can experience anxiety in a variety of ways. For some children, it may be more noticeable when they are under pressure or have something important to do. Other children may not feel particularly anxious at all but simply find activities that used to make them feel happy (like spending time with family or playing) less enjoyable.
Regardless of the way that children experience anxiety, it is important to get help if it is causing problems in their lives. The Center for Disease Control and Prevention (CDC) has revealed an alarming number of children living with anxiety.
There are many different types of anxiety disorders, but some common symptoms include: feeling tense and anxious all the time; having trouble sleeping; being easily embarrassed or frightened; avoiding social situations; getting nervous about doing tasks even when there's no reason to be
Fear of being separated from parents
Child’s clingy behavior
Inability to speak up in a social scenario
The child refuses to talk, listen or follow instructions
Your child may say, “I have no friend, nobody is going to play with me”
These and many more situations can be warning signs for parents to look for. They may indicate your child's disturbed mental health known as anxiety. the Diagnostic Manual for Mental Disorder, Fifth Edition (DSM, V) defines anxiety as
Keep reading to learn about
Types of Anxiety
Signs and symptoms of anxiety in children
Causes and Risk Factors of Anxiety in children
What does anxiety feel like for a child?
Why is anxiety in children on the rise?
How can you assess anxiety in children?
How parents can help?
Treatment
Conclusion
Types of anxiety
For a general understanding, the following table shows some common fears and sources of anxiety your child may face.
These fears are normally faced by most children. Sometimes these fears may take the form of serious concern and need clinical attention and help. You can briefly view what these are and how can they impact your child.
1. Separation anxiety
Increased distress levels when parted/separated from parents and caregivers. Fear of something unfortunate may happen to them or the child himself when separated.
2. Social anxiety/social anxiety disorder
Excessively anxious and self-conscious when in a social situation (school, classroom, playground, on stage, among peers) and fear of being humiliated and judged.
3. Specific phobia
Excessive and unrealistic fear about certain people, things, or events like storms, particular person, animals, or enclosed places. The anxious child avoids phobic objects and may exhibit anxiety symptoms when exposed to these situations.
4. Selective mutism
The child is too fearful to talk, communicate or respond in selective (anxious) situations.
5. Generalized anxiety
Excessive worry about a larger number of things like school, class performance, home assignments, health, family, studies, etc. The growing anxiety and its symptoms interfere with the child’s regular performance.
6. Obsessive-compulsive disorder (OCD)
Repetitive thoughts (obsession) and repetitive actions (compulsions) define OCD. It’s not about the usual nail-biting or lip biting but the loss of control over repetitive actions and thoughts that hinder the overall performance. For example, several times washing of hands-on touch a contaminated object only because the person perceives his hands still dirty after several washes.
7. Panic disorder
A sudden surge of intense physical signs or symptoms without any actual reason or danger is just based on excessive fear of tragedy or loss of control over any situation. Panic attacks in form of shortness of breath, dizziness, pounding of heart or numb hands overwhelm the child.
8. Posttraumatic stress disorder
Either by experiencing or witnessing a traumatic event the child experiences anxiety in form of nightmares, flashbacks, or extreme anxiety.
A recent study by Steinsbekk, Ranum, and Wichstrøm (2021) found prominent childhood anxiety in children from preschoolers to adolescents. Generalized anxiety disorder (GAD) accounts for 7.8%, social anxiety 3.1%, specific phobia 7.7% and separation anxiety 2.7%. The development and progression of different anxiety symptoms appear in childhood. If left untreated, they may further develop into serious problems, deterring performance at school, in social settings, and in daily life activities of your child.
Signs and symptoms of Anxiety
- Inattention and/or restlessness
The usual squirming and fidgeting behavior of a child while sitting on desk results in a preoccupation with anxious thoughts and inattention in the classroom.
- Disruptive behavior
These behaviors could be exhibited as throwing tantrums, repetitive questioning or questioning a lot, aggressive behavior, and compulsively kicking a chair of a fellow classmate.
- Compulsive behavior
Repetitive physical behaviors for instance hand washing, erasing, and rewriting, again and again, to make it perfect, defined object arrangement on the desk
- Discreet and passive attitude
The anxious child may even behave passively in the class. Avoiding eye contact, trying to hide or disappear, and upon calling on them they may freeze or be unable to speak (selective mutism).
- Frequent trips to the sick bays/first aid rooms
Anxiety often shows up in physical disturbances. The anxious child may encounter numerous unexplained physical complaints like nausea, vomiting, headache, stomach ache, thumping heart, tense muscles, sweaty palms, and short breaths.
- Fear of failure
It is mainly due to anxiety caused by an attempt to give the maximum potential to one’s academic and extra-curricular activities. The performance anxiety is visible through when strives to strive to present perfect assignments, the best handwriting, rewriting and erasing over and over, and other related behaviors.
- Learning problems
Children may face learning difficulties and problems when anxious about certain subjects. This calls for careful assessment of the child’s problem because some may identify it as a learning disorder while it may be only due to anxiety.
- Absenteeism
In an attempt to overcome anxiety child might end up increased refusal to attend school, making lame excuses to avoid school, and even clingy behavior. This may occur when a child is facing separation anxiety or social anxiety.
Other common signs that a child may be suffering from anxiety include:
- feeling restless and hyperactive,
- having trouble concentrating,
- experiencing frequent panic attacks or nightmares,
- developing sleep disorders such as insomnia or excessive snoring,
- losing interest in things they used to enjoy,
- excessive clinginess and fear of separation
- procrastination
- poor memory
- eating disturbances
- crankiness and crying, and
- becoming fearful of changes in their environment.
Anxiety in children can be a reaction to their surroundings. For example, if you've seen irritation and rage, make sure it's not due to a fight with a friend at school or a sibling. It's time to get treatment if your child appears tense, unhappy, or irritated for a lengthy period and it's interfering with their normal activities.
Causes and Risk factors
Anxiety can be caused by different sets of situations. It's almost certainly a mix of risk factors, such as social and environmental influences, or the result of biological ones. The attributes listed below may predispose your child to anxiety, so keep these in mind as you look for signs of stress, worry, fear, and anxiety in your child.
What does anxiety feel like for a child?
Based on severity and level of interference in everyday activities, normal levels of anxiety or worry differ from clinical anxiety. Anxiety symptoms might make it difficult for your child to get asleep, leave for school, or have clingy behavior towards parents. The child sees his inflated concerns and worries as realistic in the early years and often expresses them via behavioral actions, instead of verbal expression.
This is because kids have recently been exposed to a variety of life events. In their small minds, they must comprehend and interpret a great deal of fresh information. This is probably due to a lack of communication, education, and prior experience. Hand washing to keep hands clean, checking for the presence of a parent, or exam anxiety is acceptable and quite normal.
However, repetitive hand-washing without any definite exposure to dirt or germs, excessive clinginess with parents and refusal to leave them out of sight, or exam anxiety that becomes so difficult to manage that your child misses school are all scenarios that you should be wary of and seek clinical help.
The child will also avoid the anxiety triggers in severe circumstances. For example, he may go to the bathroom frequently at school or throw tantrums when he has a doctor's appointment. As parents, you must be on the lookout for indications and symptoms that make children anxious, impair their self-esteem, show aggression, or completely shun a specific person or event.
Why are our children more exposed to Anxiety now than in past?
1. Under recording of cases
Many experts believe that there are no underlying causes for the increased number of anxiety episodes in children. People are more mindful of their mental health now than in the past. They seek professional help as soon as they see warning signs of mental illness, such as anxiety in their child.
Previously, people used to associate stigma and discrimination with mentally upset individuals. With technological and psychological developments many people are now convinced that mental health and well-being are just as important as physical health. Secondly, seeking treatment for mental health is essential for many people, and you are not alone in this.
2. Parents’ expectation
Authoritarian parenting style, strict rules, and regulations by parents focus on punishments than rewards and appreciation. This leads to fulfilling higher parental expectations and achievement by the children. Failure to come to the expectations and demands of the parents and their harsh attitude cause anxiety in children.
3. Peer pressure
Another prevalent but inescapable aspect is peer pressure. Humans are social creatures by nature, and gaining social acceptability is an unavoidable part of moving through the world of people. Failure to meet peer acceptability standards might cause worry. Severe peer pressure, particularly among teenagers, can hurt their mental health and self-esteem, as well as raise anxiety and fear of rejection.
4. Social media
The standards for living, confidence, social life, success, and self-confidence , have changed. The spectrum for reality checks has moved to these platforms with the introduction of many social media platforms.
Success, achievement, social approval, life events, hangouts, meetups, education, profession, family, and every other activity you can think of is shared and acknowledged on social media, by most teenagers. On the other hand, rejection from social media users and others with better ideas is admired and causes anxiety and concern in your child.
5. Poor sleep patterns
The new handy gadgets that have emerged as a result of the digital revolution generate artificial light, and excessive use leads to poor sleeping patterns. The children have addicted to the use of laptops, mobile phones, tablets, and other devices till late at night. The exposure to blue light waves successfully convinced the mind that its day time. Consequently, the brain stops producing or producing low levels of melatonin-the sleep hormone. Many researchers have found that adolescent use of smartphones disrupts sleep patterns, leading to depression and anxiety.
6. Threatening and fearful image of the world
Throughout history, there have been several deadly events that have posed risks and put the lives of many people in jeopardy. 9/11, pandemics, wars, and natural calamities can all hurt your child's confidence and trust. During any ongoing or perceived threatening event, in the absence of counseling and reassurance, anxiety disorders may take a toll, especially in children.
How to screen anxiety in your child?
To rule out the particular type and condition of childhood anxiety, a variety of strategies can be used. Interviews with parents, teachers, and the child, as well as behavioral observations, can all be beneficial. Therapists and pediatricians over the world employ various screening tests. The following are some of the most widely used and successful scales for assessing both screening and treatment progress.
- Spence Children's Anxiety Scale (SCAS) (child self-report measures),
- Multidimensional Anxiety Scale for Children,
- Screen for Child Anxiety and Related Emotional Disorders (SCARED),
- Preschool Anxiety Scale (a parent report), and
- Pediatric Anxiety Rating Scale (a clinician-rated measure)
How parents can help anxiety in a child?
Dealing with a child with anxiety disorder asks for care and reassurance on part of a parent. Being a parent, you need to understand his issues and stressors, no matter how trivial or unimportant they seem to you. The issues that appear smaller or unnecessary to you are haunting your child, sucking up to his self-confidence, destroying his self-esteem, and putting him behind other kids of his age. It’s better to
- You need to reassure them that they can count on you, whatever the trigger is and whenever they face a panic attack, you are there to protect them. They are not alone.
- If you are having disagreements, let them talk through or ask questions. It's fine for people to disagree and have their own viewpoints. Assure them that you can have a good discussion with them and come up with the best answer.
- For the preschooler child, encourage him to have an unobtrusive toy with him that he can squeeze, hug or hold when feeling anxious.
- Acknowledging the fears of your child and not dismissing them is the key to helping them overcome their fears.
- If they feel scared or have a panic attack, help them by reassuring your cooperation and support. Non-verbal cues for reassurance like giving a hug or a pat on the back can also calm them down
- Encourage the child to speak up, write a story or draw a picture about the fearful situation, and whatever they like easier to communicate their stressful experience. It allows you to gain a far better and more complete understanding of their worries.
- If a specific person, event, or object is causing anxiety. Tell them that they cannot eliminate the stressor, but rather learn how to manage it. For instance, if your child is scared of one of his uncles, tell them that you are with him when you will meet him, “He’s not going to hurt you”, “I am there with you, it's ok to say hi and you can sit with me” and “We will have a nice time together”, “Whatever gets wrong I will be there with you to protect you”. This way he will gradually learn how to handle a situation in a calm way rather than finding a way to escape.
- Help your child learn age-appropriate relaxation techniques like deep breathing, backward counting, meditation, or yoga. These would help him to relax and calm in a stressful situation. Breathing exercises and guided meditation can be easily learned by preschool children.
- To lighten the mood, sprinkle in some humor and casual conversation. Carefully progress the conversation by presenting the stressors in a way that is not as frightening as they appear to the child and without making fun of them.
- Don't make their anxieties and phobias worse. If your child has had a negative experience with animals in the past. Try not to tell kids to be afraid of the animals or to be cautious of them, either verbally or nonverbally. Rather, progressively reduce their fear by exposing them to the feared object in a friendly manner.
- Sort out solutions to anxiety situations with your child. For instance, if your child is afraid of spiders and you can ask him, “What would you do if you see a spider?”. You can tell them that it won’t hurt you in the first place. But if you are still afraid of them, “I am here with you, we will take five deep breaths and you can sit with me on the couch”. This way they will learn to face the anxious situation calmly without panicking and running away. This exercise needs your supervision and several practices
- It's time to focus on your coping mechanisms. As a parent, you must figure out answers to difficulties, handle them effectively, and set an example for your child to follow. If you panic or complain often, act violently, or get depressed as a result of your difficulties, your child will find it difficult to develop healthy coping mechanisms.
- Encourage to develop a healthy routine for your child. Limit the consumption of sugary foods, help early-to-bed routines and reduce the use of digital devices, especially at night. Bedtime stories are also a great idea. The goal is to promote healthy habits and alleviate physical signs of anxiety.
Treatment of anxiety
The good news is anxiety is manageable and treatable. You can look for warning signs that are problematic in your child’s daily life. Early detection aids in the reduction of symptoms and the avoidance of major clinical outcomes. Initially, if you find something bother your child, you can see a healthcare provider and discuss about his mental health evaluation.
The mental health professional can devise a strategic treatment plan and decide what treatment schedule will work best for your child. Sometimes, the therapist may involve school teachers and parents as part of therapeutic treatment, which indeed yields beneficial results. Further, consultation with health care provider helps in medication for your child to speed up the recovery process.
a) Therapeutic treatment
The therapeutic treatment usually involves one or more therapies to help out the child effectively cope with anxiety, fears or phobias.
1. Psychoeducation
This intervention is used to educate the child and his family about the disorder and how further treatment like exposure therapy can help minimize the child’s anxiety. It is intended to build rapport with the child, boost his motivation and assure his cooperation in exposure therapy.
2. Cognitive Behavior Therapy (CBT)
It is one of the most widely utilized and effective treatment methods for treating childhood anxiety and other mental health issues by psychologists all over the world. It's a 12-16 week program designed to teach you new ways of thinking. Negative self-talk, thinking, and misinterpretations are restructured into positive ones.
3. Acceptance and Commitment Therapy (ACT)
As the name suggest, the child is aided by accepting unfavorable occurrences and experiences in life without overthinking or becoming overly concerned about them Nobody can completely eradicate negative events, occurrences, or feelings from their lives, but you can learn to live with them in a productive and meaningful way.
4. Dialectical Behavior Therapy (DBT)
It is an intensive program that handles two contradictory approaches at the same time. The therapist tells how to manage intense emotions with positive behavioral changes, which may otherwise result in self-harming and self-destructive behaviors.
5. Exposure Therapy
The child is exposed to fearsome or phobic stimuli in a systematic and gradual way. Usually, without being forced, the child is exposed to the phobic object in a safe and secure environment and encouraged to let go of his illogical negative associations with the object.
6. Relaxation Techniques
This one is my favorite. You may quickly pick them up and teach them to your child too. The purpose is to slow down biological responses such as racing heartbeat, headache, nausea, tense muscles, and so on. Your therapist can advise you on the best strategy for reducing your child's somatic symptoms. Mindfulness, meditation, yoga, progressive muscle relaxation, and controlled breathing are some of the most common methods for reducing anxiety symptoms.
b)Medication
When psychotherapies fail to provide satisfactory results, or when your child is suffering from a severe kind of anxiety that interferes with his eating, sleeping, and other routines, drug therapy is utilized. Parents may be hesitant to utilize medicine, but it is necessary for your child's progress
1. Selective Serotonin Reuptake Inhibitors (SSRIs)
These commonly used anti-depressant used to treat anxiety and depression. The medicine promotes the production of serotonin, a mood-enhancing substance in the brain. It promotes sensations of happiness and well-being. These medications have no negative effects and are non-addictive. Zoloft and Prozac are examples of SSRIs.
2. Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs)
Another class of drugs used to manage serotonin (controls mood) and norepinephrine levels (regulates emotions, energy levels, and alertness). These drugs are non-addictive but may show withdrawal symptoms for a while.
3. Tricyclic Antidepressants
These drugs are used when other commonly used medications are not giving desired results. Tricyclic antidepressants are useful for treating mood disorders, depression, and some anxiety disorders.
4. Benzodiazepines
These drugs can make the child dependent, so these are only used for severe anxiety problems only a for short period of time.
c) Complementary and Alternative Medication
Complementary and alternative medication and procedures are not accepted as standard medical treatment but sometimes give people unbelievable results. These include many different practices and health rituals but mind-body therapies are the ones that are effective for treating anxiety symptoms in your child.
With help of mental focus, body coordination, and breathing, the hyperactive bodily symptoms can be calmed down. Some mind-body therapies are meditation, acupuncture, yoga, tai chi, imagery, and creative outlets. For best results, use these practices with psychotherapies and medications.
Summary
Do you ever feel your child is facing any of above-listed anxiety types or going through emotional and physical signs of anxiety?
Childhood anxiety needs serious attention by parents and caregivers. Earlier detection and treatment can help a long way. If you overlook the emotional and physical disturbances of your child, he may later develop serious pathological problems that would take time to settle down.
There are numerous treatment options for your child. You need right guidance and evaluation first. Your healthcare provider can guide you the process. With help of therapeutic techniques and medication your child can bravely fight of his inner fears and anxieties, but only if you care.
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