Child Anxiety

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Child Anxiety

Anxiety Disorders in Children and Teens

Children and teens have anxiety in their lives, and like adults, they can suffer from anxiety disorders, too. Stressful events such as starting school, moving, or the loss of a parent can trigger the onset of an anxiety disorder, but a specific stressor need not be the precursor to the development of a disorder. Research has shown that if left untreated, children with anxiety disorders are at higher risk to perform poorly in school, to have less developed social skills, and to be more vulnerable to substance abuse.

While children can develop any of the recognized anxiety disorders, some disorders are more common in childhood. Some tend to be specific to stages of development. Separation anxiety disorder and specific phobias are more common in children about 6 to 9 years old. Generalized anxiety disorder (GAD) and social anxiety disorder are more common in middle childhood and adolescence; panic disorder can occur in adolescence, too. As with adults, depression has a high rate of comorbidity in children, particularly teenagers.

Although children experience the symptoms of anxiety in much the same way as adults do, they display and react to symptoms differently. This can lead to difficulties in diagnosis, and it may be difficult to determine if a child's behavior is "just a phase" or whether it constitutes a disorder.

Separation Anxiety Disorder

Many children experience separation anxiety between 18 months and three years of age, when it is normal for a child to feel some anxiety when a parent leaves the room or goes out of sight. Usually he/she can be distracted from these feelings. Crying when first being left at daycare or pre-school is also common, and the crying subsides when the child becomes engaged in his/her surroundings.

Usually four year olds are able to leave their parents. If not, the problem could be separation anxiety disorder, which affects approximately 4% of children. With separation anxiety disorder, a child experiences extreme anxiety when away from home or separated from parents or caregivers. In this case, the desire to be in contact with missed persons is excessive, extreme homesickness and feelings of misery at not being with loved ones are common. While separated, it is not uncommon for these children to have fears regarding the health and safety of their parents.

Children suffering from separation anxiety disorder may:

* Try to avoid going places by themselves;

* Refuse to go to school or camp

* Be reluctant or refuse to participate in sleepovers

* Follow a parent around

* Demand that someone stay with them at bedtime, or "appear" in their parent's bedroom during the night

* Awake from nightmares about being separated from loved ones.

Onset of separation anxiety disorder can occur any time before age 18, but it is most common in children between the ages of seven and nine.

School Refusal or Avoidance

A child experiencing more than just "school jitters" usually refuses to go to school on a regular basis or has problems staying in school. This should not be confused with truant children who avoid school because they display antisocial behavior or delinquency.

School refusal or avoidance is often a symptom of a deeper problem, and if not treated it can have a negative effect on socialization skills, self-confidence, coping skills and, of course, education. Anxiety-based school refusal affects 2 to 5 percent of school-age children. It is common at times of transition, such as graduating from elementary school to middle school and from middle school to high school. Anxieties tend to differ among age groups, but these are the most common stressors:

• separation anxiety

• concerns about academic performance

• anxieties about making friends

• fear of a teacher or bully

The most common ages for school refusal are between five and six, and between ten and eleven. Children who suffer from school refusal tend to be average or above average in intelligence.

Their stress may come out in physical symptoms such as the following:

• headaches

• stomachaches

• nausea

• diarrhea

In addition to physical symptoms, they may exhibit behavioral symptoms:

• tantrums

• inflexibility

• separation anxiety

• avoidance

• defiance

Older Children

Older children not only experience the stress that goes along with transition from one school to the next, but they have the added academic pressure in the higher grades when they begin to consider what their futures hold. These stresses may manifest themselves in an extreme preoccupation with appearance, sleeplessness, or rebellion. As with younger children, it is important that they remain in school, although they may fight it. Missing school reinforces anxiety rather than alleviating it.

There may be many fears related to school, but these are the most common:

• Separation from caregivers

• Riding on the bus

• Eating in the cafeteria

• Using the school bathroom

• Being called on in class

• Changing for gym

• Interacting with other children or teachers

• Getting picked on by peers or older children

Obsessive-Compulsive Disorder (OCD)

People suffering from OCD are plagued by persistent, recurring thoughts (obsessions) that reflect exaggerated anxiety or fears; typical obsessions include worry about being contaminated or fears of behaving improperly or acting violently. The obsessions may lead to performing a ritual or routine (compulsions), such as washing hands, repeating phrases, or hoarding, to relieve the anxiety caused by the obsession.

Selective Mutism

Children who refuse to speak in situations where speech is expected or necessary, to the extent that their refusal interferes with school and making friends, may be suffering from selective mutism, thought to be a severe form of social anxiety disorder. Onset of selective mutism is usually before five years of age, but it often comes to a head when the child enters school. The average age of diagnosis is between 4 and 8 years old, but these children probably exhibited "extreme shyness" at a much earlier age. For selective mutism to be diagnosed, the behavior must persist for at least one month. These children can be very talkative, even boisterous at home, or in a place where they feel comfortable.

Children suffering from selective mutism may exhibit the following:

* Stand motionless and expressionless, turn his or her head, chew or twirl hair, avoid eye contact, or withdraw into a corner.

* Become anxious before entering an uncomfortable situation, common symptoms of anxiety before social events include stomachaches, headaches, and other physical ailments.

* Display additional signs of severe anxiety: separation anxiety, frequent tantrums and crying, moodiness, inflexibility, sleep problems, and extreme shyness. These can show up as early as infancy.

Social Anxiety Disorder

Social anxiety disorder, or social phobia, is characterized by an intense fear of social and performance situations. The most commonly feared situations include initiating conversations, unstructured peer activities, performing in front of others, speaking up in class, and inviting others to get together. Avoiding these activities significantly interferes with the quality of children’s lives, often impairing their school performance and attendance, as well as their ability to socialize with peers and develop and maintain relationships.

The onset of social anxiety disorder peaks in adolescence, when establishing and managing friendships independently is a crucial part of healthy development. Untreated, the disorder can persist into adulthood and may increase the risk for depression or alcohol abuse later on.

Parents and teachers may not be aware of the warning signs of social anxiety disorder, or they may not consider extreme shyness a problem warranting professional attention.

Read on for some signs of social anxiety disorder, as well as tips for parents and teachers.

Signs to watch for

* Hesitance, passivity, and discomfort in the spotlight

* Avoidance or refusal to initiate conversations, perform in front of others, invite friends to get together, telephone others for homework or other information, or order food in restaurants

* Avoiding eye contact

* Speaking very softly or mumbling

* Minimal interaction and conversation with peers

* Appearing isolated or on the fringes of the group

* Sitting alone in the library or cafeteria, or hanging back from a group in team meetings

* Overly concerned with negative evaluation, humiliation, or embarrassment

* Difficulty with public speaking, reading aloud, or being called on in class

When faced with anxiety-producing situations, a child can suffer from these symptoms:

* sweating

* racing heart

* stomachache

* dizziness

* crying

* tantrums

* freezing

Tips for Parents

* Expose your child to play groups, birthday parties, after-school activities, or other social situations where the child will have opportunities to interact with peers.

* Encourage your child to speak up, such as ordering food in a restaurant. Don’t speak for your child.

* Praise or offer rewards for speaking up. For example, offer a trip to the movies if he or she asks for the tickets at the box office.

* Lead by example. Teach your child by showing how you handle social situations.

Tips for Teachers

* Implement procedures to get socially anxious students more involved, such as calling on them in class.

o Explain to these students beforehand that you want to help them feel more comfortable in class, not more embarrassed.

o Coach them, if necessary, to make sure they know the answers.

* Remind them that speaking up in class will get easier with practice.

* Do not single out a student; call on all of them for answers.

* Incorporate oral presentations into your curriculum to help all your students develop confidence in public speaking.

Finding Help for Your Child

Taking your child to the doctor for a mental health problem is as important as visiting the doctor for an ear infection or broken arm. But knowing when and where to seek mental health care can be difficult. Here are some these tips for parents to make the process easier.

When to seek help

Many physical and emotional signs suggest a possible mental health problem. Any problem that is personally bothersome warrants evaluation. Further investigation may be necessary when a child seems out of step with peers or exhibits changes or problems in any of the following areas:

• Eating habits or appetite

• Sleeping

• Schoolwork

• Activity level

• Mood

• Relationships with family or friends

• Aggressive behavior

• Behavior typical of a younger child

• Speech and language and other development milestones

Test Anxiety

You went to class, completed your homework, tackled tough essays and studied. You arrive at your exam confident you know the material. As you take your seat, you start to feel butterflies in your stomach and your palms begin to sweat.

Prepared for the test, your butterflies turn to nausea. You are sweating profusely. You feel lightheaded. Your heart is racing. Your mind is a blank. You want to run out of the room. You may have test anxiety. Read on for causes, symptoms and ways to manage test anxiety.

What is test anxiety?

Test anxiety is a type of performance anxiety - just like when some people get nervous speaking to large crowds or trying something new.

What causes test anxiety?

Test anxiety occurs for a number of reasons.

Fear of Failure. While the pressure to perform can act as a motivator, it can also be devastating to individuals who tie their self-worth to the outcome of a test.

Lack of Preparation. Waiting until the last minute or not studying at all can leave individuals feeling anxious and overwhelmed.

Poor Test History. Previous problems or bad experiences with test-taking can lead to a negative mindset and influence performance on future tests.

What are the symptoms of test anxiety?Individuals suffering from test anxiety may experience a variety of symptoms. These include:

Physical Symptoms. Headache, nausea, diarrhea, excessive sweating, shortness of breath, rapid heartbeat, light-headedness and feeling faint can all occur. Test anxiety can lead to a panic attack, which is the abrupt onset of intense fear or discomfort in which individuals may feel like they are unable to breathe or having a heart attack.

Emotional Symptoms. Feelings of anger, fear, helplessness and disappointment are common emotional responses to test anxiety.

Behavioral/Cognitive Symptoms. Difficulty concentrating, thinking negatively and comparing yourself to others are common symptoms of test anxiety.

How can you manage your test anxiety?Test anxiety can be so severe that it may interfere with your ability to learn, concentrate and study effectively. This may prevent you from performing well. The following tips may help you manage your test anxiety.

Be Prepared. Develop good study habits. Study at least a week or two before the exam, in smaller increments of time and over a few days (instead of pulling an "all-nighter"). Try to simulate exam conditions by working through a practice test, following the same time constraints.

Develop Good Test-Taking Skills. Read the directions carefully, answer questions you know first and then return to the more difficult ones. Outline essays before you begin to write.

Maintain a Positive Attitude. Remember that your self-worth should not be dependent on or defined by a test grade. Creating a system of rewards and reasonable expectations for studying can help to produce effective studying habits. There is no benefit to negative thinking.

Stay Focused. Concentrate on the test, not other students during your exams. Try not to talk to other students about the subject material before taking an exam.

Practice Relaxation Techniques. If you feel stressed during the exam, take deep, slow breaths and consciously relax your muscles, one at a time. This can invigorate your body and will allow you to better focus on the exam.

Stay Healthy. Get enough sleep, eat healthy, exercise and allow for personal time. If you are exhausted - physically or emotionally - it will be more difficult for you to handle stress and anxiety.

Visit the Campus Student Services or Counseling Center. Schools are aware of the toll exams can take on students. They have offices/programs specifically dedicated to helping you and providing additional educational support so that you can be successful.

If these do not help you or you want additional help, talk to your doctor and find a local therapist.

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