Anxiety Disorders Association
of British Columbia (AnxietyBC™)
Anxiety, worry and fear are normal tools the body uses to alert us to danger. The danger may be something sudden and obvious like encountering a bear. In this case, the body sends clear messages in the form of a racing heart and the urge to run. We may also feel threatened by new or challenging situations, such as the first day of school or a piano recital.
It is normal to feel some anxiety when meeting people or trying new things. In fact, feeling anxious or afraid can be a good thing. A rush of worry just before a big race can help us to run faster. Pre-exam jitters can help us ace a test. How much worry is too much?
Anxiety becomes a problem when the body tells us there is danger when there is no danger. If a child cannot overcome normal worry and anxiety, even when things are fine, this interferes with daily life. This is called an anxiety disorder. Anxiety disorders affect as many as one in five children. This is among the most common mental health issues in childhood and adolescence. Anxiety can seriously affect a child’s ability to function.
It is important to identify a child who is suffering with excessive worry as early as possible. This problem may lead to others down the road. Children who worry too much often miss school and withdraw from fun activities. Family relations can become strained. For some children, feeling overly anxious can even lead to depression. Some children self-medicate by using drugs or alcohol.
The causes of anxiety are complex and not fully understood. Genes likely play a role, as children with anxious parents also tend to be anxious. As well, a child may have ‘learned behavior’ that is picked up in a nervous family environment. Overprotection or excessive control may also contribute.
Since it is easy to confuse anxiety with being difficult, stubborn or overly sensitive, the diagnosis can be missed. Understanding anxiety disorders can help you decide if your child might be too anxious and seek help.
A child who cannot control the amount of time spent worrying may have generalized anxiety disorder (GAD). Children who suffer from GAD worry more often and more intensely than other children the same age. GAD causes mental distress because worrying continues even when everything is fine. Children may worry about their health when they are not sick, school when things are going well, or disasters that are unlikely to occur like an earthquake or fire. They may be stressed about minor matters (such as whether their shirt matches their pants) or adult problems (such as family finances).
GAD can also cause physical distress. A child may have stomach aches or headaches, even a racing heart or dizziness. A child may become fidgety, restless or irritable when anxious. Some have difficulty sleeping or concentrating. These symptoms are not dangerous but can be very frightening.
GAD causes changes in behaviour. Children who are overly anxious begin avoiding activities that cause distress. For instance, they may not want to go to school or hang out with friends. They may also seek constant reassurance while doing regular daily activities. They may be perfectionists, redoing projects over and over again, and sometimes giving up altogether. Children with GAD may become too safety conscious. They will ask for extra supervision with even the safest of activities (like a sleepover or a school trip).
Unfortunately, GAD may cause a child to miss school, refuse play dates, or avoid other fun childhood activities. If life is being disrupted by excess worry, a visit to your health care provider may be helpful.
From about the age eight months to two years, children learn the difference between familiar caregivers and strangers. During this time, children may be very reluctant to separate from major attachment figures like a parent, an older sibling or a grandparent. A classic example is when a child clings to a parent’s leg, crying and screaming when taken to day care. These behaviors are very common. Such displays of separation anxiety are a normal part of every child’s development. However, the key to normal separation anxiety is that the parent does eventually leave the child at day care.
If you cannot leave your child at day care (or miss work because of it), your child’s anxiety may be a disorder. Separation anxiety becomes a disorder when it begins to interfere with your child’s or your family’s daily life.
With separation anxiety disorder, the intensity of worry is out of proportion to the situation. For instance, your child may insist that you wait in the hallway at school for an hour until she feels comfortable enough for you to go. She may demand that when dad takes her to a birthday party, he stay the whole time so that she does not feel afraid. Since situations like school or parties are essentially safe, her worry is exaggerated. Your child may worry too much about getting lost, or something bad happening to mom or dad when they are out of sight.
Signs that your child may have more than normal levels of separation anxiety include repeated hesitancy or refusal to go to school, refusal to go to sleep unless the loved one is there, and repeated nightmares. Physical symptoms can be similar to GAD. They may include stomach aches, headaches, and even a racing heart. Since these children fear school, camp, or even visiting friends, their need to avoid such situations can negatively affect both the child and family.
Social anxiety (or social phobia) is when a child is terrified of being humiliated or embarrassed in social situations. These children greatly fear appearing foolish or doing anything that may be seen as ridiculous. Triggers include meeting new people, being called on in class, or being watched while speaking in public or performing.
At first glance, these children may just seem very shy. It is not always easy to tell the difference between shyness and social anxiety. The difference is that a shy child may feel uneasy about certain situations but can still be convinced to participate. This child’s daily life is not disrupted. On the other hand, overly fearful children may avoid scary situations completely. They may choose to stay quiet or hide in the background, or feel they need a buddy along wherever they go. This can result in having fewer friends and participating less fully in fun activities.
Most children are at least somewhat afraid of one thing or another. Usually, a few comforting words and gentle coaxing gets them back on track. However, some children cannot escape their feelings. They have such intense irrational fears about certain things or situations that they cannot overcome them. Common triggers include dogs, bees or needles. Many children are afraid of these things. However, children with an actual phobia find their anxiety disrupts daily routine, school and family functioning, and even social relationships. For instance, a child who has a phobia of dogs may be unable to visit Grandma’s house because of little Fido. Another child who is very afraid of bee stings might be unable to play outside, making it impossible for the family to go camping. Crying, tantrums, freezing or clinging are the most common behaviors shown by a child with a specific phobia.
Childhood anxiety disorders generally have a good outcome when they are recognized early and treated effectively. This helps avoid problems like missing school and other opportunities, depression and even substance abuse. If you are concerned about your child’s level of anxiety, it may be wise to get advice from your health care provider. An expert can help decide whether your child’s anxiety is a normal part of development or has become a disorder. If your child does have an anxiety disorder, certain home management tips may be suggested.
Other home management strategies can also give your child relief. The www.anxietybc.com website contains detail on anxiety and strategies to manage it.
If your child’s worry and behavior continues to be disruptive, home management may not be enough. Your child may need a certain type of therapy to help change negative thought patterns. Your family doctor can direct you to that kind of care if needed. Your doctor might also recommend a medication. Although treating anxiety disorders may not be easy, with proper support you and your family can overcome this challenge.