Anxiety

• Anxiety disorders are the most common and functionally impairing mental health disorders to occur in childhood and adolescence.
• May affect up to 20% of children/adolescents
• Pre-puberty, the female to male ratio is 1:1. Post-puberty, the female to male ratio is 2:1 or 3:1.
• Many of the anxiety disorders seen in adults have their origins in childhood and adolescence.
• The manifestations of anxiety disorders tend to change during development.

There are six main anxiety disorders.

Symptoms:

Separation Anxiety Disorder

A diagnosis requires at least three of the following eight symptoms of developmentally-inappropriate and excessive anxiety concerning separation:

• Excessive distress when separating
• Worry about losing major attachment figures
• Worry about untoward event that will lead to separation
• Persistence refusal/reluctance to go to school
• Fearful of being alone
• Difficulty sleeping without attachment figure
• Repeated nightmares regarding separation
• Physical symptoms during the anxiety

Panic Disorder (with/without agoraphobia)

Panic attacks are more than episodes of anxiety.  They are discrete periods of extreme anxiety in which a person often feels like they are going to die.  They include physical symptoms such as heart palpitations, sweating, trembling, shortness of breath, choking sensation, chest pain, nausea, dizziness, derealization, fear of losing control or fear of going crazy, fear of dying, paresthesia, and chills or hot flashes.

Agoraphobia is anxiety about being in places where escape might be difficult.

Obsessive Compulsive Disorder (OCD)

OCD involves either obsessions or compulsions, or both.

Obsessions are recurrent, persistent thoughts, impulses or images in the mind that are intrusive and cause anxiety and distress.

Compulsions are repetitive behaviors or mental acts that a person feels compelled to perform.  Once the person performs the act, this relieves their anxiety temporarily.  Common compulsions are touching things a certain number of times on the left and right for "balance," washing for fear of germs, and performing rituals that the person believes will prevent bad things from happening.

Generalized Anxiety Disorder (GAD)

GAD involves a number of excessive and unrealistic worries that have been present for six months or longer.  The worries are often about personal appearance, performance on tests or other tasks, being on time, loved ones, and safety.  The worries are usually accompanied by physical symptoms such as restlessness, tiredness, difficulty concentrating/mind going blank, irritability, muscle tension, and sleep disturbance.

Social Phobia

The fear of any situation in which a person might be subject to the criticism of others, such as going out in public and speaking in front of others.

Specific Phobia

Unreasonable or irrational fear of specific objects or situations, such as heights, bridges, small spaces, or flying.

Screening:

Interview with a doctor or counselor.  There are no blood tests or computerized tests.

For a diagnosis, the symptoms must persist for at least one month and the patient must also have impairment in functioning.  A free, public domain questionnaire is the Screen for Child Anxiety-Related Emotional Disorders (SCARED), which covers all of the anxiety disorders well except for OCD.  Parent-report and child-report versions can be downloaded below.  A score of 25 or higher may indicate the presence of an anxiety disorder.  

When to Refer/Seek Help

If the symptoms have been present for at least one month, a referral to a mental health clinician is indicated.  While many individuals live with anxiety disorders without treatment, they often have to make drastic changes to the way they live and function in order to accommodate their anxiety.

Treatment:

Both psychopharmacology and psychotherapy can be helpful, and the combination of both usually provides added benefit.  For psychotherapy, the best research evidence exists for cognitive-behavioral therapy (CBT).  There are several selective serotonin reuptake inhibitors (SSRI) approved in children or teenagers: fluoxetine (Prozac, approved for >7 years), sertraline (Zoloft, for >6 years), escitalopram (Lexapro, for >12 years), and fluvoxamine (Effexor, for >8 years).  Two tricyclic antidepressants, clomipramine and imipramine, are also approved for youths.

Local Experts

On the Find A Provider page of the Kid Catch Directory, you can use the Issues filter box to search for local experts on anxiety.  Clicking on this filter selection will return results of clinicians who advertise themselves as working with this problem.  Kid Catch cannot guarantee that clinicians who advertise themselves this way are truly expert.

One local clinic, Child Counseling Associates, has gone the extra yard and tracks the outcomes of the patients they treat with anxiety with standardized measures.  They are unique in the country, as far as we know, for posting the results publicly on their website to be transparent about their success and so that parents can be more educated consumers.  You can see their results here.

Resources

A professional resource for families is the Anxiety and Depression Association of America (ADAA).

A more consumer-driven, community-style resource is The Mighty.

- updated March 6, 2019