Anxiety In Children

Anxiety is a normal experience that serves protective functions throughout a person’s development.  However, sometimes the anxiety in anticipation of or in response to a situation is consistently exaggerated and may interfere with functioning or cause significant distress.   We expect to find a certain level of fear and anxiety in children; however, anxiety disorders in children are different from normal childhood fears in that they tend to be more intense and maladaptive, and they tend to last longer¹.  Most childhood fears are usually not very serious, they vary by age, and they don’t last long². 

Anxiety disorders are some of the most frequent childhood and adolescent disorders, occurring in about 20% of children and adolescents during any stage of their development^{3, 4}.  Some children may continue to experience anxiety disorders into adulthood^{5, 6}.  Children with any anxiety disorder may experience excessive anxiety that causes distress and interferes with normal functioning; however, the differences among anxiety disorders center around the feared situation itself and the anxiety reaction produced by it⁷.  For example, in the context of social anxiety disorder in children, the fear focuses on being judged in social situations; whereas the anxiety in obsessive-compulsive disorder in children is a product of obsessions, which are generally unpleasant thoughts, images, or impulses that are repeated frequently and seem uncontrollable.  Compulsions are carried out in an effort to avoid or decrease the anxiety produced by obsessions and they are physical or mental acts that are repeated a given number of times or until the anxiety subsides. 

Symptoms of anxiety disorders, including OCD, in children usually manifest in the same way as in adults, sometimes with minor variations.  You can find detailed descriptions of the different anxiety disorders, including information about symptoms and treatment, in the corresponding sections. 

What causes anxiety disorders?  Multiple factors play a role in the development of anxiety disorders.  As in other disorders, genetic factors seem to play a role, particularly when it comes to individual characteristics, such as temperament or how a person reacts to a situation, and neurobiological determinants or how the brain and body react to stress⁸.  In addition, children with anxiety disorders tend to pay special attention to anything that could potentially be threatening and they are more likely to interpret vague situations as dangerous⁸.  Therefore, they perceive having less control over their environment and have a harder time adapting.  Such children may also believe that they lack control in their own emotional responses, and  therefore they may have difficulty in soothing themselves⁸.  Environmental factors, such as caregiver attention, can also influence the emotional development of children⁸.  For example, when a caregiver is not responsive to the child’s needs or cries, that child may develop the perception of being helpless and become more prone to anxiety.

What maintains anxiety or makes it worse?

1. Avoidance: Experiencing anxiety in some situations can lead a person to avoid those and similar situations in an effort to prevent or reduce anxiety.  However, even though avoidance reduces anxiety temporarily, it prevents the person from learning to cope with anxiety and it may produce even a stronger anxiety response to that situation⁸.
2. Poor competence: Shying away from social interactions can keep children from learning social skills and may make them more prone to experiencing social failure⁸.
3. Cognitive biases: Children with anxiety disorders tend to misinterpret situations as threatening, they expect bad things to happen on a regular basis, and they assume others are judging them negatively⁸.
4. Negative experiences: Avoidance and cognitive biases get in the way of learning what to do and how to cope with certain situations.  Therefore, children with anxiety disorders are more likely to have negative experiences and failures, which then only perpetuate their anxious feelings, biased thoughts, and maladaptive behaviors⁸. 
5. Parental Responses: When parents or other caretakers are overprotective of children by keeping them from anxiety-producing situations, they are essentially teaching them avoidance⁸.  On the other hand, when caretakers are not sensitive or do not respond to the children’s needs they may not provide the emotional support when children are exposed to fearful situations⁸.
6. Negative transactions: It is important to remember that anxious children tend to ask for the overprotective behavior of their parents⁸.  Also, parents are more likely to encourage avoidance when the child has a very negative response to an anxiety-producing situation⁸.  In fact, children might learn anxious behaviors and responses from their anxious and avoidant parents, or parents who have difficulty managing their own anxiety may not have the skills to soothe anxious children⁸.

1. Kerig, P. K., & Wenar, C. (2006).  Developmental Psychopathology: From infancy through adolescenceI (5^thed.).  New York: McGraw Hill.
2. Hagopian, L. P., & Ollendick, T. H. (1993).  Simple phobia in children.  In R. T. Ammerman & M. Hersen (Eds.), Handbook of behavior therapy with children and adults: A developmental and longitudinal perspective.  General psychology series, Vol. 171.  Boston, MA, USA: Allyn & Bacon, Inc.
3. Shaffer, D., Fisher, P., Dulcan, M. K., Davies, M., Piacentini, J., Schwab-Stone, M. E., Lahey, B. B., Bourdon, K., Jensen, P. S., Bird, H. R., Canino, G., & Regier, D. A. (1995).  The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC): Description, acceptability, prevalence rates, and performance in the MECA study.  Journal of the American Academy of Child and Adolescent Psychiatry, 35, 865-877.
4. Verhulst, F. C., van der Ende, J., Ferdinand, R. F., & Kasius, M. C. (1997).  The prevalence of DSM-III-R diagnoses in a national sample of Dutch adolescents.  Archives of General Psychiatry, 54, 329-336.
5. Pine, D. S., Cohen, P., Gurley, D., Brook, J., & Ma, Y.  (1998).  The risk for early adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders.  Archives of General Psychiatry, 55, 56-64.
6. Alpert, J. E., Maddocks, A., Rosenbaum, J. F., & Fava, M. (1994).  Childhood psychopathology restrospectiley assessed among adults with early onset major depression.  Journal of Affective Disorders, 31, 165-171.
7. Ollendick, T. H., Grills, A. E., & Alexander, K. (2001).  Fear and anxiety in children and adolescents.  In C. A. Essau and F. Petermann (Eds.), Anxiety in Children and Adolescents: Epidemiology, Risk Facktors, and Treatment.  London: Harwood Academic Publishers.
8. Vasey, M. W., & Dadds, M. R.  (2001).  An introduction to the development psychopathology of anxiety.  In M. W. Vasey & M. R. Dadds (Eds.) The developmental psychopathology of anxiety (pp. 3-26).  New York: Oxford University Press.