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Overview of Anxiety Disorders in Children and Adolescents

By

Josephine Elia

, MD, Nemours/A.I. duPont Hospital for Children

Reviewed/Revised May 2023 | Modified Jun 2023
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Anxiety disorders are characterized by fear, worry, or dread that greatly impairs the ability to function and is out of proportion to the circumstances.

  • There are many types of anxiety disorders, distinguished by their primary focus on fear, worry, or dread.

  • Most commonly, children refuse to go to school, often using physical symptoms, such as a stomachache, as the reason.

  • Doctors usually base the diagnosis on symptoms but sometimes do tests to rule out disorders that could produce the physical symptoms often caused by anxiety.

  • Behavioral therapy is often sufficient, but if anxiety is severe, medications may be needed.

All children feel some anxiety sometimes. For example, 3- and 4-year-olds are often afraid of the dark or monsters. Older children and adolescents often become anxious when giving a book report in front of their classmates. Such fears and anxieties are not signs of a disorder. However, if children become so anxious that they cannot function or become greatly distressed, they may have an anxiety disorder. Studies show that about 3% of 6-year-olds, 5% of adolescent boys, and 10% of adolescent girls have anxiety disorders. Children with an anxiety disorder are at increased risk of depression Depression and Mood Dysregulation Disorder in Children and Adolescents Depression includes a feeling of sadness (or, in children and adolescents, irritability), and/or loss of interest in activities. In major depression, these symptoms last 2 weeks or more and... read more , suicidal behavior Suicidal Behavior in Children and Adolescents Suicidal behavior is an action intended to harm oneself and includes suicidal gestures, suicide attempts, and completed suicide. Suicidal ideation is thoughts and plans about suicide. Suicide... read more , alcohol Alcohol-Related Liver Disease Alcohol-related liver disease is liver damage caused by drinking too much alcohol for a long time. In general, the amount of alcohol consumed (how much, how often, and for how long) determines... read more Alcohol-Related Liver Disease and substance use disorders Overview of Substance-Related Disorders Medications and other substances, whether used for legitimate medical purposes, as a habit (for example, caffeine), or recreationally, are an integral part of everyday life for many people ... read more , and academic difficulties Learning and Developmental Disorders later in life.

People can inherit a tendency to be anxious. Anxious parents tend to have anxious children.

Anxiety disorders include

During the COVID-19 pandemic, anxiety symptoms in young people doubled, especially in girls. Mental health visits for anxiety also increased. After controlling for gender, age, and pre-COVID anxiety symptoms, the following were found to be significant predictors of COVID-19 anxiety symptoms in children:

  • Poor connectedness to caregiver

  • Sleep problems

  • High amounts of screen time

Symptoms

Some children talk specifically about their anxiety. For example, they may say “I am worried that I will never see you again” (separation anxiety) or “I am worried the kids will laugh at me” (social anxiety disorder). However, most children complain of physical symptoms, such as a stomachache. These children are often telling the truth because anxiety often causes an upset stomach, nausea, headaches, and sleep problems in children.

Many children who have an anxiety disorder struggle with anxiety into adulthood. However, with early treatment, many children learn how to control their anxiety.

Diagnosis

  • A visit with a doctor or behavioral health specialist

  • Sometimes questionnaires about symptoms

  • Sometimes observing the child's behavior

  • Tests to check for other causes of symptoms

Doctors usually diagnose an anxiety disorder when the child or parents describe typical symptoms. The doctor will also talk with the child and may observe the child's activities or ask the child or parents to fill out a specialized questionnaire.

Some symptoms that anxiety can cause may also be caused by a medical issue, and doctors may do tests for physical disorders before an anxiety disorder is considered.

Treatment

  • Behavioral therapy

  • Sometimes medications

One form of therapy that is often effective is called cognitive-behavioral therapy (CBT). CBT is a short-term, structured form of talk therapy designed to help people identify and then challenge negative thought patterns so that they can deal with difficult situations more effectively.

Another approach is called exposure therapy. Therapists expose children to the situation that triggers anxiety and help the children remain in the situation and feel comfortable. Thus, children gradually become desensitized and feel less anxiety. When appropriate, treating anxiety in parents at the same time often helps.

If anxiety is severe, medications may be used. A type of antidepressant called a selective serotonin reuptake inhibitor Selective serotonin reuptake inhibitors (SSRIs) Several types of medications can be used to treat depression: Selective serotonin reuptake inhibitors (SSRIs) Norepinephrine-dopamine reuptake inhibitors, serotonin modulators, and serotonin-norepinephrine... read more (SSRI), such as fluoxetine or sertraline, is usually the first choice if drug treatment is needed for a long time. Most children can take SSRIs without any problem. However, some children have an upset stomach, diarrhea, or insomnia or gain weight. A few become restless or more impulsive. There has been concern that antidepressants may cause a slight increase in the risk of suicidal thinking in children and adolescents (see Antidepressant drugs and suicide Antidepressants and suicide Depression includes a feeling of sadness (or, in children and adolescents, irritability), and/or loss of interest in activities. In major depression, these symptoms last 2 weeks or more and... read more ).

If drug treatment is needed only for a short time (for example, because a child is very anxious before a medical procedure), benzodiazepines, a type of sedative, are usually used.

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