Anxiety Disorders: Symptoms and Treatment (Family, Youth, and Caregiver Guide)
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Anxiety is an emotional state characterized by worried thoughts, feelings of tension, and in some cases, physiological symptoms like sweating, trembling, dizziness, and increased heart rate. Anxiety is sometimes equated with fear, but anxiety is typically longer lasting, and it centers on vaguely-defined or imaginary threats rather than clear and present dangers.
It is normal for a child to feel anxious from time to time, but persistent and recurring anxiety can indicate an anxiety disorder. Anxiety disorders in children consist of intense and/or continuous anxiety about particular situations or environments, such as school or social interactions.
Almost 1 in 11 children ages 3–17 and 1 in 3 adolescents ages 13–18 will experience some type of anxiety disorder, making it an extremely common mental health challenge. Anxiety disorders are about 1.5 times more prevalent in girls than boys. Age of onset varies considerably and according to the specific disorder; for example, phobia-related anxiety disorders typically begin around ages 7–14, but other anxiety disorders rarely begin before the later teenage years.
Types and Symptoms
There are several types of anxiety disorders that differ in terms of how and when symptoms are experienced.
➤ Generalized Anxiety Disorder (GAD)
GAD is characterized by persistent and excessive worry that interferes with daily activities, as well as persistent signs of physiological arousal, such as muscle tension and sleep disturbance. Youth with GAD may experience anxiety about school grades, family issues, relationships with peers, and performance in sports. They might also have a tendency to strive for perfection, seek approval or reassurance from others, and judge themselves harshly when they fall short of expectations.
➤ Panic Disorder
Panic disorder is distinguished by recurring attacks of severe anxiety or panic. These attacks include both physical and psychological distress, and they are generally unexpected, occurring for no apparent reason. Symptoms experienced during a panic attack may include: sweating, trembling, heart palpitations, chest pain, shortness of breath, dizziness, nausea, feeling detached, fear of losing control, and fear of dying. Panic attacks can at times occur in the context of another anxiety disorder.
➤ Separation Anxiety Disorder
A person who has separation anxiety disorder experiences excessive anxiety about being away from someone to whom they are attached. In children, this often manifests as extreme homesickness or persistent feelings of misery when separated from parents or caregivers. Children with separation anxiety often worry about bad things happening to their parents or caregivers, resulting in a reluctance to be apart from them.
➤ Social Anxiety Disorder
Social anxiety disorder involves intense anxiety and discomfort surrounding social situations. This anxiety is typically rooted in a fear of being embarrassed, humiliated, rejected, or looked down on by others. School-aged children may fear being called on in class or starting conversation with peers, which can significantly impair their academic performance and their ability to develop and maintain relationships. The extreme anxiety leads to either avoiding social situations or enduring them with marked distress.
➤ Specific Phobias
A specific phobia is an intense and exaggerated fear of an object, situation or activity that, for most people, triggers only normal, brief fear. Common childhood phobias include specific animals or insects, storms, heights, water, blood, the dark, and medical procedures. Children will typically avoid their phobic objects unless they are forced to confront them, in which cases they might cry, throw tantrums, cling to caregivers, or manifest physical symptoms like headaches and stomachaches. Unlike adults, they do not usually recognize that their fear is irrational.
Agoraphobia is an atypical phobia in which a person fears being in situations where escape may be difficult or embarrassing. Examples include using public transportation, being in open spaces, being in enclosed places, standing in line or in a crowd, and being outside the home alone. A person with agoraphobia will actively avoid these uncomfortable situations, to the point that they may become unable to leave their home.
➤ Selective Mutism
A child who refuses to speak in situations where talking is expected or necessary may suffer from selective mutism. Avoidance behaviors may include standing motionless and expressionless, turning their head, chewing or twirling their hair or clothing, avoiding eye contact, or withdrawing into a corner to avoid talking. These behaviors are often severe enough to interfere with school performance and making friends.
Anxiety disorders can be challenging to live with, but they are treatable, and many children who suffer from them go on to live full, normal lives. Some disorders may resolve themselves over time, but others can linger into adulthood. In either case, therapy and medication can help individuals with anxiety disorders manage their symptoms.
Anxiety disorders and other mental health conditions tend to be highly intertwined with a child’s personal relationships. As such, it is imperative for caregivers and family members to be involved in and supportive of their child’s treatment. If their relationships and home/school environments do not change to support their treatment, then its efficacy will be greatly reduced.
➤ Therapy and Skills Training
Professional therapy and counseling are important components of treatment for anxiety disorders. Treatments like individual therapy, family therapy, and skills training can help children and their families learn how to manage symptoms of anxiety.
Some common therapeutic practices include:
- Teaching you and your child about anxiety disorders and what they mean.
- Talking about and helping your child understand the thoughts and fears that cause symptoms of anxiety. When talking about these thoughts, the therapist is able to change them and help your child think differently.
- Encouraging your child to pay attention to their thoughts, feelings, and behaviors and to connect those to feelings of anxiety.
- Guiding your child through relaxation, meditation, and deep breathing techniques, and teaching your child how to perform these techniques on their own.
- Teaching your child techniques to change their negative thought patterns.
- Slowly exposing your child to their fears and to the objects or situations that make them feel anxious. This is a practice known as exposure therapy.
Psychiatric medications may be used in combination with therapy to help your child manage their anxiety symptoms.
Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), are commonly used to treat anxiety disorders. They are generally effective and have few side effects, although they do not provide immediate relief. Mild tranquilizers known as benzodiazepines may also be prescribed for short-term relief of intense anxiety, although they have many side effects, including drowsiness, and can be habit forming at higher doses.
You should speak with your clinician or psychiatrist about the potential benefits and possible negative side effects before starting your child on any psychiatric medication for anxiety.
Supporting a Child with Anxiety
Parents, caregivers, and other family members play an important role in supporting children diagnosed with anxiety disorders. The younger the child, the more likely they’ll need help learning how to manage the symptoms of their disorder. Family members can be instrumental in modeling and guiding new coping behaviors.
The following section includes tips that can be helpful for supporting your child’s progress. Keep in mind they might not all be right for you and your family, but it could be useful to give them a try.
➤ Educate yourself
Stay educated on what anxiety disorders are, how they affect children, and how they affect your child in particular. Help your child understand what anxiety is and what the treatment process will be like.
➤ Get involved in therapy
Actively participate with the clinician in your child’s treatment plan, and assist your child with taking any medications at home. Be open and flexible about meeting for treatment. Make time for both you and your child to participate individually and as a family.
➤ Stay involved with school
An anxiety disorder can directly and negatively affect your child’s progress in school. If you inform the necessary school staff of your child’s anxiety disorder, they can help keep your child safe and supported when you are not around.
➤ Create a positive home environment
Make sure that your home is a safe place for your child and the rest of your family. Have meals together, take walks as a family, and spend plenty of positive time together. Anxiety disorders in children can cause extra stress on the family, so it is important to de-stress.
➤ Create support systems
Make sure everyone who lives in your home is informed about what is going on in order to create a strong family support for your child. Find people you can trust and confide in to help you with transportation to appointments, taking care of family members, and emotional support.
➤ Practice coping skills
There are a variety of coping skills you can practice with your child to help them manage anxiety symptoms. Examples include mindfulness, meditation, deep breathing, and using imagery. Moving the body can also help to reduce anxiety symptoms.
➤ Develop structures
Changes in routine are inevitable if your child begins treatment of any kind. Do your best to stay organized with appointments, medication, work, and social plans with friends and family. Remember to stay flexible and allow extra time for your child during transitions.
➤ Take care of yourself
Know your limits and seek support if you need it. Join support groups, check out community services, and seek professional guidance if you think it would be helpful. You are your child’s source of support and comfort, so feeling your best will help your child feel their best!
➤ Reduce your stress
You may laugh at this one, but it is important nonetheless. The less stress you have in your life, the better off everyone will be. Continue doing things you love and be sure to stay healthy (exercise and eat nutritious foods).
➤ Don’t place blame
Blaming yourself, your child, or anyone else will not help the situation. Be supportive in any way possible and don’t feel guilty about what your child is going through. Don’t punish anyone if they make mistakes.
➤ Stay calm
Remember to stay calm whenever your child is experiencing anxiety. They will need support and guidance during these difficult periods.
➤ Be proud of yourself
This is a difficult time. You are already on the right path just by staying informed and involved in your child’s life.
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