Anxiety and Stress Disorders in Children
Anxiety symptoms are linked to specific mental and behavioral disorders which can appear even in very young children. Examples of these anxiety symptoms are thoughts and fears about safety of self and parents, expressing worries about things before they happen, or constant worries or concern about school, friends, or sports. Some anxious children are afraid to meet or talk to new people. As a result, they have few friends outside the family. Anxiety can also be expressed through physical complaints such as frequent stomachaches and headaches. In addition, anxiety in children can be expressed as overly clingy behavior at home and panic or tantrums at times of separation from parents. Anxious children are often tense or uptight. Some may seek a lot of reassurance, and their worries may interfere with activities. Because anxious children may also be quiet, compliant, and eager to please, their difficulties may not be easily noticed . Parents should be alert to the signs of severe anxiety so they can intervene to prevent complications. Early treatment can prevent future difficulties such as loss of friendships, failure to reach social and academic potential, and feelings of low self-esteem. In addition, early treatment can also prevent complications such as clinical depression or the formation of more severe anxiety disorders.
Anxiety symptoms can also be a response to stressful events. A child’s reaction to stress is often brief and recovery usually occurs without complications. A child or adolescent who experiences a catastrophic event, however, may develop ongoing difficulties known as posttraumatic stress disorder (PTSD). The stressful or traumatic event involves a situation where someone’s life has been threatened or severe injury has occurred. Examples of this are being the victim or a witness of physical abuse, sexual abuse, violence in the home or in the community, automobile accidents, natural disasters such as flood, fire, and earthquakes, and being diagnosed with a life threatening illness. A child’s risk of developing PTSD is related to the seriousness of the trauma, whether the trauma is repeated, the child’s closeness to the trauma, and his/her relationship to the victim(s).
Obsessive-Compulsive Disorder (OCD) is one of the more severe anxiety disorders of childhood treated by psychiatrists. OCD is seen in as many as 1 in 200 children and adolescents. OCD is characterized by recurrent obsessions and/or compulsions that are intense enough to cause severe discomfort. Obsessions are recurrent and persistent thoughts, impulses, or images that are unwanted and cause anxiety or distress. Frequently, they are unrealistic or irrational. Obsessions are not simply excessive worries about real-life problems or preoccupations. Compulsions are repetitive behaviors or rituals (like hand washing, hoarding, keeping things in order, checking something over and over) or mental acts (like counting, repeating words silently, avoiding). In OCD, the obsessions or compulsions cause significant anxiety or distress, or they interfere with the child’s normal routine, academic functioning, social activities, or relationships. The obsessive thoughts may vary with the age of the child and may change over time. A younger child with OCD may fear that harm will occur to himself or a family member. For example, they may fear that an intruder will enter the house through an unlocked door or window. The child may compulsively check all the doors and windows of his home after his parents are asleep in an attempt to relieve the anxiety. The child may then fear that he may have accidentally unlocked a door or window while last checking and locking, and then must compulsively check again. An older child or a teenager with OCD may fear that he will become ill with germs, AIDS, or contaminated food. To cope with his/her feelings, a child may develop “rituals” (a behavior or activity that gets repeated). Sometimes the obsession and compulsion are linked; “I fear this bad thing will happen if I stop checking or hand washing, so I can’t stop even if it doesn’t make any sense.” Research shows that OCD is a brain disorder and tends to run in families, although this does not mean the child will definitely develop symptoms. A child may also develop OCD with no previous family history.
Anxiety is a natural part of life. Anxiety in children is expected and normal at specific times in their development. For example, from about age 7 months through the preschool years, healthy youngsters may show intense distress (anxiety) at times of separation from their parents or other persons with whom they are close. Young children may also have short-lived fears, (such as fear of the dark, storms, animals, or strangers). Assurance and support from parents is usually all that is required to ease these fears. When anxieties become severe and begin to interfere with the daily activities of childhood, such as attending school and making friends, parents should consider seeking the evaluation and advice of a child and adolescent psychiatrist.
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