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Understanding Anxiety Disorders

Anxiety is normal. Everyone feels anxious or fearful of something at some point in their lives. For children, there are many fears that can be experienced during development. Such fears include strangers, being separated from a parent, or unfamiliar sounds and places. These fears change as we get older and have more interaction with the world. These feelings are usually mild, brief, and are an emotional response that allows a child or youth to protect themselves from danger.

For a child or youth living with an anxiety disorder, this fear occurs frequently, is intensified and can last for hours or even days. This fear becomes overwhelming or irrational, and can cause extreme distress for the individual. It also starts to have a negative impact on their day to day functioning. Children and youth who have been in the foster care system have experienced some form of trauma. Children and youth who have experienced trauma can have additional feelings of anxiety, which may lead to an anxiety disorder. Anxiety disorders can also be hereditary. Anxiety disorders are common and treatable. The good news is, support from caregivers and early treatment can allow for children and youth living with an anxiety disorder to live a healthy and happy life.

Signs of an Anxiety Disorder

For children, youth, and adults there are three ways that anxiety can be exhibited.

  • Mentally- The way we think
  • Physically- The way our body feels
  • Behaviorally- The way we act

These three areas (mental, physical and behavioural) are displayed in all anxiety disorders and share similar features. These features are:

  • Irrational and excessive fear
  • Apprehensive and tense feelings
  • Difficulty managing daily tasks and/or distress related to these tasks

Specifically, for a child or youth living with an anxiety disorder, these features can manifest into symptoms such as (*Note: this list is a guide and not a comprehensive list):

  • Clinging, crying, and/or tantrums when there is separation from a caregiver
  • Excessive shyness, avoiding social situations
  • Constant worrying
  • Avoiding particular places because of excessive fears
  • Frequent stomachaches or headaches
  • Pounding heart, chest pains or nausea
  • Shortness of breath
  • Experience of frequent and sudden panic attacks
  • Difficulty sleeping
  • Feeling irritable 

Children may not understand what they are feeling and have difficulty describing their symptoms of anxiety. For instance, they may only be able to verbalize their physical symptoms rather than psychological symptoms. Teenagers are more likely to talk about their symptoms; however, sometimes they can appear frightened or upset for no particular reason. Many times, signs and behaviours consistent with an anxiety disorder can seem strange or unreasonable to others. Children and youth with an anxiety disorder, especially children and youth who have been in foster care get labeled as “difficult”, “stubborn” or “too sensitive” It is important to remember that these children and youth are reacting to something they perceive as a threat, and their flight, fight or freeze responses are activated to protect themselves. While their reasons may appear strange it is important to know they are experiencing very real emotions. 

General Warning Signs of Anxiety Disorders in Adolescents:

Serious mental health issues typically start to show in adolescence; however, they can also manifest in childhood. It is important to know that anxiety typically accompanies many other mood disorders such as depression and bipolar disorder, as well as additional mental illness such as psychosis. Many of the warning signs for mental health issues can also look like typical teenage behavior. Regardless, when a child or youth’s behavior begins to interfere with daily functioning it is important to seek help quickly. Early intervention can help to reduce negative impacts such as poor school attendance, ruined relationships, hospitalization, and crisis and self-harm. The signs and symptoms of an anxiety disorder, present differently in youth in comparison to children. 

The following signs and symptoms are only a guide and not an exhausted list.

  • Fear of something specific, avoiding certain situations or worrying too much
  • Withdrawal from friends and family
  • Sleep disturbances
  • Changes in appetite or weight
  • Decrease or increase in energy
  • Frequent physical complaints (for example, headache, stomachache, or fatigue)
  • A decrease in the ability to make decision
  • Difficulty concentrating
  • Irritability, hostility, or aggression
  • Decline in academic performance
  • Persistent feelings of sadness
  • Having low self-esteem
  • Hypersensitivity to failure or rejection
  • Running away or threats of running away from home
  • Suicidal thoughts or attempts
  • Feelings of wanting to die

*Note: This section was provided by the mood disorders association of Ontario.

Types of Anxiety Disorders

For children and youth there are seven types of anxiety disorders.

Separation Anxiety

Separation Anxiety is when children or youth have excessive worry about being left alone or being left by a primary caregiver. This can be a reality for many children who have been in foster care or group homes. For children under the age of 4, the feeling that something terrible is going to happen once their caregivers are not around is common. If a child is over the age of 4 and still having these feelings they may have Separation Anxiety Disorder.  Although Separation Anxiety Disorder is more common in younger children, teenagers can also experience this type of anxiety.

For younger children, they may not be able to identify the specific worry and instead, may not want to participate in particular activities. Teenagers may describe that they have the feeling that something “bad” is going to happen to them.  Teenagers with separation anxiety can experience symptoms of anxiety when adjusting to a change, transition or a stressful situation. Some examples of the behaviours that can be exhibited are:

  • Not feeling comfortable using public transportation alone
  • Discomfort in an environment without a trusted caregiver
  • Not wanting to participate in social events without the presence of a trusted caregiver

Specific Anxiety Disorder

Specific Anxiety Disorder is an intense fear of an object or situation. Fear is expected in childhood, adolescence and even into adulthood; however, when these feelings of fear become worse over time and more severe this can turn into what is known as a phobia. A phobia can also be further described as extreme anxiety over something that is not causing immediate danger. An example of a phobia is a fear of dogs, spiders, or heights. Reassurance that everything is going to be okay does not decrease the fear that a child or youth may feel about a specific object or situation. This phobia can make it difficult to participate in certain activities, to attend school, and to be around other children.

Generalized Anxiety Disorder (GAD)

Signs of Generalized Anxiety Disorder will usually begin to present around adolescence. GAD is experienced as uncontrollable and excessive worries with day to day living. This could affect activities like school, sports or health, as well as impact home life, school and relationships with peers. Children and youth with GAD have the same worries as other children and youth; however, they worry more frequently than the average person and cannot stop their worry once it has started. For a child or youth to have a diagnosis of GAD, they need to have excessive worry for approximately 6 months.

Obsessive-Compulsive Disorder (OCD)

A diagnosis of OCD involves a combination of frequent obsessions and compulsions. OCD can develop in early childhood or early adolescence. Obsessions are unwanted thoughts, doubts or urges that constantly repeat in the mind. Compulsions occur when an individual experiences an intense perceived need to perform a behaviour or “ritual”.  Acting out these behaviours reduces the anxiety created by the obsessive thoughts. For example, an overwhelming and debilitating fear of germs (obsession), can be reduced by constant and repetitive hand washing (compulsion). Many children and youth have particular rituals or behaviours when it comes to doing certain things. However, when these rituals or behaviours impact quality of life and daily living then this could be a sign of OCD.

Post-Traumatic Stress Disorder (PTSD)

PTSD develops after a child or youth has experienced an extremely stressful and traumatic event. Symptoms that develop after the experience of this traumatic event involve flashbacks, re-experiencing the trauma/stress, or avoidance of people, places, or things that remind them of the event. It is normal for a child or youth to have feelings of anxiety after a traumatic event however, if this anxiety does not decrease over time after the trauma it may be a sign of PTSD. Chronic abuse is an example of a form of trauma that can cause PTSD and symptoms look different for infants, children and youth.

Social Anxiety Disorder

Social Anxiety Disorder usually develops around adolescence. Children and youth with Social Anxiety Disorder will have excessive anxiety in social/public situations. An example of this is a fear of embarrassment from public speaking or talking to strangers. They excessively worry about embarrassing or humiliating themselves, and what others will think of them. Social Anxiety Disorder can develop after a particular event or situation, or progress over a period of time. For children and youth social anxiety can be about one particular thing or of a variety of social situations.

Panic Disorder

A panic disorder can start when a child or youth begins to experience panic attacks. Panic attacks are sudden intense feelings of anxiety. A child or youth will experience a number of mental, physical and behavioural symptoms that can be very overwhelming. They then begin to worry about future attacks and the impact that the attacks may have on them. It is important to be aware that not all people who experience panic attacks will develop a panic disorder. Children and youth who have unexpected, frequent attacks followed by at least one month of worry about having another panic attack may have a Panic Disorder. This can be as a result of genetics, childhood experiences and other current life stressors.

Agoraphobia

Agoraphobia is a fear of wide open and crowded spaces, it can also occur in enclosed spaces. Agoraphobia is not a panic attack and while it can occur in association with them, it does not cause it. For children and youth with agoraphobia it can be extremely difficult to leave the house. For example, going to a mall or fair with many people can be very difficult. These individuals will feel helpless, trapped and perceive that they have no control over the situation. This fear is caused by the feeling that there is no access to a place they perceive as safe. They can exhibit any or all physical, mental or behavioural symptoms that accompany other anxiety disorders. 

How is an Anxiety Disorder Diagnosed? 

Every anxiety disorder has a certain set of criteria that is used for a diagnosis. Children and youth with symptoms of an anxiety disorder will have constant worry, avoid particular situations or places, constantly seek reassurance and have signs of anxiousness (physical, mental and behavioural). These symptoms interfere with daily living and an ability to complete day to day tasks.

If you suspect your child or youth has an anxiety disorder it is important to be aware of their family medical information because there is a biological connection. Many children with anxiety often have family members who also live with anxiety issues. Additionally, recognize that there is a combination of factors that result in an anxiety diagnosis. Some individuals are prone to a diagnosis because of their childhood environment, experiences and their sensitivity to situations that can cause feelings of unease. Children and youth who have experienced trauma or attachment needs in their life often learn to be very aware and to perceive risk in all situations.

Sometimes symptoms of anxiety go away on their own; however, with anxiety disorders, the symptoms become chronic and worsen over time. Consulting with a professional, such as a psychologist, family doctor, or pediatrician, will support your child or youth in managing their symptoms of anxiety, and identify specific tools and treatments to support them.

Sometimes anxiety is misdiagnosed as ADD or ADHD if an extensive history and assessment is not completed by the clinician.

Supporting a child or youth with an Anxiety Disorder

There are a number of treatments available for children and youth living with an anxiety disorder. Treatments can include therapy, counseling, medication, or a combination of the two.  

Cognitive-Behavioural Therapy (CBT) is an effective form of therapy for children and youth living with an anxiety disorder. CBT is a treatment that can allow the child or youth to address negative thoughts, and gain control by learning techniques to replace them with positive thoughts.

Exposure therapy is another treatment used for anxiety disorder. This treatment consists of a gradual exposure to the fear or phobia that the child or youth is experiencing.  They are then taught techniques in order to relax until the fear or phobia can be tolerated or even diminish completely.

There are also many treatments that focus on triggers of anxiety; some of these treatments include relaxation training, meditation, and stress management to help with anxiety disorders.

Medications, such as antidepressants or benzodiazepines, can also be used to treat anxiety disorders. These are prescribed by a doctor or psychiatrist.

Support group programs, and counseling for your child or youth, as well as your family, can be useful to support individuals living with an anxiety disorder.

Parenting a Child with an Anxiety Disorder

As a parent, you play an important role in supporting and helping your child or youth. There are many techniques and tools that can be used to help your child or teen manage their anxiety. Every anxiety disorder is different and has various methods and strategies to helping your child; however, there are general strategies that you can use at home and implement in your day to day activities to support your child or youth.

Tips and tools:

  1. Learning about Anxiety- When your child or youth has a diagnosis of an anxiety disorder take the time to learn as much as you can about symptoms, different types of anxiety disorders and treatments. This will help you to understand and also support your child or youth throughout their daily lives.
  2. Encouraging their treatment plan- Supporting and sticking to a treatment plan is very important, even if the child or youth is feeling well.
  3. Self-care and minimizing stress- Reducing stress and tension in the home is imperative. Stress and tension in the home can have a negative effect on your child or youth. Take the time to care for yourself and look for ways to reduce stress within the home. Explore different ways to resolve conflict when it arises, and be aware of how you express your frustration and anger. Taking time each day to relax with your family and have “fun time” is very important.
  4. Relaxation Techniques- Learning strategies to help your child or youth relax is very useful. Techniques such as calm breathing and muscle relaxation can help to reduce anxiety.
  5. Routines- Routines can significantly help reduce anxiety for your child or youth. Setting structure that works for your child or youth can be a great support to helping them manage their anxiety. Routines such as homework, bedtime (plenty of sleep is especially important), mealtime etc.  
  6. Talking about fears and worries- Talking to your child or youth about their anxiety is very helpful. Help them to understand their anxiety and worries by exploring their perceptions with realistic thinking. Offering reassurance and helping to change some of their thoughts can help reduce symptoms of anxiety.
  7. Encourage Exercise- Physical activity can help reduce anxiety. Exercise will increase energy and reduce worry. Consider going on walks, swimming or doing any type of physical activity with your child or youth.
  8. Nutrition- Many children and youth with an anxiety disorder may not feel hungry, can forget to eat or have upset stomachs. Encourage healthy eating in the home and family meal times as much as possible.
  9. Break goals up into small attainable tasks to help your child or youth feel less overwhelmed. Offer positive feedback with each goal attained.

Help for Parents

When dealing with children who have anxiety or mental health issue, parents need to ensure they get help for themselves so they are able to continually support their child or youth. Some options include counselling, self-care and family support agencies.

Anxiety disorders are manageable, treatable, and eventually decrease over time. Listening, support, education, and especially, normalizing anxiety is helpful to children and youth living with an anxiety disorder. 

Helpful Links and Resources for Anxiety Disorders

ADAC/ACTA Anxiety in Children and Adolescents Brochure - http://anxietycanada.ca/english/pdf/childrenEn.pdf

AnxietyBC for Parents - http://www.anxietybc.com/parent/index.php

Anxiety Disorders Association of Canada- http://www.anxietycanada.ca/english/index.php

Canadian Mental Health Association- http://www.cmha.ca/get-involved/find-your-cmha/

Mood Disorders Association of Ontario- http://www.mooddisorders.ca

Teen Mental Health- http://teenmentalhealth.org/learn/mental-disorders/

The Psychology Foundation of Canada- http://www.psychologyfoundation.org/index.php/programs/kids-have-stress-too/school-age/

R. Rapee, S. Spence, V. Cobham & A. Wignall, Helping Your Anxious Child: A Step-By-Step Guide for Parents, New Harbinger Press (2000).

S. W. Garber, Monsters under the bed and other childhood fears: Helping your child overcome anxieties, fears and phobias, (n.p) (1993).

Manassis, K. Keys to parenting your anxious child, Barron’s Educational Series (1996).

Content References

Anxiety Diosrders in Children and Adolescents (n.d) Retrieved from- http://anxietycanada.ca/english/pdf/childrenEn.pdf

Anxiety BC (n.d) Retrieved from- http://www.anxietybc.com/

Anxiety Disorders An Information Guide , Rector N.A., Bourdeau, D.,   Kitchen, K.,  Joseph-Massiah, L. Library and Archives Canada Cataloguing in Publication. (2009) Retrieved from- http://www.camh.ca/en/education/about/camh_publications/Pages/Anxiety_Disorders_Infoguide.aspx

Mood Disorders Association of Ontario (n.d) Retrieved from- http://www.mooddisorders.ca

Leanne Needham- Mood Disorders Association of Ontario. Personal Communication March 2015

Maryann Shaw- Sick Kids Hospital. Personal Communication May 2015