Mild anxiety is normal for children, as it is for adults; stress and anxiety are part of most people's lives, and can even contribute to productivity and motivation. However, in some children anxiety can become elevated to a degree where it can impair how a child functions. When anxiety impairs function to a significant degree over a significant period of time, it is called an anxiety disorder. There are multiple anxiety disorders that can impact children; those listed below are the most common disorders that can impact children.
- Obsessive-Compulsive Disorder (OCD): OCD is characterized by unwanted and intrusive thoughts (obsessions) and feeling compelled to repeatedly perform rituals and routines (compulsions) to try and ease anxiety. Most children with OCD are diagnosed around age 10, although the disorder is usually present to some degree in infancy.
- Generalized Anxiety Disorder (GAD): GAD is characterized by worrying excessively about a variety of things such as grades, family issues, relationships with peers, and performance in sports. Children with GAD tend to be very hard on themselves and strive for perfection. They may also seek constant approval or reassurance from others.
- Panic Disorder: Panic disorder is indicated when your child suffers at least two unexpected panic or anxiety attacks, followed by at least one month of concern over having another attack, losing control, or "going crazy." Panic attacks can occur at any time (including in the middle of the night), do not normally have a reason or cause, and can include shortness of breath, fear of medical problems such as heart attack, crying, screaming, hiding, shaking, refusal or inability to talk, or freezing in place.
- Posttraumatic Stress Disorder (PTSD): Children with posttraumatic stress disorder, or PTSD, may have intense fear and anxiety, become emotionally numb or easily irritable, or avoid places, people, or activities after experiencing or witnessing a traumatic or life-threatening event. Not every child who experiences or hears about a traumatic event will develop PTSD. It is normal to be fearful, sad, or apprehensive after such events, and many children will recover from these feelings in a short time. Children most at risk for PTSD are those who directly witnessed a traumatic event, who suffered directly (such as injury or the death of a parent), had mental health problems before the event, and who lack a strong support network. Violence at home also increases a child’s risk of developing PTSD after a traumatic event.
- Separation Anxiety Disorder: This disorder is most common in children ages 7-9, and affects approximately 4% of children. Separation anxiety in children under the age of 3, or when children are first being left at day care or school, is considered normal. If your child is older than 3 and is unable to leave you or another family member, and takes much longer to calm down after you leave than other children, then the problem could be separation anxiety disorder. When separation anxiety disorder occurs, a child experiences excessive anxiety away from home or when separated from parents or caregivers. Extreme homesickness and feelings of misery about not being with loved ones are common. Other symptoms include refusing to go to school, camp, or a sleepover, and demanding that someone stay with them at bedtime. Children with separation anxiety commonly worry about bad things happening to their parents or caregivers or may have a vague sense of something terrible occurring while they are apart.
- Social Anxiety Disorder: Social anxiety disorder, or social phobia, is characterized by an intense fear of social and performance situations and activities such as being called on in class or starting a conversation with a peer. This can significantly impair your child’s school performance and attendance, as well as his or her ability to socialize with peers and develop and maintain relationships.
- Selective Mutism: This disorder is characterized by refusal to speak in situations where talking is expected or necessary, to the extent that their refusal interferes with school and making friends. Children suffering from selective mutism may stand motionless and expressionless, turn their heads, chew or twirl hair, avoid eye contact, or withdraw into a corner to avoid talking. These children can be very talkative and display normal behaviors at home or in another place where they feel comfortable. Parents are sometimes surprised to learn from a teacher that their child refuses to speak at school. The average age of diagnosis is between 4 and 8 years old, or around the time a child enters school. This disorder is frequently co-morbid with speech impediment and/or learning disability.
- Specific Phobias: A specific phobia is characterized by an intense, irrational fear of a specific object, such as a dog, or a situation, such as flying. Common childhood phobias include animals, insects, storms, heights, water, blood, the dark, and medical procedures. Children will avoid situations or things that they fear, or endure them with anxious feelings, which can manifest as crying, tantrums, clinging, avoidance, headaches, and stomachaches. Unlike adults, they do not usually recognize that their fear is irrational.
An anxiety disorder can be more difficult to recognize in children than adults, and many children live with unidentified or misdiagnosed anxiety disorders. Although difficult to identify in children, it is important to remember that an anxiety disorder is a serious mental illness. For children with anxiety disorders, worry and fear are constant and overwhelming, and this can be severely damaging to academic, social, and emotional development. Many therapies and treatments are available to address anxiety in children, including medical intervention.