By Paul Jeffery, Clinical Psychologist, Private Clinics Australia. Tel 9485 2955
All of us experience a degree of anxiety nearly every day of our lives. Growing up, children
experience a range of developmentally appropriate fears (fears of loud noises,strangers, the
dark, monsters, intruders, fear of failure etc). For most, these fears are transient and respond well to
positive experiences, reassurance and maturity as the child grows. It is now well recognised, however,
that approximately 10% of children and adolescents will develop a diagnosable anxiety disorder by
the age of 20, making it the most prevalent mental health problem across this age range.
The experience of excessive anxiety for children and adolescents can involve:
.Rapid and persistent physiological arousal (i.e. tachycardia,sweating,shakiness, stomach upset,
dizziness).
.Increased vigilance about the feared object, worry, negative self-perceptions, and perception of the
self as unable to cope.
.Behavioural responses such as avoidance, reassurance seeking, oppositionality.
What causes an anxiety disorder?
Vulnerability to excessive anxiety can be inherited, however environmental factors also play a
significant role in the development and maintenance of anxiety. With the exception of cases of abuse
and neglect, parents are not the cause of anxiety problems in children. Factors, however,such as
parental anxiety, reactions to stress, promotion of child independence and ways of coping can influence
children’s sense of competence and ability to cope.
Child anxiety disorders
There are a range of anxiety disorders with which children can present.
.Separation Anxiety Disorder (marked fear of separation from caregivers)
.Generalised Anxiety (excessive anxiety about everyday concerns)
.Specific Phobias (e.g. fears of dogs,storms, heights)
.Social Phobia (fear of negative evaluation from others)
.Panic Disorder (fear of anxiety itself)
KEY POINTS
*Anxiety is the most prevalent mental health problem in children and adolescents.
*Nature and nurture can contribute to child anxiety problems.
*Anxiety involves physiological arousal, changes in thinking, and changes in behaviour.
*Symptoms vary depending on the disorder.
*Anxiety can be hard to detect, with behavioural symptoms most easily identified.
*Sources of genuine stress should be assessed and dealt with if possible.
*Psychological treatments, particularly CBT, can be very effective for child anxiety.
*Obsessive Compulsive Disorder (e.g. fears of contamination or responsibility for danger
that leads to ritualised checking, washing, ordering etc)
The anxiety disorders most commonly seen in children include Separation Anxiety, Generalised
Anxiety, and Specific Phobias.
In adolescence, Social Phobia and Panic Disorder can become more prevalent (along with GAD
and Specific Phobia).
Obsessive Compulsive Disorder and Post Traumatic Stress Disorder can occur across the
developmental range, however their prevalence is lower than the other disorders.
Anxiety disorders can be associated with other mental health, family, peer relationship, physical
health and learning problems, and are one of the biggest risk factors for development of
depression later in adolescence.
Presentation and assessment of anxiety
Anxiety is an internal experience. Due to their limited emotional and cognitive development,
younger children can find it difficult to describe what they are afraid of. For many teenagers, anxiety
can be an embarrassing, isolating experience. Adults can also interpret the behavioural symptoms of
anxiety as a child being naughty, difficult or lazy. The net result is that it can be difficult to accurately
detect and help a young person deal with anxiety.
Some potential indicators include:
.Behavioural inhibition (patterns of avoidance of certain people and situations).
.Excessive reassurance seeking,that can be verbal (questions about what to expect in future), and /or
physical (hugs,seeking physical proximity).
.Strong emotional reactions to certain situations (sometimes fear, but also anger and crying).
.Behavioural problems,such as oppositionality and non-compliance.
.Somatic complaints (stomach ache, headache).
.School refusal (avoidance of school, not including truancy).
If an anxiety problem is suspected or identified, it is also crucial to assess whether the child is
facing any particular stressors at home, with peers or at school. Anxiety problems in children
can often ameliorate if the source of stress is removed.
Anxiety treatment
Australian trials indicate that over 80% of children participating in Cognitive Behavioural
Therapy for anxiety show clinically significant improvement, which persists over several years.
The involvement of parents in treatment programs is also crucial, particularly for primary
school-age children. In more severe or complex cases, a psychiatric assessment and intervention may
be required in conjunction with a physchological approach. Cognitive Behaviour Therapy for children
typically involves psychoeducation about anxiety, recognising signs and symptoms of anxiety,
followed by gradual exposure to the feared situation. In addition, children learn to turn around anxiety
provoking thoughts,plan a range of options for relaxing, learn problem solving, identify support
people they can trust, and reward themselves for effort in tackling the anxiety. Parents play crucial
roles in helping children to systematically face their fears, and supporting their child’s competence
through encouragement and reward. Following school holidays,school refusal can become a problem.
In more severe cases, a joint approach between parents,the school,and the practitioner is sometimes
required to help. Generally, once the source of the anxiety is properly identified, parents might need
coaching and support on how to manage the drop-out at school,the child might need help in coping
with their fear, while schools need to work with parents in managing the child’s initial transition
to the school yard.
Who can help?
Private clinical psychologists/psychiatrists
School psychologists
CAMHS c linics
University mental health clinics
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