Anxiety disorders differ from normal anxiety. Anxiety is a healthy and important emotion that everyone has, to alert them to danger so that they can take effective steps to avoid or escape from the danger. Anxiety disorders, on the other hand, occur when people have excessive and persistent fears and worries about things or situations that do not pose real danger. While every day stress-induced anxiety is usually brief and easily managed, persistent anxiety can last for months and impact on daily functioning. For young children, this includes school refusal, absenteeism and reduced class participation, which impacts on learning, academic achievement, ability to make friends and maintain relationships, and developing independence in a variety of domains. Many anxiety disorders develop during childhood and if left untreated tend to continue into adolescence and adulthood. Anxiety disorders include separation anxiety disorder, selective mutism, phobias, social anxiety disorder, agoraphobia, and generalised anxiety disorder.
Anxiety symptoms will vary across the different anxiety disorders in terms of the types of situations or things that are feared. The symptoms typically last for at least 6 months but this duration may be shorter for very young children (e.g., approximately one month for separation anxiety and two months for selective mutism). In very young children, associated features may include tantrums where a child shows anger and aggression in response to the anxiety (i.e., the ‘fight’ aspect of ‘fight or flight’). Other associated features include withdrawal, sadness, difficulties concentrating on work or play, and frequent reassurance-seeking.
Separation anxiety disorder:
Social anxiety disorder:
Generalised anxiety disorder:
There are multiple factors that contribute to the development of an anxiety disorder. This makes it difficult to prevent them from happening or predicting who may develop one. It is natural for children to avoid things or situations that make them feel anxious. However, by doing so they “learn” that the way to get rid of their anxiety is to avoid, which then results in more avoidance. It is also normal for children with problematic anxiety to often rely on their parents for help to avoid the things and situations that they fear or worry about. Parents may accommodate their child’s anxiety by deliberately doing or not doing something to reduce their child’s anxiety. For example, a parent may speak on behalf of their child with selective mutism or social anxiety, or not send their child with separation anxiety to school. This pattern of behaviour of feeling scared, turning to a parent, and then feeling the relief of avoidance can turn into a vicious cycle that strengthens the anxiety and leads to an anxiety disorder. It is usually challenging to control a child’s anxious behaviours, thus it may be easier and more effective for parents to change and control their own behaviour first.
These are some strategies that parents can use to help their children manage anxiety before it turns into a disorder:
There are multiple causes and risk factors for developing an anxiety disorder. Genetics, environmental factors (e.g., life stressors), and temperament (e.g., negative affect, behavioural inhibition) can account for the development of anxiety disorders.
The diagnosis of an anxiety disorder is usually made by a clinician such as a psychologist or medical doctor. Tools such as structured interviews, questionnaires, behavioural observations and interactions are often used to aid in the diagnosis of an anxiety disorder.
Research has identified interventions that are effective in reducing anxiety and managing anxiety disorders. These interventions usually focus on addressing the thoughts and behaviours behind the anxiety. Strategies typically focus on helping individuals face the feared object or situation instead of avoiding or escaping them. Parent-based intervention is also available for very young children with an anxiety disorder who are not able to participate effectively in direct intervention due to their reduced language and cognitive abilities.
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