Childhood Anxiety

Childhood Anxiety

According to William T. Goldman, M.D, “Anxiety Disorders are the number one health problem in America, ranging from a simple Adjustment Disorder to more difficult and debilitating disorders, such as Panic Disorder and Posttraumatic stress disorder. The lifetime prevalence of adult anxiety is twenty-five percent (Goldman). While anxiety disorders in children are becoming more common, many go unseen or misdiagnosed. It’s important to find out who is at risk, what the causes are and what can be done for treatment.

The Webster’s Dictionary defines anxiety as, “a state of being anxious, and concern” (New Expanded, 1988). Fears and anxieties in children are a normal part of growing up. It is instilled in people from birth as a reaction to loud noises and aversion to strangers. These are normal stages that help children adapt to the world they live in. Distressing, persistent anxiety or maladaptive behavior characterizes anxiety disorders (Franzoi, 2007). In Dr. Paul Foxman’s book, The Worried Child, it states that, “The Surgeon General’s office, the Department of Health and Human Services, and the Substance Abuse and Mental Health Services Administration (SAMSA) have all reported a crisis in the mental health needs of our children and adolescents” (Foxman, 2004). SAMSA indicates that one in five American children and adolescents have a mental health problem. If one in five children had pneumonia; we would consider it an epidemic. Federal dollars need to be allocated to manage this crisis (Foxman, 2004).

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A variety of causes can bring on anxiety. Psychological anxiety results when a combination of stresses overwhelms a person’s ability to cope. Studies show that genetics can also be responsible for the onset, when at least one relative has a diagnosed anxiety disorder. Biological anxiety is the imbalance of noradrenergic and serotonergic neural systems. This is an abnormal function in the brain. Medical illnesses, such as cardiovascular disease, valve prolapsed, lung disease, etc, can bring on anxiety (Goldman). There are a variety of anxiety disorders that affect children: Overanxious Disorder (Generalized Anxiety Disorder), Panic Disorder, Obsessive-Compulsive Disorder, Posttraumatic Stress Disorder, Separation Anxiety Disorder,

Avoidant Disorder, Phobic Disorder and Anxiety associated with medical conditions.

All of these disorders, except Separation Anxiety Disorder, can be found in adults and children (Foxman, 2004).

Overanxious Disorder, also known as Generalized Anxiety Disorder, is excessive worry, apprehension and anxiety that occurs most days and lasts for a period of six months or more. It is worry over a number of activities and events. There is no clear object or situation that causes the anxiety. Instead the anxiety is “free-floating”.

Overanxious disorder occurs in about 5% of the general population, usually associated with other anxiety disorders or depression. It occurs twice as often in women as men, and more often in people over the age of 24 (Franzoi, 2007). Children that suffer from overanxious disorder are nervous, seek reassurance from others and often avoid performance-based activities because they are easily slighted and are highly sensitive to criticism. They often complain of headaches and stomachaches during periods of

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anxiety. Teachers may be unaware of the child suffering from the disorder because such children are usually well behaved and cooperative (Foxman, 2004). The Diagnostic and Statistical Manual of Mental Disorders, also referred to as the DSM, the American handbook for mental health professionals lists categories of mental health disorders and the criteria for diagnosing them. The DSM criteria for diagnosing overanxious disorder is (at least 4 of 7 must be met):

1.) Unrealistic worry about future events

2.) Preoccupation with the appropriateness of the individual’s behavior in the past.

3.) Over concern about the competence in a variety of areas (e.g., academic, athletic, and social).

4.) Excessive need for reassurance about a variety of worries.

5.) Somatic complaints, such as headaches or stomachaches, for which physical basis can be established.

6.) Marked self-consciousness or susceptibility to embarrassment or humiliation.

7.) Marked feelings of tension or inability to relax (Klein & Last, 1989, p. 30).

Panic disorders are characterized by recurrent, unexpected panic attacks with inter-episode worry about having other attacks. Panic attacks are 10-30 minute episodes of heart palpitations, sweating, trembling or shaking, shortness of breath, chest discomfort or pain, nausea, feelings of unreality or unattached from one’s self, fear of losing control or going crazy, fear of dying, tingling sensations, chills or hot flashes (Goldman).

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The DSM criteria for Panic disorders with or without agoraphobia are:

1.) Recurrent unexpected panic attacks

2.) At least one of the attacks has been followed by 1 month (or more) of one (or more) of the following:

a.) persistent concern about having additional attacks

b.) worry about the implications of the attack or its consequences (e.g., losing control, having a heart attack, “going crazy”)

c.) significant change in behavior related to the attacks

3.) The presence (or absence) of agoraphobia

4.) The panic attacks are not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a general medical condition (e.g., hyperthyroidism).

5.) The panic attacks are not better accounted for by another mental disorder, such as social phobia (e.g., occurring on exposure to feared social situations), specific phobia (e.g., on exposure to dirt in someone with an obsession about contamination), posttraumatic stress disorder (e.g., in response