Childhood Anxiety
Fears and anxiety are normal and natural emotions
Fear and anxiety are normal and expected feelings experienced by all
people of all ages. People may feel afraid or anxious when faced with a
difficult or challenging situation. It is unrealistic to expect to
live life “anxiety-free”. Anxiety and fear are not emotions that need
to be “cured”. Instead, anxiety and fear are emotions that children and
youth need to learn to manage and control effectively.
Normal developmental fears
Normal children can have a surprisingly large number of fears. Fears
emerge and develop at different stages of a child’s development. Put
another way, the focus of children’s fears changes as they grow up.
Girls tend to report a greater number of fears than boys. The content
of fears changes from concerns about concrete and external things to
more abstract and internal things. This means that children and young
people are more vulnerable to different kinds of fear and anxiety at
different stages in their development. Most children
experience certain fears at some time in their lives. What may differ
is the age at which children experience particular fears and the amount
of fear that shows up when it does. What may be regarded as an
“age-appropriate” fear at an earlier stage of development may be viewed
as less appropriate when the child is older. A child will normally
“grow through” these fears as they go through developmental stages and
master developmental challenges. Thus, a specific treatment plan may be
unnecessary. Some examples of common fears that may show up at particular stages, are given below:
- Infants commonly fear strangers, loud or unexpected noises and excessive sensory stimulation
- Fear of separation from parents, caretakers and other attachment figures shows up in various ways at a number of ages.
- At around age 3, common fears include animals, masks and being alone.
- At around age 4, fears of the dark, noises and animals are common.
- At around age 5-6, predominant fears include robbers,
kidnappers, “bad” people and supernatural creatures such as ghosts and
monsters; fears of animals and the dark are common
- At around age 6, common fears include sleeping alone and thunder and lightning
- At around age 7-8 years, common fears include
supernatural creatures such as ghosts and monsters found in films and
books, major events such as bombings, kidnappings and war, staying
alone and physical injury.
- By ages 9-12, common fears include school tests,
speaking or answering questions in class, school performance, physical
appearance, negative evaluation by others (they may be more
self-conscious and try to “fit in”), bullying/teasing and peer
rejection.
- By age 13-18, common fears include failure,
school performance, social alienation, embarrassment and humiliation,
serious illness, injury and death and human-made or natural disasters.
Clinical Fears: When do fears and anxiety become a problem? When
anxiety goes significantly beyond the norm, it may be called
“clinically significant”. Since fear and anxiety are normal emotions, a
key question is: “What differentiates normal fear and anxiety
reactions from a clinical phobia or anxiety disorder?”
In many
ways, clinical fears can be thought of as normal fears that have “gone
too far”. That is, they are more extreme, intense and wide-ranging.
As a rule of thumb, fear and anxiety in childhood and adolescence become a problem when:
- They lead the child or young person to be excessively upset or emotionally distressed
- The fear reaction is out of proportion to the actual demands, or realistic level of danger, in the situation
- The content of the fear is focused on what “objectively” may be regarded relatively safe situations or stimuli
- The fear cannot be reasoned away with appropriate reassurance-giving or information-giving
- They interfere with day-to-day
functioning for an extended period of time;
clinical fears and anxiety may “muck
things up” for the young person in one
or more important situations or
environments For example, at home,
at school or with friends
- The child does not learn to cope with or master
the fear despite repeated exposure to the situation or stimulus that
sets it off (when this might reasonably be expected)
- Fear and anxiety stop the child from doing the things that they like or want to do
- The fear or anxiety reaction leads to escape or avoidance of situations the child may reasonably be expected to face
- The fear and anxiety reaction persists for a
period of time that is excessive. For example, the reaction may last
for days or hours rather than seconds or minutes; the reaction may
persist for months or years rather than days or weeks
- The fear is “out of stage”, meaning that it occurs at an unexpected stage of development
- The fear and anxiety reaction is intrusive and beyond the child’s voluntary control
- The child tends to “make
mountains out of molehills” to a level
that causes difficulties
Are anxiety problems common in children and adolescents? Yes.
Anxiety disorders are the most prevalent form of mental health
problems experienced by children and adolescents. Anxiety disorders are
found in 8-12 percent of children in the general community. Put
another way, this means that up to one in approximately 10 children
meets formal diagnostic criteria for an “anxiety disorder”. Some
anxiety-related difficulties are more common at particular ages. For
example, Separation Anxiety Disorder (excessive fear of separating from
primary caregivers, home or other familiar surroundings) is generally
considered to be more common in childhood. In contrast, during
adolescence, there is an increase in the prevalence of Generalised
Anxiety Disorder, Panic Disorder and Social Phobia, which is often
preceded by childhood shyness. Another childhood difficulty, Selective
Mutism, is grouped with problems that are first diagnosed in childhood
or adolescence. It involves the persistent and consistent unwillingness
to speak in social situations when speech is expected - such as
kindergarten or school - despite speaking in other situations.
Course of anxiety disorders: What happens over time? Many
anxiety problems in adulthood have their origins in childhood or
adolescence. Once upon a time, the thinking of many parents and
professionals was along the lines that children will simply “grow out
of it”. Anxiety can be a “passing problem” for some young people.
However, professionals now recognize that excessive anxiety in
childhood, if left untreated, is likely to persist and may lead to
long-term consequences. Short-term consequences might include emotional
distress, tension and squabbles within the family, reduced school
attendance or performance, unpopularity or difficulty interacting with
peers and over-dependence on adults in social situations. Longer-term
effects might include lower self-esteem, an avoidant style of
problem-solving and coping, family conflict, educational
underachievement, under-employment, increased medical utilization,
substance abuse, impaired peer or sibling relationships, or other
serious mental health problems in adolescence or adulthood, such as
depression. Anxiety disorders represent one of the most significant
health problems in terms of burden of disease.
Are effective treatments available? Yes. Over the last 1-2 decades, there have been major advances in our understanding of anxiety disorders.
- Prevalence
- How anxiety disorders develop and what causes them,
- Factors which maintain anxiety disorders and keep them going.
- How anxiety disorders can be treated in children and adolescents.
Like many other childhood difficulties, treatments for childhood
anxiety have lagged behind treatments for adults. However, this is
changing quickly. There have been significant advances in the
development of evidence-based, scientifically validated treatments for
children and young people. There are now well-researched brief
psychological treatments that are highly effective.
When should I seek assistance? If
you have concerns that your child may have clinical fears, or is
at-risk of developing them, then seeking a professional opinion from a
Clinical Psychologist may be warranted. At the Anxiety Disorders and
Trauma Clinic, we have highly trained and experienced Clinical
Psychologists who specialize in working with young children, school-age
children and adolescents.
|