Anxiety Disorders & Trauma Clinic

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.