This article is reprinted from the website of the National Mental Health Services Knowledge Exchange Network (KEN) from the Substance Abuse and Mental Health Services Administration's Center for Mental Health Services.

Anxiety Disorders in Children and Adolescents

This is one of a series of fact sheets on the mental, emotional, and behavior disorders that can appear in childhood or adolescence. The Center for Mental Health Services extends appreciation to the National Institute of Mental Health for contributing to the preparation of this fact sheet. Any questions or comments about its contents may be directed to the CMHS National Mental Health Services Knowledge Exchange Network (KEN)--see contact information below.

What Are Anxiety Disorders?

Young people with an anxiety disorder typically are so afraid, worried, or uneasy that they cannot function normally. Anxiety disorders can be long-lasting and interfere greatly with a child's life. If not treated early, anxiety disorders can lead to:

• missed school days or an inability to finish school;
• impaired relations with peers;
• low self-esteem;
• alcohol or other drug use;
• problems adjusting to work situations; and
• anxiety disorder in adulthood.

What Are the Signs of Anxiety Disorder?

There are a number of different anxiety disorders that affect children and adolescents. Several are described below.

Generalized Anxiety Disorder. Children and adolescents with this disorder experience extreme, unrealistic worry that does not seem to be related to any recent event. Typically, these young people are very self-conscious, feel tense, have a strong need for reassurance, and complain about stomachaches or other discomforts that don't appear to have any physical basis.

Phobias. A phobia is an unrealistic and excessive fear of some situation or object. Some phobias, called specific phobias, center on animals, storms, water, heights, or situations, such as being in an enclosed space. Children and adolescents with social phobias are terrified of being criticized or judged harshly by others. Because young people with phobias will try to avoid the objects and situations that they fear, the disorder can greatly restrict their lives.

Panic Disorder. Panic disorder is marked by repeated panic attacks without apparent cause. Panic attacks are periods of intense fear accompanied by pounding heartbeat, sweating, dizziness, nausea, or a feeling of imminent death. The experience is so scary that the young person lives in dread of another attack. He or she may go to great lengths to avoid any situation that seems likely to bring on a panic attack. A child with panic disorder may not want to go to school or be separated from his or her parents.

Obsessive-Compulsive Disorder. A child with obsessive-compulsive disorder becomes trapped in a pattern of repetitive thoughts and behaviors. Even though the child may agree that the thoughts or behaviors appear senseless and distressing, the repetitions are very hard to stop. The compulsive behaviors may include repeated hand washing, counting, or arranging and rearranging objects.

Post-Traumatic Stress Disorder. Post-traumatic stress disorder can develop in children or adolescents after they experience a very stressful event. Such events may include physical or sexual abuse; being a victim of or witnessing violence; or being caught in a disaster, such as a bombing or hurricane. Young people with post-traumatic stress disorder experience the event again and again in strong memories, flashbacks, or troublesome thoughts. As a result, the young person may try to avoid anything associated with the trauma. They may also overreact when startled or have difficulty sleeping.

How Common Are Anxiety Disorders?

Anxiety disorders are among the most common mental, emotional, and behavior problems that occur during childhood and adolescence. As many as 1 in 10 young people may have an anxiety disorder (*2). Among adolescents, more girls than boys are affected. About half of the children and adolescents with anxiety disorders also have a second anxiety disorder or other mental or behavioral disorder, such as depression.

Who Is at Risk?

Researchers have found that a person's basic temperament may play a role in some childhood and adolescent anxiety disorders. For example, some young people tend to be very shy and restrained in unfamiliar situations. This may be a sign that the child or adolescent is at risk for developing an anxiety disorder.

Researchers also suggest watching for signs of anxiety disorders when children are between the ages of 6 and 8. At this age, children grow less afraid of the dark and imaginary creatures and more anxious about school performance and social relationships. High levels of anxiety in a child aged 6 to 8, therefore, may be a warning sign that the child may develop anxiety disorder later. A child's fears may change as a child ages, which complicates research.

Studies suggest that children or adolescents are more likely to have an anxiety disorder if their parents have anxiety disorders. However, the studies do not prove whether the disorders are caused by biology, environment, or both. More studies are needed to clarify whether or not anxiety disorders can be inherited. The Federal Government's National Institute of Mental Health, a part of the National Institutes of Health, is pursuing a wide range of studies on anxiety disorders in children, adolescents, and adults (*2).

What Help Is Available for a Young Person With an Anxiety Disorder?

Children and adolescents with anxiety disorders can benefit from a variety of treatments and services. After an accurate diagnosis, possible treatments include:

• cognitive-behavioral treatment (where young people learn to deal with fears by modifying the way they think and behave);
• other individual therapy;
• family therapy;
• parent training; and
• medication.

While cognitive-behavioral approaches are effective in treating some anxiety disorders, medications work well with others. Some anxiety disorders benefit from a combination of these treatments. In general, more studies are needed to find which treatments work best for the various types of anxiety disorders.

A child or adolescent in need of treatment or services and his or her family may need a plan of care based on the severity and duration of symptoms. Optimally, this plan is developed with the family, service providers, and a service coordinator, who is referred to as a case manager. Whenever possible, the child or adolescent is involved in decisions.

Tying together all the various supports and services in a plan of care for a particular child and family is commonly referred to as a "system of care." A system of care is designed to improve the child's ability to function in all areas of life--at home, at school, and in the community. For a fact sheet on systems of care, call 1.800.789.2647.

What Can Parents Do?

If parents or other caregivers notice repeated symptoms of an anxiety disorder in a child or adolescent, they should:

• Talk with the child's doctor. The doctor can help determine whether the symptoms are caused by an anxiety disorder or by some other condition. Then, if needed, the doctor can refer the family to a mental health professional.
• Look for a mental health professional who has training and experience:
  • working with children and adolescents;
  • using cognitive-behavioral or behavior therapy; and
  • prescribing medications for this disorder or, if appropriate,cooperating with a physician who prescribes medications.

The mental health professional should be willing to work closely with the parents as well as with the child or adolescent and his or her school.

• Get accurate information from libraries, hotlines, or other sources.
• Ask questions about treatments and services.
• Talk to other families in the community.
• Find family network organizations.

It is important for people who are not satisfied with the mental health care they are receiving to discuss their concerns with the provider, to ask for information, and/or to seek help from other sources.

*1 Prevalence of serious emotional disturbance in children and adolescents. Mental Health, United States, 1996. Center for Mental Health Services, Substance Abuse and Mental Health Services Administration, U.S. Department of Health and Human Services, 1996.

*2 This estimate provides only a rough gauge of the prevalence rates (number of existing cases in a defined time period) for these disorders. The National Institute of Mental Health is currently engaged in a nationwide study to determine with greater accuracy the prevalence of mental disorders among children and adolescents. This information is needed to increase understanding of mental health problems and to improve the treatments and services that help young people who are affected by these conditions.

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