I recently had to submit an informal research paper on a special needs topic. I chose anxiety disorder, and I was surprised to find out how prevalent it is in children. This is the bulk of the information…
Some anxiety is a normal part of life, even for children. However some people, including young children, suffer from an anxiety disorder to the point where they avoid people, places, and activities. Anxiety disorders affect 18% of adults and one in every 8 children. Recently a trend has been noted of mentally ill people turning up in jails and homeless shelters. Researchers are reporting that parents and teachers can potentially alter the path of anxiety and related disorders in young at-risk children.
There are several categories of anxiety disorder in children. The most common anxiety disorders are separation anxiety disorder (beyond what is developmentally appropriate), generalized anxiety disorder, and social phobia. Separation anxiety is the most common anxiety disorder in children. It is a deep fear that something bad is going to happen to the child or a family member. The child may get headaches, stomach aches, or diarrhea when separated. With generalized anxiety disorder, children worry about multiple areas of their life, including the future, school, family, natural disasters, etc. Social phobia causes children to be very uncomfortable talking out loud and become “socially mute.” These disorders often make children want to hurt themselves because they feel hopeless. In one research study of eleven year olds, 3.5% had separation anxiety disorder, 2.9% had generalized anxiety disorder, and 1% had social phobia. Another study of 7-11 year old children found 15.4% of combined diagnosis.
Anxiety may be the result of nature or nurture. It may be nature as typically at least one of the parents is found to have anxiety disorder. In one study of mothers with anxiety disorder and their preschool children, 80% of their preschool children were determined to be insecurely attached. Out of twenty total children, three preschool children met criteria for anxiety disorder. 65% were classified as behaviorally inhibited. Anxiety may be the result of nurture due to the effects of negative or over controlling parenting, demographic area, and stressful situations. Some beginning symptoms can show around as young as 6 months old. Nature cannot be prevented, but nurture can be. It is important for educators to be aware of anxiety symptoms in students and respond appropriately.
Some studies have shown that young children with anxiety disorders grow up to have anxiety disorders and are at an increased risk of later depression, drug dependence, eating disorders, self-harming disorders, and educational underachievement. For example, one study followed children who were diagnosed with anxiety in first grade. They found that anxiety in first grade significantly predicted anxiety in fifth grade. Also, those fifth grade children who had been followed in the study tested lower in achievement test scores than their peers.
The most common anxiety symptoms include extreme concern about competence, excessive need for reassurance, fear of the dark, fear of harm to an attachment figure, and somatic (medical) complaints. A student with anxiety disorder may show severe separation anxiety, lower grades or test scores, or they may show trouble adjusting to changes and new situations. Sometimes students are absent more often than others, usually claiming to be ill. Sometimes students may be the ‘quiet one’ and receive less attention. Some students may suffer from depression also. They may cry often, seem sad, or just seem less ‘happy’ than the other students. Some children may not feel that they are important to anyone. Others may have irritability, anger, or hostility issues or have difficulty with relationships.
Depending on the type of anxiety disorder, students may have intense feelings of fear, panic, or unease. They may have uncontrollable thoughts that have become obsessive about normal or abnormal things. They may have frequent thoughts about traumatic experiences. They may display certain behaviors often or repeat them often with a specific ritual. They may have problems sleeping or have nightmares. They may have feelings of being suffocated, shortness of breath, nausea, or dizziness. They may lack the ability to stay calm. They may have muscle tension and will often feel uneasy.
Diagnosis and treatment can be difficult. Often pediatricians lack specific training to correctly diagnose or treat children who are depressed or anxious. A recent government report showed that there are only about 7500 psychiatrists currently treating children and adolescents, yet an estimated 5 million children are affected. Also, mental health care is expensive and often requires out-of-pocket costs as it is typically not covered by insurance. Unfortunately, there is also social stigma attached to getting mental health care which stops a lot of people from seeking help. If professional help is obtained, intervention is multi-faceted. Professional treatments include cognitive-behavioral therapy, relaxation training, role playing and modeling how to handle stress, bibliotherapy, group therapy, and medications. Often parents are worried about the side effects of medicine; however there it is important to note the side effect to not taking medications is that the child may remain unwell.
There are community resources available for children, parents, and teachers. The Anxiety and Stress Disorders Institute of Maryland in Towson accepts patients and has a wealth of information on the web. Their website is anxietyandstress.com. They have examples of what can be said, such as “you can do it, no matter how you feel” and “face the fear and it will disappear.” There are Panic and Anxiety Support Groups in our area that can be found doing a simple web search. One meets in Baltimore the first and third Wednesday of each month at 6:30 pm at the Church of the Redeemer on North Charles Street. It provides screening of anxiety disorders and provides support.
Teachers can be aware and help students with anxiety disorder. Children with anxiety disorder can feel alienated and set apart from their peers. Often they may be in an abusive or neglectful situation or they may just be in a high-pressured, over-scheduled, stressful situation. As educators, we need to be careful that we are not unintentionally adding to that by seeming to expect perfection. We also can be alert to the students’ behaviors. We should not try to diminish a person’s feelings, but try to be patient and willing to listen when the student has something to say. A student with social phobia will be afraid to talk to or in front of others, so we should not call on the student if they don’t raise their hand. We can reduce stress by utilizing small group discussions rather than large group discussions. We should try to model positive self-talk, and choose materials that incorporate positive messages about overcoming fears. We can encourage participation through one on one peer interaction. We can set up a ‘safe spot’ for the student to go if they need to be alone. We should respect the student by not talking about their struggles in front of others. We ideally should collaborate with the parents, other teachers, and professionals to come up with a plan based on the students’ individual needs to make a difference in the child’s future mental health.
Gail A. Bernstein, MD; Carrie M. Borchardt, MD; Amy R. Perwien, BA.
Anxiety Disorders in Children and Adolescents A Review of the Past 10 Years.
Retrieved from www.peace4minds.com/uploads/Anxiety_Disorders_in_Children_and_Adolescents.doc.
How to Help Children Under 10 Cope with Anxiety. Retrieved from
CUCARD, The Columbia University Clinic for Anxiety and Related Disorders. Separation Anxiety Disorder. Retrieved from http://www.anxietytreatmentnyc.org/separation.html.
Medscape. Pediatric Generalized Anxiety Disorder. Retrieved from
WebMD Anxiety and Panic Disorders Health Center. Retrieved from
Anxiety and Depression Association of America. Childhood Anxiety Disorders. Retrieved from