Different Presentations of Anxiety in Children
By Emily Habelrih (@theplayfulpsychologist)
Anxiety is the most common mental health condition that affects an individual’s ability to concentrate, sleep, and carry out basic daily tasks. Anxiety affects 1 in 10 children and is the most common type of mental health condition in both children and adults. Often, children who seem angry, defiant, or oppositional are severely anxious, and can be misdiagnosed as their presentation differs greatly from how anxiety presents itself in adults. In children, age appropriate ‘fears’ are often mislabelled as anxiety. Fear itself is a natural emotion that helps us survive, cope with difficulties, and manage challenging situations. The key difference between fear and anxiety is that we often feel fear in regards to a real threat or danger. Anxiety however is commonly a response to an imagined threat or danger. Anxiety becomes a concern for children when it begins to impact their everyday life: from difficulty maintaining friendships, to lack of engagement in social activities, and behavioural problems such as avoidance/difficulty separating. Anxiety in youth has a variety of causes, including:
- Parental mental health concerns
- Emotional regulation difficulties
- Friendship and peer difficulties
- Low self-esteem
- Social modelling from caregivers
- Being the victim of bullying
- Traumatic experiences
- The need for social acceptance
- Academic difficulties
- Academic pressure
Anxiety is not often caused by one of these factors, and is usually a combination of several different factors. Furthermore, there is a common misconception that ‘anxiety’ is an umbrella term that covers all different types of worries, which is in fact false. There is also another common misconception that children can’t experience certain types of anxiety because they are ‘too young.’ Again, false! Anxiety is completely dependent on experience, and unfortunately, children are often exposed to situations/events that are age inappropriate, leading to a variety of anxiety-related disorders. Let’s go through the most common anxiety presentations:
Generalised Anxiety Disorder (GAD)
GAD is when children experience multiple non-specific fears. Their fear is not focused on one specific object, situation or event. Children with GAD appear to worry about almost everything and anything. This may even include a fear of worrying about worrying.
Separation Anxiety Disorder
Separation anxiety disorder is classified as a fear of being separated from a parent or attachment figure. Children who experience separation anxiety often display clingy behaviour and/or refusal to go to school/pre-school. Although somewhat age appropriate in early periods of separation, children with separation anxiety are not able to regulate their emotions long after their caregiver has left. An example of this is, one child might cry and have a small meltdown when his mother drops him at school. He may even cry for 10-15 minutes after she has left, however he is eventually able to regulate his emotions and be redirected by his teacher. A child with separation anxiety disorder however, might cry for hours on end, and may be completely unable to concentrate on any task or engage in any activity until they see their parent/caregiver again at home time.
Social Anxiety Disorder
Social anxiety relates to a fear of being negatively evaluated by others, or of embarrassing oneself in front of other people. Social anxiety has an impact on social functioning and social skills may potentially have further impacts in later life (e.g., obtaining employment).
Post-Traumatic Stress Disorder (PTSD)
PTSD occurs after the experience of a traumatic event. Trauma is usually perceived as life threatening to the child or others. It includes recurring fearful thoughts and memories after the traumatic event has occurred. Children who experience PTSD often try to avoid situations or events that remind them of the traumatic event. Often, PTSD can lead to GAD or separation anxiety disorder.
Specific Phobia’s are a fear about a particular object, event or situation (e.g., fear of spiders, injections, heights, rollercoasters, small spaces). It often includes the overestimation of the likelihood that the particular object will cause harm. Specific phobia’s differ to GAD in that the anxiety is confined to one or two specific things.
Obsessive Compulsive Disorder (OCD)
OCD is commonly known for repetitive or compulsive behaviours (e.g., turning a light switch on and off multiple times before leaving a room). These behaviours are often triggered by intrusive, repetitive and obsessive thoughts that harm will occur if a particular behaviour is not performed correctly.
Panic disorder relates to a fear of unexpected panic attacks. Panic attacks include intense and extreme bouts of anxiety which occur in short isolated periods. Attacks mainly consist of uncontrollable physical symptoms such as heart palpitations and rapid breathing. The difference between a panic attack and panic disorder is that, a panic attack is a single episode of anxiety. Contrastingly, panic disorder is the fear of future panic attacks.
Anxiety disorders can be treated in a variety of ways. If you believe your child might be experiencing anxiety, it is best to consult a child psychologist, who can assist with both assessment of the child’s anxiety and therapy to assist with management of the anxiety.