Every child experiences anxiety on occasion, but healthy children are fairly relaxed most of the time. So children who routinely experience fear and nervousness or demonstrate shyness may be suffering from an anxiety disorder. It is crucial that parents understand the warning signs of social anxiety in children and respond appropriately—which may require seeking medical assistance — rather than assuming that reticence is just a stage. That can be the case and separation anxiety, in particular, is fairly common. But it isn’t always so it’s important that parents be honest in their assessment of the issue.
Childhood mental health problems are surprisingly common. The Child Mind Institute estimates that 49.5 percent of American youth will be diagnosed with a mental health illness before age 18. Anxiety disorders are, by far, the most common and account for about half of these psychiatric conditions. Studies suggest up to 80 percent of children with anxiety disorders are not receiving treatment. Part of the problem may be the tender age at which anxiety first manifests. Unlike ADHD and mood disorders, conditions that usually show up in the early teen years, the median age of onset for anxiety disorders in children is a mere six years old.
Childhood anxiety disorders comprise a family of psychiatric conditions, and impact children’s lives in different ways. Generalized Anxiety Disorder, one of the most difficult to diagnose, is characterized by excessive worry about grades, family issues, relationships with peers, or performance in sports. It can be difficult to distinguish GAD from perfectionism, or simple conscientiousness but, as with most psychiatric disorders, the diagnosis comes down to a question of quality of life. If a child is suffering from the drive to succeed, GAD is a possibility.
More specifically, children may suffer from panic disorders (at least two unexpected panic or anxiety attacks, followed by at least one month of concern over having another attack), separation anxiety disorder (when a child is unable to leave a family member), and social anxiety disorder (intense fear of being called on in class, or starting a conversation with a peer). In extreme cases, children with anxiety disorders may suffer from selective mutism and intense phobias. Obsessive-compulsive disorder and posttraumatic stress disorder, while not traditionally considered anxiety disorders, are often associated with the more extreme cases.
Cognitive behavioral therapy is the preferred treatment method for anxiety disorders, because it is not particularly invasive and, in children, has particularly high rates of success. Therapy usually involves identifying and interrogating unhealthy patterns of thinking, and teaching children strategies to conjure more positive thoughts and feelings in their stead. If therapy is ineffective, or a child has a particularly severe case of anxiety, prescription medications (usually selective serotonin reuptake inhibitors, or SSRIs) are an option. Studies suggest that therapy and antidepressants, together, can be more effective than either treatment in isolation.
Awareness is the key to protecting your children, and ensuring that those who are suffering actually get help. “Parents should not dismiss their child’s fears,” according to a statement from the American Academy of Child Adolescent Psychiatry. “Because anxious children may also be quiet, compliant, and eager to please, their difficulties may be missed. Parents should be alert to the signs of severe anxiety so they can intervene early to prevent complications.”