Understanding And Dealing With Anxiety Disorders (6 to 12 years old)

Revised: January 17, 2007

Feelings of anxiety and fear are the most common symptoms of psychiatric/psychological problems. There are more than 100 common terms used to describe various anxiety conditions and behaviors.

Anxiety and fear mean essentially the same thing. They are each defined as a collection of three types of reactions to a situation or object:

(1) motor reactions such as avoidance, trembling, or white knuckles,

(2) subjective reactions such as thoughts of danger, images of monsters, or verbal report of discomfort, distress, or terror, and

(3) physiological reactions such as heart palpitations, profuse sweating, or rapid breathing.

Less than 8% of all children will develop an anxiety disorder. Research has documented a large number of fears and anxieties which affect children. A single child may have as many as 4 to 6 fears. Under normal circumstances, the actual number of fears and anxieties that children have do not appear to change with age. As a child begins to adapt, their fear of a given situation or object will diminish. While the number of feared situation or objects may stay the same, the actual object or situation will change with age. The fears and anxieties of children also vary with sex and socioeconomic status.

Children who have parents with anxiety disorders are more likely to have anxiety disorders. Mothers and siblings have a significant impact on anxiety and fear reactions that children acquire or experience. Children of mothers who are overprotective and restrictive tend to be anxiety prone. There is some evidence of a genetic factor link to anxiety proneness. Some stimuli are more biologically predisposed to becoming feared objects. Respondent conditioning is involved in the acquisition of fears and anxieties and instrumental conditioning is involved in their maintenance. Medical and health related problems are also related to symptoms of anxiety disorders.

Feeling anxious or fearful can be a normal reaction to a real danger. Temporary fears are necessary for a child to recognize a challenging situation and gain a sense of accomplishment and mastery. To understand what constitutes excessive or unreasonable you must consider the maturity of the child and the feared situation or object. Several hundred situations and categories of objects have been identified which can evoke an anxiety or fear response.

Once A Fear Or Anxiety Response Has Been Elicited, The Response Tendency Can Be Maintained In A Number Of Ways.  A Few Of These Are:

  • Self-talk or "automatic" thoughts (e.g. I can't handle new situations. All dogs want to bite me.)
  • Avoidant behavior (e.g. A child steps on a dogs tail and is bitten by the dog. The child is then afraid of all dogs and avoids them. The child avoids talking about their fear.)
  • Inappropriate response to fearful child(e.g. The child’s parents begin to ridicule him for feeling afraid instead of rewarding the child’s effort and courage.)

Symptoms and Behaviors Associated With Anxiety

  • Excessive or unreasonable fears
  • Recurrent memories and feelings about a traumatic event
  • Persistent avoidance of a feared situation, object or situation associated with a previous trauma
  • Physiological reactivity associated with feared situations, objects or previous trauma
  • Recurrent or persistent ideas, thoughts, impulses or images that are initially experienced as intrusive or senseless
  • Repetitive, purposeful and intentional behavior designed to minimize discomfort or prevent some feared event. The behavior is excessive or not connected to the situation or feared object.

There Are Roughly 11 Diagnostic Categories Associated With Anxiety Disorders.

  • Separation Anxiety Disorder. Anxiety is the result of separation from a significant figure or person (usually a parent).
  • Avoidant Disorder. The feared situation is social contact with others.
  • Overanxious Disorder. Persistent anxiety which is not linked to an identifiable situation.
  • Generalized Anxiety Disorder. Unrealistic or excessive anxiety or worry about two or more life circumstances.
  • Agoraphobia Without History Of Panic Disorder. Fear and anxiety associated with being alone or in a public place from which escape or aide might be difficult.
  • Panic Disorder. Unexpected and immediate episodes of intense fear which are not linked to any specific situation.
  • Panic Disorder with Agoraphobia. Same as a panic disorder but also an intense fear of situations in which escape or aide might be difficult.
  • Obsessive Compulsive Disorder. Anxiety is related to recurrent obsessive thoughts, images, or impulses. Symptoms may also be tied to compulsive behavior in the form of regimented, rigid or useless behavior that is excessive or unreasonable.
  • Post-Traumatic Stress Disorder. Anxiety is related to a catastrophic event and is repeatedly relived symbolically through play, dreams, or flashbacks.
  • Social Phobia. Fear associated with being scrutinized by others or appearing foolish.
  • Simple Phobia.  A fear/anxiety response to any object or situation not mentioned in any of the other diagnostic categories.

Common Treatment Approaches

A large number of treatment strategies have been developed for the treatment of anxiety related disorders. Some of these are:

  • Prolonged Exposure. The child is encouraged to confront the feared situation or object using real or imagined versions in conjunction with other supportive aides such as relaxation, hypnosis or biofeedback.
  • Modeling. Children observe another person interacting with the feared situation or object. Adaptive responding is demonstrated with guided instruction, support, and feedback.
  • Contingency Management. External events that follow the child's fear/anxiety reactions are manipulated using rewards for successful interaction and bolder steps. Rewards are rescinded for refusing to interact.
  • Self-Management. Subjective and physiological reactions are altered or changed by teaching a child adaptive ways of appraising an upcoming situation, adaptive ways of thinking, and deep muscle relaxation techniques.

The are numerous anti-anxiety medications that are routinely used with adults and rarely with children. Benzodiazapenes are the largest class of drugs and are referred to as sedative-hypnotics. Sedative-tranquilizers are used in some cases but less frequently. Each of these drug categories are moderately to highly addictive and are effective in reducing or eliminating symptoms. They do not cure the disorder. While there a number of medications used with children, their side effects and the effectiveness of psychosocial treatment approaches limit their use.

In general, anxiety disorders are very responsive to psychotherapy. Panic disorder is one of the most responsive.  Effective therapy must include evaluation of the patient's entire biological, psychological, social and cultural background.  Medications can be helpful, but the side effects of these medications and the potential for addiction with some medications must be considered. Psychotherapy can be a very effective alternative to the use of medications. In most cases, there must be changes in the patient’s environment and social support system for treatment of a patient to be successful. Families of people with anxiety disorders often fail to see how they reinforce the disorder. They are often resistant to change despite expressed dedication of support and a desire to do whatever is necessary. Embarrassing or punishing a person will only make the disorder worse. There are effective and ineffective therapies. While some professionals prefer to emphasize that psychotherapy is effective, it is worth recognizing that effective therapies can be used incorrectly by well intended therapists.   Competence, commitment as well as outstanding interpersonal qualities in a therapist are crucial for treatment to be successful.

Psychotherapy requires a significant commitment of time where as treatment of anxiety and panic disorders with medication requires less effort. Since normal anxiety can improve over time without therapy, a brief period of medication can relieve symptoms, restore functioning and does not necessarily require life long or long term reliance on medications. However, the impact of these potent medications on the developing brains of children can be damaging and can result in a dependence on that medication to manage anxiety. Psychotherapy is almost always the first treatment of choice except in cases where anxiety or panic is so severe that immediate relief is necessary to restore functioning and to prevent immediate and severe consequences. Medication is the second choice after a comprehensive and competent trial of psychotherapy. Combined use of medications and psychotherapy at the onset of treatment can confuse evaluation of treatment effectiveness. It is harder in a combined medication and therapy approach to tell which approach is or is not helping and how much it is helping.  A trial of inadequate and incompetent psychotherapy can make future efforts more difficult and can leave a young adult feeling resigned, helpless and hopeless.

There are some problems and symptoms that usually get worse without treatment. Some problems and symptoms may seem to go away initially but will eventually resurface months or years later.  Positive treatment outcomes are primarily dependent on a correct diagnosis, understanding of the etiology, and an appropriate intervention by the family or a psychotherapist.   Intensive interventions are often necessary when symptoms become persistent.   Available treatment procedures are extensive. Psychotherapy, or the psychotherapist, can generally be considered ineffective if a trial of 3 months has not produced a measurable and noticeable improvement. A decision to change therapists or to start a medication may be necessary at this point. Several trials of psychotherapy or medications may be necessary to successfully treat anxiety or panic disorders. The prognosis for cure of anxiety related disorders in children can be excellent when there is appropriate treatment.