Children may have different anxiety disorders that deserve attention and appropriate treatment
By Miguel Angelo Boarati, Child and Adolescent Psychiatrist *
Fear and anxiety are normal and even necessary human reactions, as they are part of a body mechanism to identify possible threat situations. There is a complex process, which involves brain and hormonal functions, and allows a quick reaction, which can lead to fight or flight behavior when faced with a situation of real and imminent danger. An anxiety disorder, on the other hand, is a pathological reaction of fear in the face of a danger that is not real or does not have the magnitude interpreted by the person.
It is no different with children. They tend to be naturally more fearful than teenagers and are especially afraid of simple things, like getting away from their parents and talking to strangers.
Early in our life, given our high degree of vulnerability, dependence and immaturity, experiencing reactions of fear and anxiety is much more frequent than when we become adults – and, as we develop a more realistic understanding of the world and the real ones dangers, we come to fear only situations of real risk.
When to worry about anxiety in children?
To understand when fear is characteristic of an anxiety disorder in children, it is necessary to consider the age group it is in, its duration and the associated losses and suffering. A child in the age group of five to six who cannot get away from their parents in any way, for example, may have a disorder called Separation Anxiety.
This is an expected situation in a two-year-old child, but in an older child, who is about to enter school, it is not appropriate. This disorder appears in older children, being less present in adolescents and adults, but when it reaches older ages it usually continues with other complications, such as depression, relationship problems, self-esteem and school difficulties.
Another anxiety disorder that can occur in children is Generalized Anxiety Disorder (TAG) which is characterized by fear and excessive concern about different situations and contexts, such as a fight between parents, bad grades, illnesses etc.
Children who suffer from GAD are usually tense, distressed and cannot relax. They are also very perfectionist and sensitive to criticism and rejection. They may have low self-esteem and a chronic feeling of being incapable, in addition to being very likely to have depressive conditions.
There is also social phobia which is an exaggerated fear of situations of social exposure and which differs from shyness by the intensity in which it occurs, causing paralysis and avoidance of any and all possibilities of exposure. These children have great suffering since there is a desire to make friends and socialize, but they feel unable to face this situation.
Approximately 15% of children and adolescents have some type of anxiety disorder that would require specialized treatment. The causes of childhood anxiety are several, ranging from genetic factors, child temperament and environmental factors.
The parents’ behavior is very decisive, both in the occurrence of anxiety disorders and in the intensity of symptoms. Anxious, rigid, perfectionist, and highly charged parents can generate insecurities and fears in children who can progress to an anxiety disorder.
How to treat childhood anxiety?
The first point is to know how to differentiate children’s fears and anxieties from an anxiety disorder, which would require specialized treatment. If the child does not socialize, does not go to school or has strong emotional reactions whenever he needs to be exposed to a situation he fears, we may suspect an anxiety disorder. Psychological treatment of the child, together with parental guidance, is the main therapeutic approach.
Unlike adults, children do not respond adequately to drug treatments and there is no level of scientific evidence to validate the use of the class of antidepressants or benzodiazepines in these cases. On the other hand, it is possible that parents need to be referred for psychological and psychiatric treatment if they have anxiety levels that justify their child’s disorder.
Often anxiety disorders in children can be confused with pampering or tantruming behavior, because every time the child is faced with an anxiogenic situation he may try to avoid, cry or refuse to do what he needs. It is important to make this differentiation, since exposing a child to a phobic situation or that generates anxiety in an abrupt way can cause more suffering and worsening of the condition.
That is why it is important to seek specialized care with psychiatrists and child and adolescent psychologists who can clarify and adequately address the situation.
* Miguel Angelo Boarati is a Child and Adolescent Psychiatrist and a doctor at the ALICE Community, an individual health plan.