ANXIETY IN CHILDREN: SYMPTOMS, TYPES, CAUSES AND TREATMENTS - ARTE - 2025

The anxiety in children is the appearance of an intense feeling of discomfort without an objective reason to justify it, accompanied by feelings of apprehension and repetitive thoughts.

It is one of the psychological alterations that occur most frequently during childhood. Recent studies have shown that the prevalence rates of this type of psychological problems in children would be between 9 and 21%.

Characteristics of anxiety in children

Cognitive and somatic symptoms

Anxiety responses include both cognitive symptoms (referring to thinking) and somatic symptoms (referring to the body), which express an over-activation of the brain's autonomic system.

In children, the manifestations of anxiety will be different depending on the stage of development in which they are.

Younger children

Younger children often present shrill behaviors, excessive activity, a wake-up call, difficulties in moments of separation and affective disturbances when going to sleep.

In these cases, many times a poor evaluation of anxiety symptoms can lead to misdiagnoses such as attention deficit disorder with or without hyperactivity (ADHD) or oppositional defiant disorder.

Older children

For their part, older children (adolescents and pre-adolescents) have a greater capacity to describe their subjective experiences, and are capable of experiencing certain symptoms such as fear, nervousness, tension or anger, as well as showing certain inappropriate behaviors or antisocial.

The environment is important

In addition, in childhood anxiety, the environment in which the child develops and, therefore, the context in which he expresses his symptoms is of special importance.

While these factors may go unnoticed in adults, an environment that negatively influences a child's anxiety responses can cause developmental problems.

If a child expresses his anxiety symptoms in a supportive environment in which parents or caregivers are able to employ strategies that help the child manage his nervous state, the child will be able to successfully manage his anxiety states.

However, if the child develops in an environment in which he is blamed for his symptoms or forced to confront them, when he still does not have the personal resources necessary to do so, his development may be greatly compromised.

Types of anxiety disorders in childhood

Diagnostic manuals in psychopathology do not yet present a detailed classification of anxiety disorders that can present in childhood.

This fact is explained by the fact that the majority of anxiety disorders that appear during childhood do not usually last during adulthood, since the emotional alterations that children present tend to be less clearly differentiated than those that adults present.

However, in the same way that adults do, children can also experience and suffer from anxiety symptoms and disorders. In fact, the prevalence of these disorders during childhood can reach 21%.

On the other hand, if a child experiences anxiety frequently, the chances that they will suffer from an anxiety disorder in adulthood increase.

Below we will discuss the 7 anxiety disorders that occur most frequently and that are most relevant in children.

Separation anxiety disorder

According to some studies, this is the most prevalent anxiety disorder during childhood. Separation anxiety consists of experiencing excessive feelings of anxiety when the child has to separate from their parents or caregivers.

The dislike of being separated from their parents is usually a common phenomenon among children, so it is considered a normal response during the first months of life.

However, from 3-4 years of age, the child already has the cognitive capacity to understand that separating from their parents does not mean losing them forever, so the experience of excessive anxiety in separation from these ages configures a psychological alteration.

More specifically, children with separation anxiety disorder often experience the following symptoms when they distance themselves from their parents:

• Excessive worry or discomfort when parting.
• Irrational fear of losing parents or something bad happening to them.
• Resistance to going places without their parents.
• Resistance to being alone.
• Having repeated nightmares about abductions, accidents, or loss of their parents.
• Somatic symptoms: abdominal pain, vomiting, nausea, palpitations, shaking or dizziness.

Social hypersensitivity disorder in childhood

The main characteristic of this disorder is the tendency to experience feelings of extreme anxiety when interacting or meeting strangers.

Although contact with strangers is usually a not very pleasant situation for most children, in childhood social hypersensitivity disorder the child experiences abnormally high levels of anxiety when this situation is encountered.

Likewise, the anxiety that he experiences in these situations systematically leads him to avoid contact with strangers and significantly interferes with his social life.

Thus, social hypersensitivity disorder would not be defined by shyness or the absence of predisposition to interact with strangers, but in experiencing a state in which they are totally dazed and governed by their feelings of anxiety when the child is exposed to these situations.

This disorder usually appears at the beginning of schooling and is often combined with a high desire to have personal relationships with family and friends, showing many behaviors of affection and attachment towards these people.

Phobic anxiety disorder

As specified in the ICD-10 diagnostic manual, phobic anxiety disorder constitutes a specific psychopathology of childhood.

Fears are a manifestation that is considered normal during childhood. For example, many children may experience fears or anxieties during sleep or at bedtime.

Likewise, during these situations in which children manifest fears and fears, they may suffer perceptual illusions. For example, errors of recognition of a real stimulus, when perceiving the coat hanging behind the door of the room as a monster in low light.

However, these fears are considered normal and do not constitute an anxiety disorder.

We speak of phobias when irrational fears in certain situations and objects are accompanied by an avoidance of the stimulus that causes fear, causes a lot of anxiety and interferes with the child's daily functioning.

These types of phobias include fears of animals, lightning, the dark, flying, going to the doctor or closed spaces.

School avoidance disorder

In this disorder, the child experiences an irrational fear of school, which is produced by a systematic avoidance of these situations and, therefore, a total or partial absenteeism to class.

Normally the onset of this disorder is usually gradual, the child does not begin to avoid school completely at once. Likewise, it usually affects children between 11 and 14 years old, although it can already be seen in much younger children.

In general, the lack of attendance at school due to fear and dislike of these situations is usually a sufficient indication to consider the possibility that the child is suffering from an anxiety disorder and refer him to mental health services.

Social phobia

Social phobia usually occurs in adolescents and is characterized by experiencing excessive anxiety related to the possibility of saying something or acting in a certain way that can be humiliating or embarrassing.

In this way, the adolescent begins to avoid doing any activity in front of other people due to the excessive anxiety that they present in those situations and the fear they have of being embarrassed in front of others.

Actions such as speaking, eating, writing, going to parties or speaking to authority figures are often greatly feared to such an extent that the person is unable to perform them.

Generalized anxiety disorder

Generalized anxiety is characterized by excessive nervousness and anxiety, extreme and uncontrolled worrying thoughts that occur most of the day, for several weeks.

The concerns tend to revolve around a large number of aspects and are often accompanied by physical symptoms such as rapid heartbeat, sweating, dry mouth, tremors, etc.

Likewise, anxiety occurs in a generalized and constant way, and is not restricted to a particular situation. Generalized anxiety tends to appear more in adults but children can also suffer from it.

Panic disorder

Finally, panic disorder consists of witnessing anxiety attacks in a recurring and unexpected way.

These crises are based on episodes of extreme fear that start suddenly and cause symptoms such as fear of dying or losing control, palpitations, a feeling of suffocation, excessive sweating, tremors, dizziness, nausea and other physical signs of anxiety.

This disorder could be very relevant among children. Recent studies show that up to 16% of young people between 12 and 17 years old could suffer some episode of this type.

Causes of anxiety in children

Anxiety problems are explained today from the causal model of stress vulnerability. According to this model, children who suffer from this type of psychological alterations would present a series of predisposing or risk factors for suffering from an anxiety disorder.

However, the disorder would not manifest itself until the appearance of an environmental factor that would trigger the presentation of anxiety.

The factors that may be involved with childhood anxiety disorders would be:

• Genetic and constitutional factors.
• Temperament and character of the child.
• Educational and caring style on the part of parents.
• Stressful life events.
• Unfavorable social environment.

Treatment

The treatment of anxiety usually encompasses both psychosocial and psychopharmacological interventions. However, in children, drugs are usually used only in very serious cases that need some stabilization before starting psychotherapy.

In general, psychotherapy treatments usually include:

Treatment to decrease the physiological response

• Relaxation exercises
• Dramatization exercises.
• Increase in child-friendly activities.

Improve the affective response of the child.

• Increased self-confidence.
• Increased self-esteem.
• Intervention in possible affective problems.

Cognitive treatment

• Change the cognitive style of considering the situation as something threatening.
• Establish a connection between anxiety and thinking in an understandable way for the child.
• Psychoeducate the child in such a way that he is able to attribute his emotions to himself and not to the environment or external agents so that he sees that he is the one who creates his own feelings.
• Change sentences from "this situation makes me nervous" to "I make myself nervous in this situation."
• To provoke feelings of anxiety in a natural situation to make fearful thoughts and their relationship with emotions aware.

Improve the behavior that the child avoids

• Exposing the child to feared situations to be able to work on their anxiety in real contexts.
• Teach the child to control his anxiety by exposing him to feared situations.
• Train the child in specific coping strategies for the feared situation.
• Develop self-observation of antecedents, behavior and thoughts through behavior records in feared situations.

Psychoeducation of the child's parents

• Teach parents how to respond to the child's anxiety.
• Teach them not to damage the child's self-esteem due to their anxiety problems.
• Teach them not to accept the child's anxious thoughts as valid.
• Teach them to offer calm and quiet spaces to the child.

References

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3. Graham P, Turk J, Verhulst F. Development and developmental psychopathology. In: Graham P, Turk J, Verhulst F (eds.) Child Psychiatry. A developmental approach. 3rd ed. New York: Oxford University Press; 1999.p.172-266.
4. Ruiz Sancho A. Precursors of personality disorders in childhood and adolescence. Presentation in the annual course of the Adolescent Unit. Madrid: Hospital General Universitario Gregorio Marañón; 2005.
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