Anxiety Disorders in Children and Adolescents

Anxiety disorders are common; about 1 in 4 Americans will have an anxiety disorder at some point in their lives. Anxiety disorders are mental health problems that are often seen in children and adolescents; the average age when anxiety symptoms start is 11 years. Approximately 5% to 13% of children younger than 18 years have an anxiety disorder.

There are several types of anxiety disorders. A few examples and common symptoms include:

• Generalized anxiety disorder: children's symptoms include severe and uncontrollable worry about multiple parts of their lives; these may include things like being on time, doing well on tests, or keeping friendships. The more areas in which a child shows serious worries, the more likely it is that the child has generalized anxiety disorder.

• Social anxiety disorder: children's symptoms may include acting shy and, in severe cases, the child may refuse to speak to people they do not know well (especially adults). Symptoms may also include being very worried about social situations or being worried about how other people view them. Children with social anxiety disorder may try to avoid such situations, which may lead to missing school.

• Panic disorder: children with panic disorder may have sudden onset of symptoms including racing heart, sweating, shaking, trouble breathing, and feeling like something terrible is going to happen.

• Somatic symptoms: somatic symptoms are physical symptoms that can occur with anxiety disorders. These types of symptoms are common and can include chest pain, racing heart, difficulty breathing, dizziness, nausea, abdominal pain, and headaches.

Many children who have a chronic illness such as asthma also have an anxiety disorder. Common medical conditions associated with anxiety disorders include migraine headaches, abdominal problems, asthma, and seasonal allergies. Having both a chronic medical illness and an anxiety disorder can make both illnesses more serious.

Anxiety disorders can lead to school problems including missing school, refusing to go to school, doing poorly on tests and assignments, and getting lower grades. Untreated anxiety disorders can lead to adult mental health disorders such as depression and substance use disorders.

Many children have worries and fears that may present at certain ages or developmental stages. This is normal. Anxiety disorders are more severe and persistent and lead to problems with daily functioning.

Anxiety disorders are treatable. If you are concerned that your child or adolescent may have an anxiety disorder, see your pediatrician. Mild anxiety disorders are often treated with education and by encouraging the child to return to regular activities gradually. Some children and adolescents will be helped by a referral to a counselor or psychiatrist for additional tests or treatments. Treatments can include medication or behavioral treatments such as cognitive behavioral therapy to learn skills to overcome anxiety.

To find this and other Advice for Patients articles, go to the Advice for Patients link on the Archives of Pediatrics & Adolescent Medicine Web site at http://www.archpediatrics.com.

Source: This article was based on a larger review article that appeared in this month's Archives (Ramsawh HJ, Chavira DA, Stein MB. Burden of anxiety disorders in pediatric medical settings: prevalence, phenomenology, and a research agenda. Arch Pediatr Adolesc Med. 2010;164[10]:965-972).

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