About six per cent of Canadian children and youth experience an anxiety disorder at some point in their lives, making anxiety disorders the most common illness to affect younger age groups, the Canadian Mental Health Association (CMAH) says.
In fact, CMAH reports that about 50 per cent to 70 per cent of mental illnesses will develop before the age of 18.
But knowing the signs and symptoms of childhood anxiety may be difficult for parents to spot, and knowing what to expect and do next may not always seem clear.
“Anxiety is a normal behaviour in children as it is in adults,” Dr. Stacey Belanger, pediatrician in developmental medicine at Saint-Justine Hospital in Montreal and member of the Canadian Paediatric Society (CPS), says. “I think what the parents need to be able to distinguish is between what we call ‘normal development fears,’ which looks like anxiety in children and teenagers versus an anxiety disorder. So anytime we look at something that’s normal and developmental, it’s something that is usually short-term as opposed to something that’s more of an anxiety disorder which is typically more chronic, tends to be more invasive and pervasive and often interferes with daily function.”
So how can parents differentiate between the two?
Signs and symptoms
There are several types of anxiety disorders, according to Belanger. They include phobias, panic disorders, generalized anxiety disorders, social anxiety, selective mutism, separation anxiety and agoraphobia – the fear of places and/or situations that cause panic and feelings of being trapped, helpless or embarrassed, the Mayo Clinic outlines.
And while each type of disorder can come with its own unique set of symptoms, there are general signs that may help parents point to a possible anxiety disorder in their children. According to the Centre for Addiction and Mental Health (CAMH), some signs and symptoms include:
- Irrational and excessive fear
- Apprehensive and tense feelings
- Difficulty in managing daily tasks and/or feels distress when doing the tasks
- Anxious thoughts, prediction and beliefs
- Avoiding feared situations and/or activities
“You can develop anxiety at any age,” Belanger explains. “Working in developmental medicine I see very, very young children with developmental delays and children who are anxious very young – as young as pre-school.”
She adds, “They present with a lot of temper tantrums and a lot of very rigid behaviours because children who are anxious don’t like change so they always like to do things in a certain way so when you change the routine they become anxious and that often manifests as temper outbursts. For a lot of the disorders, we say that the symptoms need to be present for at least a year.”
However, a study out of Washington University School of Medicine earlier this year found that early signs of anxiety and depression may be evident in newborn babies.
Researchers analyzed brain scans of 65 full-term newborns and 57 premature infants (born at least 10 weeks early) and found that the “strength and pattern of connections between certain brain regions” were able to predict the chance of a baby developing excessive sadness, shyness, nervousness or separation anxiety by age two, the study says.
Causes of childhood anxiety
Anxieties can develop as a result of several scenarios, CAMH reports. They include:
- Stressful or traumatic life events
- Family history
- Childhood development issues
- Alcohol, medications or illegal substances
- Other medical or psychiatric problems
According to 2015 study by researchers at the University of Wisconsin-Madison, anxious parents are more likely to have anxious children.
The study found that an overactive brain circuit in three areas (prefrontal, limbic and midbrain circuit) of the brain can be inherited from generation to generation and it may “set the stage” for the development of anxiety and depressive disorders, the study says.
Belanger also adds that chronic anxiety can be a learned and adopted behaviour.
Another study from 2014 by the Society for Research in Child Development concluded that a teen’s chances of anxiety can be predicted by how well their parents dealt with early childhood shyness.
Researchers of the study say that children who were insecurely attached to their parents as infants are more likely to develop anxiety in their teen years.
The child may also be feeding off their parents’ anxiety, Belanger adds.
“We see this more commonly in females who have anxiety disorders – where some of them are being treated – but don’t realize they’re projecting their anxiety,” she says. “The child sees the mom as always being worried or anxious, so they develop the anxiety.”
The difference between adults and children
“An adult would say I’m anxious and I’m worried,” Belanger explains. “But a child will not actually say that – they’ll never say they’re worried or anxious, because they don’t understand what the word anxious means. So for kids, anxiety manifests in their behaviour.”
So often instead of vocalizing their feelings, children will instead show signs of anxiety physically, Belanger points out.
For example, when a child refuses to go to school, that is often a common manifestation of an underlying anxiety disorder, Belanger says.
Other red flags include:
- Poor concentration in school or at home
- Behaviour problems at school
- Not doing well at school, or failing academically
- Avoids being with friends
- Difficulty sleeping
- Chronic fatigue
- Abdominal pain
- Shortness of breath
- Chest pain and/or heart palpitations
“Children don’t often have heart attacks but a lot of them will feel pain in the chest and usually they’re hyperventilating,” Belanger says. “These changes in behaviour are all signs parents should consult their physician.”
Anxiety is an illness that cannot be cured, Belanger says, but it is manageable – and if caught early, the prognosis of the child is more likely to be better as they get older.
“It’s important to treat these disorders early,” Belanger says. “Because when you treat these disorders early the coping strategies that you use to handle and deal with it as you get older are better – the prognosis is better.”
Treatments will depend on the type of anxiety order the child is diagnosed with, Belanger says. It can range from medications to various types of therapies.
“It depends on the level of anxiety,” she explains. “If it becomes in the realm of an anxiety disorder, then we need to consult psychology, and sometimes psychology – but not always with psychiatry.”
The No. 1 treatment for anxiety disorder in children and adults, Belanger says, is behaviour therapy, or cognitive behaviour therapy (CBT).
According to the Mayo Clinic, CBT is a talk therapy, or also known as psychotherapy, where a patient works with a mental health counsellor “in a structured way” to help the patient become aware of negative thinking so they can “view challenging situations more clearly and respond to them in a more effective way.”
“We try to deal with stressors and give them ways to deal with coping,” says Belanger. “Of course there are medications, but a lot of medications are contraindicated in children. They can be used and typically it will be a psychiatrist who prescribes the medication and that’s when the patient is really not functioning and already started the CBT therapy but are not able to do it because they’re so asymptomatic. So we know we’ll have to introduce medication at that time.”