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"Anxiety," as it is commonly referred to in everyday language, is a well-known and widespread natural emotion, primarily associated with a sense of fear that goes beyond the ordinary.
The feeling of anxiety is what we sometimes experience when we sense danger, watch a scary movie scene, feel extremely worried about an undesirable outcome, or face an impending exam or the anxiety that can be felt when speaking in front of an audience. Typically, anxiety is a natural and healthy process that allows us to respond appropriately to changing situations and overcome challenges that life presents us with.
However, it is crucial to distinguish between transient feelings of anxiety and a condition diagnosed as "anxiety disorder," which requires serious and professional attention. Anxiety disorders are highly prevalent in the general population, with epidemiological studies indicating that between 17% and 24% of individuals examined each year suffer from an anxiety disorder. This is a significant percentage, indicating that many people may find themselves belonging to this "club" at some point in their lives.
Anxiety disorders, unlike natural anxiety, are medical conditions characterized by heightened and often disproportionate anxiety that does not align with the situation. They negatively impact the quality of life, cause distress, and affect the level of functioning. In anxiety disorders, a sense of fear exists even in situations where there is no real danger or the perceived danger is not of high intensity. These disorders can occur spontaneously or following various events, are more common in women, and are more likely to occur in individuals with a family history of anxiety. Complex situations such as security concerns, family upheavals, and others can contribute to increased anxiety and the risk of developing an anxiety disorder.
The physical signs of anxiety attacks in children, like in adults, include increased heart rate, chest pain, palpitations, dry mouth, frequent urination, abdominal pain, and more. The psychological and cognitive symptoms encompass heightened worry, apprehension, fear, insecurity, catastrophic thinking, and the reinforcement of negative thoughts (turning a mouse into an elephant). Behavioral symptoms may involve avoidance behaviors, tendencies to become easily startled, and various forms of avoidance. These are attempts to protect oneself from perceived danger. Children with anxiety disorders may avoid sleepovers at friends' houses, refuse to go to school or extracurricular activities, avoid leaving the house due to embarrassment or fear of risk, refrain from forming social relationships for fear of disappointment, or refrain from discussing illnesses due to fear. Additionally, children with anxiety may experience sleep disturbances, night sweats, and more. These signs can manifest both in healthy individuals and in individuals with other medical conditions. They are considered a medical disorder only when they occur with high intensity, persist for a prolonged period, and cause suffering and impairment in basic functioning.
Children understand the events surrounding them well, but they often react to them differently than adults. Many times, a child may not be able to express or even comprehend the difficult emotions they are experiencing, but they may unconsciously manifest their difficulties and fears so that these manifest differently on the surface.
Anxiety in children can result from complex security situations, especially when a child lives in an area where such situations are prevalent. Nighttime sirens, for example, can certainly cause a child to feel distress, even if they do not speak about it. Significant events such as the death of a family member, parental divorce, and similar situations can also trigger anxiety in children. It is essential to remember that we may not always be able to pinpoint the direct cause of an anxiety attack in children, but it is always safe to assume that there is a cause or causes and that the child is not "making up" fears and anxieties manipulatively just to gain our attention.
Childhood fears that are not properly addressed, either by parents or professionals, can also lead to anxiety. Therefore, fear of death in children, whether it arises from close encounters with death in the immediate environment or for other reasons, should be discussed with the child, and assistance should be offered to prevent the development of anxiety.
There are several clinical presentations of anxiety disorders, including:
The most notable feature of panic disorder is short-lived episodes of intense fear or panic, often accompanied by chest pressure, heart palpitations, waves of heat, trembling, nausea, fluttering sensations in the abdomen, and sometimes numbness or tingling in the hands. Despite the terrifying sensation during these 10-20 second attacks, there is no actual danger.
Children with panic disorder often fear a medical event initially, but over time, they develop a pattern of worrying and anticipating additional attacks, leading to avoidance behaviors. These behaviors may include avoiding leaving their homes for open or public places (agoraphobia) or seeking frequent medical checks due to concerns about illnesses. In some cases, depression may also develop. Typically, the condition lasts several months and gradually diminishes. Recurrences may occur in the future, usually with less intensity. Prompt treatment can shorten the duration and severity of the problem.
In this disorder, excessive, exaggerated, and persistent worry is the primary expression. The worry is accompanied by high physical and psychological tension, physical symptoms such as fatigue, back and shoulder pain, muscle tension, digestive complaints, sleep disturbances, and difficulty relaxing due to a constant sense of needing to be "on guard."
Children with GAD may become overly concerned about their surroundings. They may refuse to be alone at home, fearing that something bad will happen to their parents or worrying excessively about their siblings. Typically, children with this disorder do not perceive their condition as a problem, but rather, they see themselves as reacting rationally to potential environmental threats. The disorder often becomes a part of their personality, and they are viewed as "always anxious, always finding reasons to worry."
In many cases, a specific trigger causes anxiety in children. For example, some children experience intense anxiety when asked to speak in class, while others become anxious when using unfamiliar public restrooms. Other common specific phobias include fear of heights (acrophobia), fear of water, or fear of animals.
Children with OCD develop a pattern of repetitive, compulsive behaviors. The purpose of these actions is to irrationally cope with intrusive thoughts and fears, often accompanied by a strong belief that performing a specific action will prevent a catastrophe from occurring. Intrusive thoughts and worries are intense and recurring (e.g., fear of becoming seriously ill or harming loved ones). Children with OCD engage in rituals related to their fears, such as repetitive handwashing as a defense against disease or compulsive door-locking to prevent intruders.
This type of anxiety disorder is closely related to specific social behaviors. Children with social anxiety disorder experience intense fear and anxiety in specific social interactions. Some may feel anxious in any situation involving strangers. In contrast, others may experience anxiety only in specific situations, such as public speaking, eating in public, using public restrooms, or answering questions in class.
Misophonia, also known as "hatred of noise," is a unique neuropsychological disorder characterized by extreme auditory sensitivity. In children with misophonia, there is an extreme aversion to specific sounds that can vary from child to child. Exposure to these sounds can lead to intense anxiety or extreme stress.
If you've identified that your child is suffering from anxiety, you've already taken a significant step. As parents, we always want to help our children, but we don't always know how. In the case of anxiety attacks of any kind, professional assistance is required. After receiving a diagnosis at one of the national child development centers, we can offer you a variety of treatments that will help your child overcome the challenge and cope with anxiety attacks effectively. Typically, anxiety treatment is divided into two categories: cognitive-behavioral therapy (CBT) and medication. However, when it comes to childhood anxiety, providing guidance to parents is also important so that you have the tools to help your child on your own. Remember that at the end of the day, you are the most valued figure in your child's life, and you have the best opportunity to support and provide comfort in the face of the challenges they are facing.
Treatment options for childhood anxiety include:
Cognitive-behavioral therapy is a short-term treatment aimed at providing children with coping skills to deal with the thought patterns that generate anxiety. The underlying concept of this therapy is that the development of anxiety attacks prevents healthy thinking patterns. The therapist works with the child specifically on this process, allowing them to avoid triggers and negative thought patterns that perpetuate anxiety.
The goal of dynamic psychotherapy is to teach children to live according to life rather than fear of danger and, of course, to eliminate the problem. Dynamic psychotherapy assumes that every disorder has deep roots in the child's psyche, and in order to help them, we need to help them uncover these roots. The therapist uses tools of play and conversation to delve into a deep and shared understanding with the child of their inner world. Revealing hidden aspects allows the child to "cleanse" themselves of the negative emotions that give rise to anxiety.
Group therapy is conducted within a group of children suffering from similar disorders. During the process, the child interacts with other friends who experience similar symptoms. The group's strength in processing and normalizing coping mechanisms can facilitate a cooperative approach to treatment. During group therapy, children play with each other, create, and engage in conversation.
Parental guidance is a crucial therapeutic tool in addition to individual or group therapy. Your strength as parents to provide your child with what they need is beyond question. The role of parental guidance is to involve parents in the therapist's efforts and provide them with tools to cope with the complex situation and try to help them better deal with their child's anxiety. Family therapy also includes meetings with other family members in an attempt to make the process interactive. Family members learn how to strengthen each other through shared interactions and serve as a stable anchor in a threatening environment.
In cases of severe anxiety, considering medication assistance for your child may be an option. Medication treatment includes anti-anxiety and anti-depressant medications such as Prozac, Zoloft, and others that are taken regularly for several months to a couple of years. These drugs are usually selective serotonin reuptake inhibitors (SSRIs). Their beneficial effects appear in most patients after continuous treatment for a month. Others may require therapeutic trials with different medications from the same family. This treatment should continue even after improvement for six months to two years and sometimes longer.
It is important to know that for some children, regular medication for anxiety may be necessary to allow them to function well without problems. Similar to regular treatment for high blood pressure or high cholesterol, a critical or accusatory approach towards the child or their parents for long-term medication use is not appropriate. It should be seen as a regular treatment for a medical problem that does not require any stigmatization. A periodic discussion with the treating physician about the benefits or drawbacks of ongoing treatment is advisable.
The first thing to remember is that even if it seems like your child is suffering greatly, as parents, we can always help and provide comfort. It's very difficult to see our child in distress, but it's essential to remember that our role is to protect and care for the child and certainly not to blame them for what they are going through. Another important point to remember is that just as the child is not to blame for their condition, we, as parents, are not to blame either.
Most importantly, once we understand that our child is dealing with anxiety, we should encourage them to share with us. If we, as parents, can encourage the child to open up and share, we can prevent them from feeling isolated in their anxiety. The act of sharing, along with the support of parents, can often alleviate feelings of anxiety. Try to view the situation through the child's eyes, explain it according to their understanding, and encourage them by emphasizing that it's a passing phase.
If the child is willing to open up and share with you, try to understand how you can help them practically. If there are specific factors that trigger their anxiety, try to understand if you can assist the child in those situations. Sometimes, small gestures can make a significant difference. Physical contact with parents can help many children, but it's important not to force it upon them, as this can sometimes have the opposite effect. If, as parents, you notice an issue beyond the usual scope, it's essential to reach out to a professional who can help. Generally, it's advisable to consult the family physician, who can refer you to a relevant specialist or child development center as needed.
Remember that a diagnosis of an anxiety disorder should only be made by a professional!
