Worry and anxiety are part of our everyday life. Browsing the news headlines or scrolling through Facebook may fuel your tension, nerves or worry. However, in proportional doses, worry can serve it’s worthy purpose of alerting us to danger and motivating us to take action. Discerning between what is normal and necessary worry and what is beyond the scope of typical can be difficult. Anxiety is a catch-all term for a spectrum of disorders. What all anxiety disorders have in common is an out-of-proportion and unmanageable behavioral or cognitive response consisting of fear, worry, tension or nervousness.
Let’s explore 5 types of anxiety that can show up in childhood:
Generalized Anxiety Disorder
As the name implies, there is a wide range of typical symptoms with Generalized Anxiety. Worries can range from excessive fear about weather events to perfectionism in school work to stress about a family member getting sick or dying. Alternately, there may not be a specific threat. A child with Generalized Anxiety Disorder may not be able to pinpoint the exact fear or worry; instead they may describe it as an unrelenting feeling that something bad is going to happen or something is going to go wrong. They may constantly ask the question “what if?” and may come up with very creative responses. If not addressed, “what if?” questions tend to spiral and get overwhelming quickly.
It is developmentally appropriate for very young children to have difficulty separating from parents at transition times. However, around the time a child starts school, they should be able to tolerate increasingly longer periods of time away from their primary caregivers. Separation Anxiety causes children to do whatever they can to avoid the feelings of nervousness when a time of separation is imminent. They may be overly clingy, throw tantrums, sob uncontrollably, insist that you be in the same room with them, sleep with or near them, or otherwise refuse to leave your side.
Social Anxiety and Selective Mutism
Children who are Selectively Mute often typically also have a form of Social Anxiety. A person with Social Anxiety typically experiences extreme discomfort in social settings. This can lead to outright avoidance of those settings or it can cause the child to temporarily refuse to speak when distressed by their surroundings. Children who are Selectively Mute do not have a physical disability that prevents them from speaking. In fact, they may have no problem talking and laughing at home, but in certain situations, they fully or almost fully stop talking due to excessive fear. Parents and siblings can inadvertently reinforce Selective Mutism by “rescuing” the child from having to verbally engage in an uncomfortable situation, which in turn reinforces to the child that they don’t have the skills or are unable to express themselves.
Childhood fears are different from phobias in that phobias are generally more intense and people go to great lengths to avoid the phobia. Additionally, whereas fears tend to recede as time goes by, phobias tend to get more intense over time. Children can be phobic of anything from animals to needles to elevators. For example, a phobia of dogs may begin with a child who has limited experience around dogs. They might feel shy or timid around an unfamiliar animal which leads to avoiding all dogs. To minimize their discomfort, they may avoid places where dogs could be. Without evidence to alleviate the fear, it gets reinforced as a phobia. Over time, their discomfort evolves into a fear and then into a Specific Phobia.
Obsessive Compulsive Disorder
Obsessive Compulsive Disorder (OCD) is the experience of unwanted, uncomfortable, and unrealistic thoughts (obsessions) and is usually, but not always, followed by actions (compulsions). A compulsion is meant to lessen the discomfort by the thought and usually must be completed to reduce the anxiety. OCD is not just about about cleanliness, germs or fastidiousness. While germ avoidance can certainly be manifested in OCD, in children there is often a fantasy or magical quality. They may believe that their behavior or thoughts directly impact something that is totally unrelated. For example, “stepping on a crack” doesn’t actually “break your mothers back”. Other examples of OCD are excessive counting, the need for symmetry, repetitive tapping or touching or strict adherence to a schedule or rituals.
Frequency, Intensity and Duration
As with many mental health concerns, on our worst day it’s easy to find ourselves meeting the criteria for any given diagnosis. However, for a diagnosis to occur, the symptoms must significantly impact the daily social, academic or family life. In other words, a problem is not a problem unless it’s a problem. If you determine your concerns are rational, think about the frequency, intensity and duration of the symptoms you are observing. Frequency is about how often you notice your child experience difficulty and where you notice them struggling. Intensity is about how severely your child is impacted by their worry symptoms. Duration is about how long the distress has been around and how long it lasts when it does happen. If you have questions or concerns about your child’s experience with worry or anxiety, reach out to their pediatrician, school advisor or seek counseling.
As you consider the last several weeks or months, ask yourself:
Does my child struggle with worry most days of the week?
Where do they struggle? Is it just at home or is it at school, daycare, with friends and at community events, too?
How much is the worry taking over? Does it cause them to miss school, lose friendships or lose control of their behavior?
When did you first notice signs of distress or worry? How long has it been going on?
How much time passes before they get back to their typical behavior?