Anxiety disorders in children belong to a wide group of emotional disorders in childhood. Their prevalence is constantly growing, currently pathology ranks second among mental diseases in childhood and adolescence (after behavioral deviations).
Active studies of the last 20 years have allowed us to identify new nosological units, which are now included in ICD-10 and DSM-IV, the official classifiers of diseases.
Epidemiological indicators range from 4 to 15% in different age groups. Preschoolers and younger students are most susceptible to anxiety symptoms. In girls, the options of disorders with a pronounced emotional component prevail, in boys, with somatic (digestive disorders and sleep, abdominal and headaches).
Anxiety is a natural reaction that increases concentration and activates the mechanisms of struggle or flight in a situation of threat. When it is strengthened, the process of adaptation is disturbed, constant psycho-physiological tension leads to exhaustion. In such cases, talking about anxiety disorder.
In children, its causes can be:
- Congenital factors. The results of twin studies prove that the tendency to intense anxiety is inherited. It may be due to the peculiarities of the humoral regulation and functioning of the nervous system. Also at risk are children with prenatal and natal lesions of the central nervous system.
- Parenting style. Symptoms of anxiety are formed as a result of a certain attitude of parents to the child. Development disorders contribute psychasthenic features of the mother (at least – the father), overprotection , policy-rearing practices.
- Psychotraumatic event. The anxiety of the child can be triggered by experiencing illness, separation from a loved one, a sharp deterioration in the material capabilities of the family, disasters, natural and military-political cataclysms. The single impact of psychotrauma is more easily tolerated by children, repeated episodes form neurotic disorders
Pathogenesis
Periodic manifestation of anxiety is a normal reaction of the body, serves as a motivational component of behavior, providing a high level of vigilance, dedication and willingness to make efforts to achieve a result. However, frequent, uncontrollable fears negatively affect the ability to adequately assess the situation and act purposefully, and in severe cases distort the perception of everyday events. Anxiety is always focused on the future and manifests fear in relation to what may happen. The more severe the disorder is, the wider the range of events that are regarded as dangerous.
At the physiological level, high anxiety is associated with dysfunctions in the parts of the limbic system and the hippocampus responsible for the regulation of emotions. IP Pavlov considered fear and anxiety as variants of the manifestation of a passive-defensive reflex. The basis of these emotions is the instinct of self-preservation, which activates all the systems of the body for flight or struggle. And if normal excitation and inhibition of the central nervous system is balanced, the natural defensive reflex gives way to relaxation, then with anxiety-type frustration there is a rigidity of neural processes – an emotion that has become irrelevant is experienced again and again.
Classification of anxiety disorders in children
There are many types of childhood anxiety disorders, differing symptoms. Their common manifestation – prolonged anxiety, inadequate to the existing situation, which negatively affects the daily life of the child, reduces the feeling of psychological comfort.
Taking into account the peculiarities of the clinical picture, there are:
- General anxiety disorder. With a generalized TR, children are constantly worried about various areas of life – about health, safety, relationships with peers and parents, and success in their studies. Of all the options for the future, the negative seems the most likely.
- Obsessive compulsive disorder. In OCD, anxiety is manifested in intrusive actions and thoughts. Rituals for a short time provide a sense of calm.
- Phobias. Premonition of danger can take shape in a steady fear ( phobia ) of certain objects and situations. Often children are afraid of heights, darkness, fictional monsters, social contacts.
- Panic attacks. Intense anxiety is sometimes manifested by an increase in the vegetative symptoms – dizziness, palpitations, respiratory spasm, overstrain of the muscles that make up the panic attack clinic . The child begins to avoid events that can trigger a panic.
- Posttraumatic stress disorder. This variant of anxiety arises as a result of experiencing a traumatic event that does not fit into the framework of the usual experience. PTSD in children is manifested by a sudden influx of memories and nightmares
Symptoms of anxiety disorders in children
The main symptom is persistent, pronounced anxiety. Patients feel emotionally tense, can not be distracted from negative experiences and relax. Because of anxiety, they have difficulty concentrating; adolescents report a feeling of “emptiness in the head.” Increased nervousness is manifested by irritability, tearfulness, fearfulness. A flinch is characteristic with unexpected harsh sounds, changes in illumination, and sudden touches. Behavior becomes avoidant (restrictive): children refuse to communicate, walk, play games, travel, use certain products.
Among the physical symptoms of anxiety disorders, causeless fatigue and rapid exhaustion prevail. Patients complain of dizziness, weakness, headaches and muscle pain, discomfort in the abdomen and chest. There may be increased sweating, especially in stressful situations, rapid heartbeat, shortness of breath, tremors and tremors, a feeling of coma in the throat, hot flushes, chills. Appetite is often reduced, but sometimes gluttony develops, followed by nausea and vomiting. Sleep disturbances include difficulty falling asleep, waking in the middle of the night, nightmares.
Symptoms of phobic disorders are persistent fears. Fear is formed of situations that do not actually pose a threat or can only be dangerous under certain conditions. Young children are afraid of darkness, heights, separation from their mother. In preschool children, the imagination is actively developing, fears are associated with fabulous or invented monsters – dragons, dinosaurs, living skeletons, zombies, werewolves. Schoolchildren come to the fore social phobias – fear of communication, dating, public speaking. Adolescents are afraid of losing control, death, madness, experiencing shame. Anxiety after experiencing psychotrauma is characterized by “flashbacks” – uncontrolled frightening influx of memories, nightmares at night.
In obsessive compulsive disorder, anxiety is accompanied by the formation of obsessive frightening attitudes. Children mentally lose negative scenarios, while experiencing fear. Ritual actions – compulsions – help them in part to cope with emotional stress. The most common are frequent hand washing, shuffling the edge of clothes, biting nails, and walking around the perimeter of a room. When panic attacks anxiety occurs for no apparent reason and instantly increases, manifesting vegetative symptoms. The state of health worsens – there is dizziness, blackening in the eyes, a feeling of alienation of one’s own personality, unreality of objects and events. The fear of the next panic attack, avoiding behavior is formed again.
Complications
Emotional disorders often lead to complications, as children are unable to understand and critically evaluate their own experiences. They do not report a depressed mood and a constant feeling of anxiety, so the diagnosis is carried out untimely. Teenagers do not talk about disturbing thoughts, for fear of misunderstanding and condemnation from others. The long-term course of the disorder without adequate therapy is complicated by depression, autistic behavior changes. Patients are prone to self-incrimination, feel lonely, become isolated, avoid communication. The risk of social maladjustment, suicidal attempts against the background of depression increases.
Diagnostics of anxiety disorders in children
The main examination is carried out by a psychiatrist : talking to parents and a child, he collects clinical and anamnestic data, ascertains the presence of somatic diseases, congenital pathologies of the central nervous system, specifies the living conditions, features of adaptation in kindergarten, school. With the prevalence of complaints about the state of physical health, the doctor sends a consultation to a pediatrician, a pediatric neurologist for differential diagnosis.
Special research methods include:
- Conversation. In the course of casual communication with a child, a specialist can often determine the cause of anxiety – fears, destructive relationships in school and family, problems with studies, memories of psychotrauma. In case of severe anxiety, children are passive, but become more open when establishing a trusting contact and discussing topical, disturbing topics.
- Observation The doctor assesses the emotions and behavior of the child. Anxiety is characterized by emotional and motor stiffness, hyper-reactions to unexpected stimuli (noise outside the door, entrance without warning to unauthorized people). Kids often do not want to move away from their mother, they are afraid to look into their eyes.
- Questionnaires. Adolescents are invited to answer questions from standardized methodologies to identify increased anxiety. The Spielberger – Hanin scale is used, Phillips school anxiety test, Beck’s level of anxiety test.
- Projective tests. For the examination of children of preschool and primary school age, methods are used that reveal unconscious dominant emotions (fear, anxiety) and problems in interpersonal relationships. Common diagnostic tools are drawing tests (drawing of a person, family, non-existent animal) and the “Choose a face” projective test (R. Temml, M. Dorki, V. Amen).
Treatment of anxiety disorders in children
Psychiatrists and psychotherapists provide therapeutic care for children, but for successful rehabilitation it is necessary to connect a mother, a father and other close relatives. The amount of treatment procedures is determined individually: in mild forms of disorders, a single course of psychotherapy and parental support is enough ; in case of a severe course, prolonged medication and periodic meetings with a psychologist are necessary.
The general scheme of treatment is as follows:
- Psychotherapy. At sessions of cognitive-behavioral therapy, the psychotherapist corrects destructive attitudes, replaces negative judgments with positive ones, and teaches the skills of managing emotions and solving problems. As a result, the child learns to independently resolve difficult situations, to withstand the effects of stressful influences. If anxiety is based on fears or phobias, a systematic desensitization technique is applied.
- Family psychotherapy. To eliminate the child’s anxiety, it is necessary to adjust the heightened anxiety of the parents and the problematic family relationships – factors for developing and maintaining the disorder. Interacting with the family, the psychotherapist uses the techniques of cognitive psychotherapy, gestalt therapy . He establishes normal communication between all family members, teaches parents to better understand the child, control emotions, and avoid situations that provoke anxiety in their son or daughter.
- Drug therapy. Medication is indicated for moderate to severe anxiety symptoms. For long-term therapy used antidepressants. The drugs of choice are selective serotonin reuptake inhibitors (SSRIs). The use of anxiolytics under the age of 18 is justified in exceptional cases when there are acute symptoms. Benzodiazepines are used for this purpose, therapy is carried out short-term.
Prognosis and prevention
The probability of recovery is largely determined by the timeliness of the start of treatment and the readiness of family members to help the child cope with emotional problems. With early referral to specialists, the prognosis is favorable. Prevention of anxiety disorders is based on trusting family relationships, the right methods of education, based on love and respect, without hyper-trust and authoritarianism. It is important to show sincerity, openness in communication, share your own positive experience in overcoming uncertainty and fears. In difficult situations it is necessary to provide support, in case of failures – to analyze the experience gained, to teach the child to draw conclusions.
Anxiety disorders in children are a group of affective disorders characterized by emotional stress, anxiety, and fears. Negative expectations and forebodings about one’s own life, health, family and school relationships are in the center of the child’s experiences. Sometimes anxiety takes the form of obsessive thoughts, compulsive actions, phobias, panic attacks, nightmares. The main diagnostic methods are history taking, interview, observation. Additionally, psychodiagnostics is used. Cognitive-behavioral psychotherapy combined with antidepressants and anxiolytics is a common treatment.
