Test Your Knowledge

There are several major types of anxiety that children may experience. All share the quality of excessive and irrational fear. The fear may be of a specific object or situation, or it may be generalized fear for which the child cannot identify a specific source. Types of anxiety commonly associated with children include:

• Generalized anxiety disorder (GAD). Diagnosed when children worry excessively about all types of life issues, including their health, family, school work, and the potential for destructive events such as accidents and natural disasters. Children may be unable to relax, even when there are no signs of trouble. Children with GAD may worry intensely, often about future events. The sense of worry may be irrational or disproportionate to the actual situation. GAD tends to be more common in middle childhood and adolescence.
  
  
• Separation anxiety disorder. Children with this disorder experience intense anxiety when separated from caregivers or homes. They worry excessively about the well-being of their parents or caregivers. Separation anxiety itself is a normal reaction for very young children between the ages of 18 months and 3 years. However, by the time a child is about 4 years old, they should be more comfortable temporarily leaving their parents. If this is not the case, separation anxiety disorder may be present. The disorder is most common in children between 6 and 9 years of age. Children with separation anxiety have a tendency to cling to parents or caretakers and may throw tantrums when they are separated from these guardians. They also tend to fear sleeping away from home.
  
  
• Social anxiety disorder. Involves a strong fear (phobia) of social situations and situations in which the child is expected to perform. Also known as social phobia, social anxiety disorder tends to be more common in middle childhood and adolescence. Children with this condition may fear speaking up in class and tend to have few friends. Social anxiety disorder is often present before age 5, but may not be diagnosed until the child enters school.
  
  
• Selective mutism. A severe form of social anxiety disorder that involves a refusal to speak in situations where such communication is expected. Children with this condition tend to talk only or mostly at home and may remain largely silent in other situations, such as daycare, school or visits to the homes of friends or relatives.
  
  
• Anxiety-based school refusal. Also known as school avoidance, it involves problems with school attendance that are related to the child’s fear of leaving home (most often in younger children), fear of the unfamiliar or of being embarrassed at school (most often in older children). Anxiety-based school refusal tends to heighten between the ages of 5 and 6 years, and again between the ages of 10 and 11 years. It is often associated with children who have separation anxiety disorder or social anxiety disorder.
  
  
• Obsessive-compulsive disorder (OCD). Diagnosed when a child is helpless to control intrusive and unwanted thoughts (obsessions) and/or to stop performing ritualistic actions (compulsions), such as repetitive hand washing. This condition usually begins in early childhood or adolescence.
  
  
• Panic disorder. Diagnosed when a person regularly experiences panic attacks – sudden episodes of fear and anxiety that usually last between 10 and 30 minutes. The attacks can cause symptoms such as racing heartbeat, heavy perspiration and shortness of breath. In some cases, panic disorder may be accompanied by agoraphobia, a type of phobia in which patients fear being caught in a place or situation in which escape might be difficult, or being trapped in circumstances in which medical help might not be available during an emergency. In other cases, panic disorder actually causes agoraphobia. Panic disorder is uncommon before adolescence and tends to begin between the ages of 15 and 19 years.
  
  
• Phobias. Diagnosed when a person has extreme and irrational fears of something that in actuality poses little or no threat. For example, social phobia involves a fear of being judged by others. Children often have phobias when they are young – onset is generally between the ages of 6 and 9 years - but usually outgrow them. However, patients with specific phobias continue to suffer from intense fear of certain objects (e.g., spiders) or situations (e.g., heights). People with phobias avoid objects or situations that they view as threatening. Children with phobias are less likely than adults to realize that the fears are irrational or out of proportion to the situation.
  
  
• Post-traumatic stress disorder (PTSD). Diagnosed when a child who has experienced a traumatic event such as war, rape, child abuse or a natural disaster begins to have nightmares, flashbacks, depression or other symptoms for more than a month. Symptoms may include constant thoughts about a traumatic event, recurrent nightmares or insomnia, re-enactment of traumatic events through play, difficulty eating and a tendency to be easily startled. Stress disorders that occur within a month of the event are known as acute stress disorders.