Anxiety Disorders

Anxiety disorders can be described as frequent fears, worries, or anxiety that negatively impact an individual’s ability to function in different environments. Research has displayed 7.1% of children aged 3-17 years old (approximately 4.4 million) have diagnosed anxiety disorders. There are several different forms of anxiety disorders which can impact an individual’s functioning.

Generalized Anxiety Disorder:

Generalized anxiety disorder (GAD) is a consistent state of increased anxiety and apprehension. GAD is often exhibited as regular and excessive worrying, fear, or dread occuring for at least 6 months. Children or adolescents with GAD experience difficulty in controlling their sense of worry which may result in distress or dysfunction.

Children diagnosed with GAD may experience difficulty coping in different environments and completing daily tasks. They often experience fears about family, performance at school, maintaining friendships, and social status amongst their peers. In addition, children with GAD may display symptoms of irritability.

COVID-19 and the resulting isolation from extended family, peers, and teachers increased stress and anxiety in nearly all children increasing the risk of GAD. Females are particularly at risk of experiencing generalized anxiety disorder (GAD) and are twice as likely to experience symptoms consistent with GAD.

Symptoms:

• Restlessness.
• Feeling tired or fatigued.
• Difficulty concentrating on tasks.
• Irritability or having a “quick fuse”.
• Muscle tension or stiffness.
• Difficulty falling or staying asleep.

Separation Anxiety Disorder (SAD):

Separation anxiety disorder (SAD) is the most common anxiety disorder in children younger than 12 years of age. Separation anxiety disorder (SAD) simply refers to developmentally inappropriate fear or anxiety about a child’s real or imagined separation from individuals to whom they are close to (i.e.; family, friends, etc.). In the United States the 6-12 month prevalence of SAD among children is 4% while the 12 month prevalence of SAD among adolescents is 1.6%.

Symptoms:

• Frequent distress when thinking about or anticipating separation from a key figure in their life.
• Persistent and excessive reluctance to leave their home and go to school or work while away from a key figure in their life.
• Persistent fear of being isolated, abandoned or alienated.
• Repeated nightmares centered on separation.
• Refusal to sleep away from home or go to sleep in the absence of the key figures in their life.

• Frequent bodily/physical complaints such as stomach upset, headache.

Separation Anxiety Disorder (Social Phobia):

Social anxiety disorder is a sense of anxiety resulting from one or more social situations in which the child or adolescent was exposed to negative scrutiny or criticism by peers or adults. The child or adolescent may fear humiliating or embarrassing themselves, resulting in an avoidance of certain related situations. They may also experience immediate and crippling fear or anxiety at the thought of or in such situations. The prevalence estimates for social anxiety disorder are around 7%, similar to the 12-month prevalence of social anxiety disorder found in children and adolescents.
 
Symptoms: 

• Fear of acting in a way that would be negatively evaluated by peers in social situations.
• Excessive worry concerning attendance of social events.
• Excessive worry and anxiety concerning class presentations or speaking group engagements (i.e., speech, giving an answer in front of peers, working collaboratively in a group).
• Avoidance of social situations such as not attending school, social functions or not eating in front of others.
• Complaints often related to physical or bodily symptoms such as stomachache, headache.
• Persistent fear or anxiety normally lasting 6 months or more.
• Symptoms in children may include tantrums, crying, freezing, clinging, or withdrawing in social situations.

Panic Disorder:

Panic disorder includes regular, recurrent panic attacks, which can happen at least once a week. A panic attack is an increase in the intense feelings of fear or discomfort usually lasting about 20 minutes and occurs from a calm or anxious state. Panic disorder is much less common among children who have not reached puberty in comparison to adolescents. Individuals often visit the ER in such situations, not realizing they may be experiencing a panic disorder associated with the symptoms listed below.

Symptoms: according to The Diagnostic and Statistical Manual of Mental Disorder - 5th Edition (DSM-5).

• Pounding heart.
• Sweating.
• Trembling or shaking.
• Feelings of shortness of breath.
• Feelings of choking.
• Chest pain or discomfort.
• Nausea or abdominal distress.
• Feeling dizzy, unsteady, faint or light-headed.
• Chills or heat sensations.
• Numbness or tingling sensation.
• Feelings of unreality or being detached from themselves.
• Fear of losing control or “going crazy”.

• Fear of dying.

Depressive disorders

Depressive disorders are mental disorders characterized by feelings of sadness or irritability that cause distress and affect an individual's ability to function effectively in society. Depressive disorders affect a child’s ability to actively take part in various aspects of their environment. Due to their difficulty in expressing their feelings, it is important that parents are aware of the symptoms of depressive disorders in children and adolescents in order to aid early prevention and treatment. Depressive disorders include major depressive disorder (MDD) and disruptive mood dysregulation disorder (DMDD), among others.

Major Depressive Disorder (MDD):

Major depressive disorder (MDD) is one of the most common psychiatric disorders in children and adolescents. As a result of the symptom variation between children and adults, MDD is often unrecognized and left untreated. Major depressive disorder (MDD) is a persistent state of sadness and loss of interest lasting 2 weeks or more that can impact how one feels, thinks, and behaves and can result in emotional and physical problems. This is the more severe form of depression that could lead to changes in behaviors, sleep, energy levels, and self-confidence.

Depression in adolescence is a risk factor for suicide, substance use disorder, and long-term psychological and social impairment in adulthood. Due to these risks, early intervention is absolutely key to the treatment of depressed youths.
 
Symptoms:

• Increased irritability.
• Crying or shouting outburst.
• Displaying symptoms of anxiety.
• Decreased interest in play.
• Thoughts of worthlessness or suicide.
• Increased bodily complaints (i.e. stomach ache, headache).
• Low self-esteem and feelings of guilt and hopelessness.
• Increased boredom.
• Poor school performance.
• Difficulty sleeping.
• Loss of appetite.
• Thoughts of self-harm or suicide. 

Disruptive Mood Dysregulation Disorder (DMDD):

Disruptive mood dysregulation disorder (DMDD) is associated with frequent outbursts in the form of physical aggression or harm towards others and oneself, often out of proportion to the situation or provocation and detrimental to the individual’s developmental level. DMDD is not diagnosed in individuals younger than 6 years old or older than 18 years old.

Symptoms: 

• Frequent displays of temper outburst (i.e. verbal rage and/or physical aggression toward people, property or oneself).
• Persistent irritability between outbursts that is observed more often than not.
  
• Getting angry in response to their environment.
• Seeming as though their anger goes from "0 to 100".
• Difficulty returning to a "normal" state after becoming angry or upset.
• The child may appear unconsolable or unable to be comforted during periods in which they experience anger that is not developmentally appropriate for their age.

Neurodevelopmental Disorders

Neurodevelopmental disorders (NDDs) are conditions characterized by impairments or changes in thinking, communication, behavior, and/or motor skills resulting from abnormal brain development. Attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) are two diagnoses defined as neurodevelopmental disorders.

Attention-Deficit/Hyperactivity Disorder (ADHD):

Attention-deficit/hyperactivity disorder (ADHD) is a disorder that develops in childhood and impacts an individual’s ability to maintain attention, concentrate, solve problems, utilize language skills, and interact socially with others. The symptoms associated with ADHD can impact an individual’s ability to function in multiple environments throughout their lives. It is estimated that 5% of children have a diagnosis of ADHD. It is important to note that there are different forms of ADHD, namely, inattentive, hyperactive-impulsive, and combined (inattentive and hyperactive-impulsive) ADHD.

Symptoms: 
(Inattention): 

• Poor attention to details and making careless mistakes.
• Difficulty sustaining attention in tasks or play activities.
• Does not seem to listen when directly spoken to.
• Does not follow through on instructions and may fail to finish school work or chores.
• Difficulty organizing tasks.
• Often avoids, dislikes, or is reluctant to engage in tasks that require sustained attention.
• Often loses materials necessary to complete tasks.
• Easily distracted by the objects in their environment.
• Forgetful in daily activities.

(Hyperactivity and impulsivity):

• May appear fidgety.
• May leave their seat often even when they are expected to remain seated.
• May run or climb in situations where it is not appropriate.
• Unable to play quietly.
• May appear often to be "on the go".
• Often talks excessively.
• Often blurts out answers prior to the question being completed.
• Interrupts others in conversation or intrudes on their conversations.

Specific Learning Disorder (SLD):

Specific learning disorder (SLD) is a neurodevelopmental disorder whose key feature is persistent difficulties learning key academic skills they are taught. A core component of a specific learning disorder is the observable presence of learning difficulties in the early developmental years, even in individuals who may not be diagnosed with a SLD into their teenage or adult years.
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Those with SLD may display low academic achievement in comparison to their same aged peers or average achievement when there are high levels of effort and support. In children, low academic skills cause significant interference in school performance (as indicated by school reports and teacher’s grades or ratings). The learning difficulties associated with SLD must not be a result of other conditions, including intellectual disability, vision or hearing problems, or difficulties speaking or understanding the language. Moreover, in order to receive a diagnosis of an SLD, individuals must display persistent difficulty for 6 months in spite of the use of interventions aimed at addressing their areas of difficulty.

Symptoms:

• Difficulty reading.
• Difficulty understanding the meaning of what is read.
• Difficulty spelling.
• Difficulty with written expression (i.e., applying math concepts or solving math problems).
• Difficulty understanding number concepts, number facts or calculation).
• Difficulty with mathematical reasoning (i.e., applying math concepts or solving math problems).

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In order to receive a formal diagnosis of a specific learning disorder, individuals should receive proven and culturally appropriate tests of academic achievement and performance. If you feel your child may display symptoms consistent with SLD, please consult your local school or school representative to explore potential options for testing and other academic resources and services.

Autism Spectrum Disorder (ASD):

Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication, and behavioral challenges. Individuals with ASD may communicate, interact, behave, and learn in ways that are different from most. To receive a diagnosis of ASD, an individual must display a consistent lack of social communication and social interaction in different environments and situations.

Those with ASD may also display restricted, repetitive patterns of behavior, interest, or activity. Symptoms may become visible during the second year of life. However, if the developmental delays are severe enough, symptoms may become observable prior to 12 months of age.

 Symptoms: 

• Lack of interest in objects.
• Not looking at objects when another person points to them.
• Having trouble relating to others or not having an interest in others.
• Avoiding eye-contact.
• Difficulty understanding other people’s feelings or talking about their feelings.
• Difficulty understanding sarcasm or humor.
• May be interested in people but be unsure of how to talk, play, or relate to them.
• Repeating words or phrases spoken to them.
• Repeating actions over and over.
• Having trouble adapting to changes in their routine.
• Experiencing unusual reactions to the way things smell, taste, look, feel, or sound.
• Fixated interest in one area (i.e., toys, school subjects).
• Repetitive bodily regulation movements such as tapping their feet, rubbing their hands, snapping their fingers, etc.

Intellectual Development Disorder (Intellectual Disability):

Intellectual developmental disorder (Intellectual disability) is a disorder which begins during the developmental period. Deficits within the developmental years must be present regardless of whether or not individuals were diagnosed in childhood, adolescence, or adulthood. This disorder impacts intellectual functioning and adaptive functioning. Deficits in intellectual functioning may appear as low academic performance, difficulty learning and retaining previously learned concepts, communication, or acting out physically on their environment. Deficits in adaptive functioning may appear as difficulty completing personal independence skills (i.e., brushing teeth, chores), difficulty completing everyday skills, deficits in social functioning, difficulty being independent, and difficulty adapting to new environments.

The severity of an intellectual developmental disorder is characterized by four levels; mild, moderate, severe, and profound. Though severe forms of the disorder may be observable from an individual's earliest days, individuals with more mild versions of the disorder may not display symptoms until middle school or higher. While individuals with mild forms of the disorder may be able to live independently with appropriate supports, for those with more severe forms of the disorder, lifetime support may be required.

Intellectual functioning is usually measured with individually administered, valid, and culturally appropriate tests of intelligence. If you feel your child may display symptoms consistent with an intellectual developmental disorder, please consult your local school or school representative to explore potential options for testing and other academic resources and services.

 Symptoms:

• Deficits in reasoning, problem solving, planning, abstract thinking, judgment, and academic learning.
• Deficits in interpersonal communication, the ability to relate to peers as friends, problem-solving, and adjusting to new environments.
• Low academic achievement.
• Difficulty remembering previously learned lessons or information.
• A tendency to be gullible within relationships, which may result in being taken advantage of.
• When frustrated, becoming physically aggressive with people or objects in their immediate environment.

Posttraumatic Stress Disorder (PTSD):

Posttraumatic stress disorder (PTSD) is a stress-related disorder that manifests as a result of traumatic experiences endured by an individual (i.e., assault, physical, emotional, or sexual abuse, accidents, fires, or the death of a loved one). Not all children who experience a traumatic event develop a stress disorder due to differences between individuals.

Individuals with PTSD may attempt to avoid memories, feelings, or external situations that remind them of a traumatic experience. They may display difficulty recalling and remembering specific aspects of the traumatic event, often blaming themselves for the trauma. They can also display a sense of anxiety or hyperarousal, have difficulty concentrating, and find it hard to sleep at times due to nightmares associated with the traumatic event. They are often detached from themselves, as though living in a dream or a world that feels unreal.

​Symptoms: adapted from Stanford Children’s Health - Lucile Packard Children’s Hospital. 

• Difficulty sleeping.
• Feeling depressed or grumpy.
• Feeling nervous, anxious, alert, or watchful (on guard).
• Loss of interest in activities they once enjoyed.
• Seeming to be detached, numb, or unresponsive.
• Difficulty feeling affectionate.
• Increased aggression or even becoming violent at times.
• Avoiding certain situations or places that recall past memories associated with the past traumatic experience.
• Losing touch with reality.
• Difficulty within school.
• Physical symptoms including headaches or stomach aches.