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The Anxious Child
All children experience anxiety. Anxiety in children is expected and normal at specific times
in development. For example, from approximately age 8 months through the preschool years, healthy
youngsters may show intense distress (anxiety) at times of separation from their parents or other
persons with whom they are close. Young children may have short-lived fears, (such as fear of the
dark, storms, animals, or strangers). If anxieties become severe and begin to interfere with the daily
activities of childhood, such as separating from parents, attending school and making friends, parents
should consider seeking the evaluation and advice of a child and adolescent psychiatrist.
One type of anxiety that may need treatment is called separation anxiety. This includes:
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constant thoughts and fears about safety of self and
parents |
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refusing to go to school |
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frequent stomachaches and other physical complaints |
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extreme worries about sleeping away from home |
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overly clingy |
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panic or tantrums at times of separation from parents |
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trouble sleeping or nightmares |
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Another type of anxiety (phobia) is when a child is afraid of specific things such as dogs,
insects, or needles and these fears cause significant distress. |
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Some anxious children are afraid to meet or talk to new people. Children with this difficulty
may have few friends outside the family.
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Other children with severe anxiety may have:
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many worries about things before they happen |
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constant worries or concern about school performance, friends, or sports |
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repetitive thoughts or actions (obsessions) |
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fears of embarrassment or making mistakes |
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low self esteem |
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Anxious children are often overly tense or uptight. Some may seek a lot of reassurance, and
their worries may interfere with activities. Because anxious children may also be quiet, compliant
and eager to please, their difficulties may be missed. Parents should be alert to the signs of severe
anxiety so they can intervene early to prevent complications. It is important not to discount a child's
fears. |
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If you are concerned that your child has difficulty with anxiety you should consult a child and
adolescent psychiatrist or other qualified mental health professional. Severe anxiety problems in
children can be treated. Early treatment can prevent future difficulties, such as, loss of friendships,
failure to reach social and academic potential, and feelings of low self-esteem. Treatments may
include a combination of the following: individual psychotherapy, family therapy, medications,
behavioral treatments, and consultation to the school.
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Obsessive-Compulsive Disorder in Children and Adolescents |
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Obsessive-Compulsive Disorder (OCD), usually begins in adolescence or young
adulthood and is seen in as many as 1 in 200 children and adolescents. OCD is characterized
by recurrent intense obsessions and/or compulsions that cause severe discomfort and
interfere with day-to-day functioning. Obsessions are recurrent and persistent thoughts,
impulses, or images that are unwanted and cause marked anxiety or distress. Frequently, they
are unrealistic or irrational. They are not simply excessive worries about real-life problems or
preoccupations. Compulsions are repetitive behaviors or rituals (like hand washing, hoarding,
keeping things in order, checking something over and over) or mental acts (like counting,
repeating words silently, avoiding). In OCD, the obsessions or compulsions cause significant
anxiety or distress, or they interfere with the child's normal routine, academic functioning,
social activities, or relationships.
The obsessive thoughts may vary with the age of the child and may change over time.
A younger child with OCD may have persistent thoughts that harm will occur to himself or a
family member, for example an intruder entering an unlocked door or window. The child
may compulsively check all the doors and windows of his home after his parents are asleep
in an attempt to relieve anxiety. The child may then fear that he may have accidentally
unlocked a door or window while last checking and locking, and then must compulsively
check over and over again.
An older child or a teenager with OCD may fear that he will become ill with germs,
AIDS, or contaminated food. To cope with his/her feelings, a child may develop "rituals" (a
behavior or activity that gets repeated). Sometimes the obsession and compulsion are linked;
"I fear this bad thing will happen if I stop checking or hand washing, so I can't stop even if it
doesn't make any sense."
Research shows that OCD is a brain disorder and tends to run in families, although
this doesn't mean the child will definitely develop symptoms if a parent has the disorder.
Recent studies have also shown that OCD may develop or worsen after a streptococcal
bacterial infection. A child may also develop OCD with no previous family history.
Children and adolescents often feel shame and embarrassment about their OCD.
Many fear it means they're crazy and are hesitant to talk about their thoughts and behaviors.
Good communication between parents and children can increase understanding of the
problem and help the parents appropriately support their child.
Most children with OCD can be treated effectively with a combination of
psychotherapy (especially cognitive and behavioral techniques) and certain medications for
example, serotonin reuptake inhibitors (SSRI's). Family support and education are also
central to the success of treatment. Antibiotic therapy may be useful in cases where OCD is
linked to streptococcal infection.
Seeking help from a child and adolescent psychiatrist is important both to better
understand the complex issues created by OCD as well as to get help.
For additional information see Facts for Families: #24 Know When to Seek Help For Your
Child, #47 The Anxious Child; #35 Tic Disorders; #21 Psychiatric Medication for Children;
and #52 Comprehensive Psychiatric Evaluation. See also: Your Child (1998 Harper
Collins)/Your Adolescent (1999 Harper Collins). |
The Development of the Facts for Families series is a public service of the AACAP. If you would like to support expanded
distribution of the series, please make a tax deductible contribution to the AACAP Campaign for America's Kids. By supporting this
endeavor, you will support a comprehensive and sustained advocacy effort on behalf of children and adolescents with mental illnesses.
Please make checks payable to AACAP, and send to: AACAP, Campaign for America's Kids, P.O. Box 96106, Washington, D.C.
20090
The American Academy of Child and Adolescent Psychiatry (AACAP) represents over 6,000 child and adolescent psychiatrists who
are physicians with at least five years of additional training beyond medical school in general (adult) and child and adolescent
psychiatry.
Facts for Families is developed and distributed by the American Academy of Child and Adolescent Psychiatry (AACAP). Facts sheets
may be reproduced for personal or educational use without written permission, but cannot be included in material presented for sale.
To purchase full sets of FFF, contact the AACAP Publications Clerk at: 1.800.333.7636, ext. 131.
Nelson A. Tejada, American Academy of Child & Adolescent Psychiatry, Operations Department, Phone: 202-966-7300 ext. 131,
Main Fax: 202-966-2891, Publication Fax: 202-464-9980 |
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