All children get anxious. Typical childhood anxiety is called “normative anxiety” and may consist of nervousness with the upcoming school year, going on an airplane for the first time or learning to ride a bike. Pathological anxiety is severe and persistent anxiety that is markedly elevated in respect to their peers. The most common anxiety disorders are generalized anxiety disorder, social anxiety disorder, panic disorder, separation anxiety disorder and selective mutism.
Generalized Anxiety Disorder
Generalized anxiety disorder (GAD) affects about 2-6% of children and typically occurs after puberty. GAD is more common in young females compared to males. The main symptom is worry. A common screening question is: “does your child worry more than most children their age?”. Worry about things being perfect, natural disasters or storms and harm coming to a family member or contracting an infectious disease are all typical of childhood GAD.
Social Anxiety Disorder
Social anxiety disorder (SAD) typically presents as a fear of being in social situations and the scrutiny that may come from said situation. Traits of SAD may be present in early childhood. Shy infants and toddlers show traits of shyness including gaze avoidance, avoidance of new activities and at times irritability or tantrums when they are in social situations. Typical fears include avoidance of birthday parties, ordering food at a restaurant, public speaking and using a public bathroom. Physical symptoms include a racing heart and nausea.
Panic disorder typically presents in mid to late adolescence. Panic attacks are a sudden and severe episode of anxiety almost always resulting in physical symptoms such as racing heart, chest pain, excessive sweating, dizziness and shortness of breath. A defining feature of panic attacks is that they come “out of the blue” and can even wake people from their sleep. Lifetime prevalence in females is 2.6% and 2.0% in males
Separation Anxiety Disorder
Separation anxiety disorder is characterized by extreme fear of separation from their caregiver, typically a parent. Most commonly it presents in children aged 5-7 at the onset of entering school and may also present when a child enters middle school. Children typically complain of physical symptoms including headaches and stomach aches. Children may also have fears of sleeping alone, have frequent nightmares, have a fear of being in a room alone and have severe tantrums when being taken to school. Selective Mutism occurs at a rate ranging from, 4-5% depending on the study.
Selective mutism typically presents when a child first goes to school and is commonly noted by an almost exclusive avoidance of speaking while at school. Speech must be absent for one month to make the diagnosis. Children with selective mutism also typically avoid eye contact as well. Children are typically able to speak at home with family, but, are shy in nature. Selective mutism is exceedingly rare with a prevalence estimated at around 0.7%.