Most psychologists and other mental health professionals use The Diagnostic and Statistical Manual of Mental Disorders – Fourth Edition Revised (DSM-1V R) to diagnose various difficulties or problems in children, adolescents and adults. Having a name or a “label”is useful in many ways, for example without a name and specific criteria it becomes difficult for further research with regard to understanding and developing effective and valuable treatment. (Medical Aid schemes in South Africa won’t reimburse clients without a diagnosis). A name for the difficulty also makes it easier for parents to understand and often provides relief with the next point of receiving effective treatment from the clinical or child psychologist. A common clinical diagnosis in children is anxiety. Anxiety is the umbrella term for various types of anxiety which can be described as follows:
Social Anxiety Disorder
A child or adolescent with a social anxiety disorder shows significant and persistent fear of social situations in which they perceive potential embarrassment or rejection may occur. They experience acute (immediate) physical reactions to feared social reactions. These children often know their fears are greatly exaggerated, however feel powerless, hopeless and overwhelmed to do anything about them. They often avoid the situation which fills them with dread at any cost to the detriment of their academic and social life.
Some children may just be fearful of one or a few social situations. In this instance the difficulty is referred to as a specific social phobia. When a youngster is afraid and avoids many social situations, it is referred to social anxiety disorder.
Generally, the symptoms fall into three categories:
- Cognitive symptoms, what a child/adolescent ‘thinks’. However, are not always evident in young children as they may react with intense anxiety and not be able to verbalise what is distressing for them.
- Physical reactions, how the body reacts to situations; and
- Behaviour, which is mostly the avoidance of the perceived fearful situation.
Separation Anxiety Disorder
The crux of this disorder is excessive anxiety about being separated from the person to whom the child is most closely attached. For most children, this is the parent, especially the mother. Fear of separation from the mother or father is a normal part of development in children between the ages of eight and fifteen months. At this stage in their development, children are expected to object to separation vociferously with tears and other signs of distress. However, in older children extreme anxiety from brief separations from their parent/s is not developmentally appropriate. Separation anxiety disorder thus becomes detrimental to the child and stressful for the parent. Children with separation anxiety disorder typically cry, scream and cling on to their parent when faced with separation. If they have to leave their home or other familiar places they become tense and fearful, especially if they have to go alone. They miss out on many fun aspects of being a child such as going to parties and being free and having fun, or going for sleepovers. Even within their own homes children with separation anxiety are afraid to be left alone. They often follow their parents around and are reluctant to go to the bathroom or to any other room by themselves. Children with separation anxiety disorder often have significant difficulties sleeping alone. A common problem associated with Separation Anxiety Disorder is school refusal, whereby on most mornings there is an excessive upheaval and fuss to get these children ready, in the car and off to school. Difficulties in this regard are worse on Mondays, after holidays or after a bout of illness which required absence from school.
Obsessive Compulsive Disorder (OCD)
Children with Obsessive Compulsive Disorder have persistent and recurring thoughts “obsessions” that seem to have an adverse effect on their daily life and generally involve exaggerated and irrational anxiety or fears. The children feel compelled to perform repetitive behaviours, known as “compulsions”, in an attempt to ward off anxiety caused by their obsessive thoughts.
Post Traumatic Stress Disorder (PTSD)
Post Traumatic Stress Disorder occurs when children experience a physical, environmental or emotional trauma. Therefore, if a child has experienced a crime related trauma, such as being hijacked, experienced a burglary or mugging, or whether they experienced a natural disaster such as a flood, or being in a motor vehicle accident they may develop PTSD. One has to bear in mind though, that at times, what children experience as traumatic may not necessarily be perceived to be traumatic by adults (such as turbulence on an aeroplane) but might be especially upsetting to a child. Consequently, a child may experience the traumatic incident again and again via nightmares, continuously thinking about what happened, or by re-enacting the event when playing. Children with PTSD can experience symptoms of general anxiety such as difficulty sleeping and eating. They also tend to be irritable, avoid reminders of the trauma and are easily startled.
Children with a specific phobia experience intense fear of a specific object or situation (such as spiders, dogs, elevators) which is irrational or unrealistic. Children with these phobias often avoid situations linked to their fear. The most common specific phobia is the fear of animals, (especially dogs), snakes, insects and mice.
Children who suffer from panic attacks experience debilitating bouts of unexpected and recurring panic and fear. Panic Disorder is rare in young children, however it becomes more common among older children and adolescents.
Panic attacks are relatively short periods of extreme anxiety. During a panic attack, the young person quickly by terrifying mental and physical sensations.
The symptoms are:
- Pounding heart and/or increased heart rate
- Trembling and shaking
- Chest pain
- Abdominal discomfort and nausea
- Sensation of choking
- Dizziness or feeling “light headed”
- Feelings of unreality or detached from oneself
- Fear of losing control or “going crazy”
- Fear of dying
- Tingling or feeling numb
Even when a child is not in the grip of a panic attack, just the thought that it could possibly happen again can make a child extremely anxious. Panic disorder causes a significant disruption of normal day to day functioning.
Generalized Anxiety Disorder
Children with generalized anxiety disorder are often described as “worry warts”or “worriers”. They tend to worry and fret about many things which have happened in the past or about what may happen in the future, such as upcoming tests, going away on camp, that someone close to them may die, about ‘baddies’, about winning or losing in a swimming race and so forth. Most youngsters with a generalized anxiety disorder are self-conscious and tend to be perfectionists as they believe they need to excel in all areas.
Genralized Anxiety Disorder is quite a common difficulty seen by the child and clinical psychologists at Sandton Psychology Centre. However, children who suffer from this disorder are usually quiet and well-behaved and their difficulties often go unnoticed and untreated and attributed to “just their personality”. This is unfortunate as this anxiety disorder is a chronic condition and children don’t just snap out of it.