Anxiety disorders in childhood

Anxiety disorders in childhood

"You have the power to decide what you let into your mind and what is going to stay. Fear does not exist as such, there are only fearful thoughts and evasion behaviors."


  • 1 What is anxiety
  • 2 Fear in childhood
  • 3 Normal and frequent evolutionary fears in the phases of child development
  • 4 Childhood phobias
  • 5 Classification of childhood anxiety disorders
  • 6 Anxiety disorders with phobic avoidance
  • 7 Anxiety disorders without phobic avoidance
  • 8 Other anxiety disorders
  • 9 Etiology of childhood anxiety disorders
  • 10 Treatment of childhood anxiety

What is anxiety

The Anxiety is an emotion that arises when the person feels in danger, whether real or not the threat. It is a normal and adaptive response to real or imaginary threats more or less diffuse that prepares the body to react to a dangerous situation. Fears become the babysitter of the child when he begins to move away from the mother and begins to explore the world alone. The three types of fears most firmly established in the human species are:

  1. Fear of animals, reminiscent of the evolutionary fear of
  2. The fear of physical damage, atavistic vestige of fear of the dangers that can be found in nature.
  3. The fear of separation, which acts in line with the previous ones and which allows small children to be kept close to their mothers, protecting them from the dangerous environment.

There are times when anxiety responses do not play an adaptive function, they shoot completely uncontrollably and cause suffering for the children who experience them. They arise, in these circumstances, as a "fear without knowing what." In the case of anxiety disorders, fear responses function as a "defective anti-theft device", which is activated and prevents a non-existent danger.

Fear in childhood

When anxiety refers to specific stimuli, it speaks properly of fear. Most children experience many mild, transient and associated fears at a certain age that are overcome spontaneously in the course of development. Fear is a primitive alarm system that helps the child avoid potentially dangerous situations. The fear of separation is the first line of defense; If it breaks, then the fears of animals and physical damage come into action. From this perspective, fears are instinctive and universal responses, without prior learning, which aim to protect children from different dangers. Innate fears can be grouped into five general categories:

  1. Fear of intense stimuli.
  2. Fear of stimuli
    strangers, such as fear of strangers.
  3. Fear of the absence of stimuli, such as darkness.
  4. Fear of stimuli that have been potentially dangerous for the human species over time, such as separation, heights, snakes or other wild animals.
  5. Fear of social interactions with strangers.

Normal and frequent evolutionary fears in the phases of child development

The boy of 0 to 1 year usually responds with crying to intense and unknown stimuli, as well as when he thinks he is helpless. In children from 2 to 4 years the fear of animals appears.

In the children of 4 to 6 years fear of darkness arises, to catastrophes and imaginary beings (such as witches and ghosts) as well as the emotional contagion of fear experienced by other people and concern for social disapproval.

Between the 6 and 9 years fears of physical damage or ridicule may appear due to the absence of school and sports skills.

The children of 9 to 12 years may experience fear of the possibility of catastrophes, fires, accidents; fear of getting serious diseases; and more emotionally significant fears, such as fear of serious conflicts between parents, poor school performance, or, in environments of family violence, fear of beatings or anger.

Between the Teens aged 12 to 18 tend to have more fears related to personal self-esteem (intellectual capacity, physical appearance, fear of failure, etc.) and with interpersonal relationships. The exposed childhood fears are very frequent and can affect up to 40-45% of children. They are, therefore, normal, appear for no apparent reason, are subject to an evolutionary cycle and disappear over time, except for the fear of strangers that can survive in adulthood in the form of shyness.

Phobias in childhood

When childhood fears stop being transient we talk about phobias. Phobias are a special form of fear that responds to the following characteristics:

  • Being disproportionate to the situation that triggers the fear response and / or being related to stimuli that are not objectively dangerous.
  • Cannot be rationally eliminated.
  • Be beyond voluntary control.
  • Not be specific for a specific age.
  • Be of long duration.
  • Interfere considerably in the child's daily life based on avoidance responses.

Childhood phobias usually appear more frequently between 4 and 8 years.

Classification of childhood anxiety disorders

Anxiety disorders in childhood can be classified into three main sections in which others appear as we can see in the following list:

  1. Phobic disorders: Specific phobias, school phobia and avoidance disorders.
  2. Anxiety disorders without phobic avoidance: Separation anxiety and excessive anxiety.
  3. Other anxiety disorders: Obsessive-compulsive disorder and mixed anxiety and depression disorder.

Anxiety disorders with phobic avoidance

Specific phobias

Specific phobias can significantly interfere with the child's daily life. Their prognosis is that they tend to remit spontaneously over time in periods ranging from 1 to 4 years. Some examples are: phobia of darkness, phobia of dogs or phobia of doctors. The phobia of the dark can produce a strong anxiety at night when going to bed, as well as tantrums and refusals to sleep outside the house. Dog phobia can lead the child to use longer roads or unnecessary detours to get home or to school. The phobia of doctors can prevent preventive controls, as well as hinder the administration of beneficial treatments.

School phobia

School phobia refers to the prolonged rejection that a child experiences going to school for some kind of fear related to the school situation. It is rare and tends to occur between 3-4 years or 11-12 years. It affects a greater number of boys than girls. Its onset in young children is sudden while in older children and adolescents it is more gradual, more intense and serious and with a worse prognosis. From a clinical perspective, school phobia is preceded or usually accompanied by physical symptoms of anxiety (tachycardia, sleep disorders, loss of appetite, paleness, nausea, vomiting, headache) and a cognitive anticipation of associated negative consequences to school as well as from a very dependent relationship with the mother and the proliferation of nonspecific fears (to the dark, to the noises).

The result is the avoidance behavior. School phobia is associated with other clinical disorders, such as depression and low self-esteem. Some predisposing factors of school phobia are the existence of anxiety or depression disorders among parents, school-related factors such as fear of a teacher or negative life events such as a prolonged illness or separation from parents. In summary, school phobia is a complex phenomenon that can denote the existence of a specific phobia (fear of being hurt at recreational games), of a social phobia (fear of being ridiculed), of an obsessive-compulsive disorder (fear to be dirty) or of a separation anxiety itself.

Avoidance disorder

Avoidance disorder is characterized by excessive avoidance of contact with unknown persons for a period exceeding 6 months and interferes with social relationships with playmates or schoolmates. All this is linked to a clear desire for affection and acceptance of oneself before others. This disorder is only diagnosed after 2.5 years since at an earlier age it can simply be the normal evolutionary fear of people outside the child. These children are usually insecure, shy, with little self-confidence and not very assertive. As a consequence of this disorder, children may have difficulty acquiring the necessary social skills in the process of adapting to an environment that is at these enormously changing ages. Social isolation and depression can be the consequences of this disorder.

Anxiety disorders without phobic avoidance

Anxiety disorder and specific fears

Separation anxiety is the disproportionate anxiety that a child experiences when he really or supposedly separates from his loved ones, especially from the mother. Separation anxiety constitutes a protection system in the first months and years of the child's life. The subsequent attenuation of this anxiety, as the child acquires greater physical mobility, is replaced by the appearance of specific fears, such as fear of darkness, heights or strangers, which replace said protective mechanism. This disorder includes the presence of irrational fears (to be alone, to go to bed with the lights off, etc.), sleep disorders (nightmares especially) and global anxiety, as well as the anticipation of negative consequences, such as feeling that something bad is going to happen or the certainty that you will not see loved ones again. Children affected by this disorder have a average age of 9 years and are distributed between both sexes, with a certain predominance of girls over boys and of low socioeconomic levels. Although it usually does not extend beyond 14-16 years, it can be a predictor of agoraphobia, panic disorder or even depression in adult life.

Excessive anxiety is a disorder characterized by the presence of persistent and widespread anxiety in very diverse situations, not limited to the separation of loved ones, and by the appearance of anticipatory fears in these situations. The tension and perfectionism are always present in this disorder. Children affected by this disorder have an average age of 13 years and are distributed equally between both sexes, with a certain predominance of medium and high socioeconomic levels. This disorder frequently appears in small families whose members live constantly worried about obtaining successes, with a dynamic of over-demand that children are not always able to assimilate. As for the prognosis, excessive anxiety arises without a clear start and tends to become chronic over time, with additional aggravation in situations of stress and with the appearance of various symptoms (tics, fear of public speaking).

Other anxiety disorders

Obsessive Compulsive Disorder

The obsessive-compulsive disorder is composed of obsessions (unpleasant illogical thoughts that arise repeatedly and that come against the will of the subject) and compulsions (repetitive behaviors that are meaningless in themselves, but that manage to suppress or reduce the anxiety induced by obsessions) . This clinical picture is more typical of adult life and is rare in childhood.

Ritual behaviors and perseverations are a normal developmental feature between 7 and 8 years old. In some cases they have a playful nature and in others they serve to control anxiety as well as to facilitate socialization. Between 7 and 11 years old, rituals related to collecting may arise. The age of onset is around 9.5 years in boys and 11 years in girls, with a usually gradual development and in subjects with a rather high IQ. This problem may arise more frequently in children with a rigid moral code and who experience, therefore, feelings of guilt frequently.

Children and adolescents with depressive disorders usually have symptoms of anxiety, hence calling the mixed anxiety and depression disorder.

Etiology of childhood anxiety disorders

In the origin of anxiety disorders they play an important role, on the one hand, stressful events like parental divorce in the critical periods of childhood and, on the other, the educational style of parents with their children. Specifically, there is a close relationship between maternal anxiety, overprotection of children and anxiety responses by them.

The child's temperament It also plays an important role and reflects the general hereditary predisposition. Anxious children tend to take excessive responsibility for failures, experience difficulties in generating alternatives for action and discriminate against those that are effective from those that are not, and finally, tend to be slow in decision making. Excessive attention of the child to his own reactions and his own thoughts helps to develop and maintain anxiety.

Treatment of anxiety in childhood

The most used therapeutic techniques are the same as those used in the treatment of adults. More than in conceptual aspects, the differences lie in the adaptation of the procedure to the age and characteristics of the child. The most frequent techniques are the following:

  • Exhibition Techniques
  • Relaxation
  • Modeling techniques
  • Reinforced practice
  • Emotional stages
  • Cognitive techniques such as Emotional Rational Therapy
  • Psychopharmacological treatments

Exposure to phobic stimuli can be done in imagination or live and is the most effective psychological treatment to cope with avoidance behaviors that appear in specific phobias. In children under 11 years of age it is recommended not to use the imagination. This technique is also recommended in obsessive-compulsive disorders since in adult cases it has great success.

Relaxation is a means of learning to reduce nonspecific anxiety and gain control of the mind. It is a useful therapeutic technique in excessive anxiety and separation anxiety. The most commonly used method is Jacobson's progressive relaxation consisting of tensing and relaxing the main muscle groups of the body while the subject concentrates on sensations related to tension and relaxation. Despite not being adequate below 8 years, an adaptation program has been established for children under these ages.

Modeling techniques are based on the important role it plays in the learning, facilitation and modification of behaviors, the observation in a model of appropriate behaviors by an observer.

The reinforced practice is focused on the acquisition of new adaptive behaviors rather than the elimination of anxiety responses. Therapy tends to make the stimulus lose its anxiety value by teaching the person a new behavior that allows him to deal with the situation as effectively as possible. It is indicated in the treatment of school phobia and avoidance disorder.

Emotional performances are the combination of live exposure, participant modeling and reinforced practice. With this joint application it is about enhancing the therapeutic results that can be obtained with each of them separately. Very useful for treating specific phobias in very young children.

A child's concerns may derive from the way, not always correct, in which he perceives reality and the resources he believes are available to address it. The thoughts generated can guide the behavior and even the emotions of the child. If they are distorted, they can lead to negative thoughts very often present in children with anxiety disorders. Hence the use of cognitive techniques for treatment since with them we can modify these thoughts and replace them with more appropriate or adaptive ones. Its usefulness, however, is limited to older children.

Psychopharmaceuticals are a complementary aid to psychological treatment and should not be used in children under 6 years.

It may interest you: 9 techniques to help an anxious child


Although there are not many studies or bibliography on childhood anxiety disorders compared to that in adults, we believe that due to the invalidation of these disorders and their subsequent consequences in adulthood, it is necessary to attend to certain signs of visible anxiety in our children and treat them with the help of a child psychologist to reduce them and thus improve the quality of life of our children. This is a way of leading them towards a more satisfied adult life.