The quick answer to whether your child has anxiety is yes. That’s because a certain amount of anxiety is a normal part of life for kids and adults. When anxiety starts to interfere with normal functioning, however, it requires treatment. Where the line is between normal worries and fears and an actual anxiety disorder can be hard to know. If you’re concerned about your child’s anxiety level, consult with your physician or a mental health professional.
While any anxiety disorder can affect children, separation anxiety disorder is the only one that always starts in childhood. The Diagnostic and Statistical Manual of Mental Disorders (4th edition, Text Revision), or DSM-IV-TR, which is the “bible” used by doctors and mental health professionals for diagnosing mental disorders and illnesses, lists the following criteria for separation anxiety disorder (these have been reworded in layperson’s terms):
- Anxiety that is extreme and not age appropriate about being away from home or from important adults, resulting in at least 3 of the following symptoms:
- Getting excessively upset when separation happens or is about to happen
- Constant extreme worry about losing important adults or about bad things happening to them
- Constant extreme worry about something separating child from important adults, such as kidnapping.
- Frequent, ongoing reluctance or refusal to go to school or elsewhere out of fear of being apart.
- Constant extreme fear or unwillingness to be alone or without important adults at home or elsewhere
- Constant reluctance or refusing to go to sleep without important adults nearby or to sleep anywhere but at home
- Frequent nightmares about separation
- Physical symptoms when separation happens or is about to happen
- Symptoms last at least 4 weeks
- Symptoms start before age 18
- Symptoms interfere in a major way with school, friendships, family or other important areas
- Symptoms are not only part of Pervasive Developmental Disorder, a psychotic disorder, and are not better described, in older children, by panic disorder.
Generalized Anxiety Disorder (GAD) is what we most commonly think of when we consider a person to have a problem with anxiety. The DSM-IV-TR criteria (in layperson’s terms) for GAD are:
- Extreme worry on the majority of days for at least 6 months, about a number of different topics.
- The person finds it difficult to control the worry.
- Three or more of the following symptoms specifically related to the anxiety Note: Only one symptom is required in children.
- Restlessness, feeling keyed up or on edge
- Getting tired easily
- Difficulty concentrating or mind going blank
- Irritability
- Muscle tension
- Trouble falling or staying asleep, or restless sleep
- The worry is not about something that is specific to another mental disorder (e.g. food in anorexia, being apart in separation anxiety disorder) and the anxiety and worry are not solely a part of Posttraumatic Stress Disorder.
- The worry and symptoms disrupt normal life in school, relationships, family, etc.
- The worry and symptoms are not caused by drugs, medications or alcohol, are not part of a mood disorder like depression, and are not part of a pervasive developmental disorder.
Phobias are fears of specific things, like heights or spiders. A certain amount of fear, even about something specific, is typical in both kids and adults. If it prevents your child from doing something they need to do (e.g. their classroom can’t be on the second floor because they’re afraid of heights) or seems particularly excessive, check with your doctor.
There are several other disorders which fall under the general category of anxiety disorders. These include Obsessive Compulsive Disorder and Post-Traumatic Stress Disorder. These are diagnosed in children, but are not usually what people are discussing when they talk about their children being anxious. If your child is showing any signs or symptoms that are of concern to you, you should check with your doctor or a mental health professional.
Only a medical doctor, psychologist, or other licensed mental health professional such as a clinical social worker or counselor can diagnose an anxiety disorder. These people are trained to know what is within the normal range for children and how much something can be bothering a child before it’s considered to be a disorder.
Diagnosis for anxiety disorders, as for most mental health issues, is based on the report of parents and teachers as well as speaking to the child. There is no blood test or other physical test for these disorders.
Some of the assessment tools professionals may use to diagnose your child include the Behavior Assessment System for Children (BASC), the Spence Childhood Anxiety Scale, and the Self-Report for Childhood Anxiety Related Disorders (SCARED). It is important for the professional to get information from more than one adult in diagnosing the child, since children may behave differently in different settings and different adults may perceive the child differently.