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CLINICAL EDITOR’S COMMENTS: Currently on the rise, anxiety is one of the most
nxiety remains one of the most prevalent mental health concerns in children between the ages of 3 and
17 with 9.4% of children in the United States carrying a diagnosis of an anxiety disorder at some point in their lives (Centers for Disease Hyperactivity Disorder is the only condition that is more prevalent in this age group, with 9.8% of U.S. children carrying such a diagnosis. Perhaps more concerning than these numbers, which represent approximately 5.8 million American children dealing with anxiety, is that the rates of diagnosing anxiety disorders in children have been consistently on the rise since 2003. A diagnosis of an anxiety disorder becomes more common as a child ages, with over 10% of U.S. teenagers dealing with anxiety. It is likely that a child or teenager diagnosed with an anxiety disorder is also diagnosed with at least one other mental health disorder. Data indicate that more than one in three children have comorbid conditions (CDC, 2022). While these data represent children who have met criteria for and been diagnosed with anxiety disorders, they do not include children experiencing anxiety who do not meet DSM-5 criteria, or who have not sought treatment for anxiety-related concerns. These numbers encapsulate all anxiety disorders that can be diagnosed in children: Separation anxiety, compulsive, social anxiety, and generalized anxiety disorders (Chiu, Falk, & Walkup, 2016). Each anxiety disorder has its own symptom presentations, criteria determinants, and root fear. However, most etiologies of anxiety presentations in children and teenagers contain some of seven primary features, as outlined by Chiu and colleagues (2016):
“hypervigilance, reactivity to novel or changes in stimuli,
heightened sensitivity to threat, avoidant coping, somatic complaints, catastrophic reactions, and parental accommodation.”
reactions. For example, hypervigilance describes children who are constantly watching and preparing for a perceived threat, be it in the physical world or in their minds (Chiu, Falk, & Walkup, 2016). Children dealing with anxiety are often able to quickly identify the aspect of the situation that triggers their worries, leading to a heightened sensitivity to threats. Reactivity refers to notable negative or anxious reactions to new stimuli, or changes in the child’s usual pattern or schedule. Catastrophic reactions refer to the heightened response that children dealing with anxiety may experience during stressful or fear-inducing moments. Some fear and worry is completely natural, and even healthy! Clinical reactivity is a much larger than expected response and lasts longer than a developmentally appropriate response. Children have many ways in which they attempt to cope with anxiety. such as breathing exercises and adapting negative thinking patterns. Other coping mechanisms are not as useful and may perpetuate anxiety symptoms.
prevalent mental health issues faced by children with pervasive symptoms and impact.
For instance, avoidant coping refers to the myriad of ways in which children work to avoid a situation: Dragging their feet, long searches for “missing” items, needing water and a hug and a story and another drink of water, excessive complaints, missing school, and so on. Children’s anxiety can present in a number of physical complaints that can also aid the child in avoiding anxiety-provoking stimuli, or activate an anxiety-response cycle. For example, changes in respiratory rate can be a result of facing an anxiety-provoking situation, and the increase in respiration can cause a child to feel out of breath and become anxious because the breathing rate has increased, thus perpetuating a cycle of anxiety reactions. Other physical symptoms may include headaches, stomachaches, tingling in the extremities, swallowing issues, and gastrointestinal issues including increased need to urinate or defecate (Chiu, Falk, & Walkup, 2016).
Parental accommodation is a particularly notable feature of anxiety
etiologies. Family members often help children avoid
anxiety-provoking situations to help alleviate the child’s distress and discomfort, often in an effort to avoid the tantrums, crying, or other outward expressions of anxiety-related avoidance (Chiu, Falk, & Walkup, 2016). This is not to say that caregivers should not help children to manage their anxiety reactions, but there needs to be a focus on helping the child navigate the anxiety-provoking experience rather than helping the child to avoid the experience. Parental accommodation, while often intended to be loving and supportive, deprives the child of opportunities to learn and grow, and may simply prolong the child’s experiences with anxiety. This is a prime reason that caregivers should be included in the play therapy treatment of children’s anxiety presentations.
Anxiety disorders often manifest as feeling out of control of situations, dreading things that can be unpredictable, and general uneasiness regarding upcoming events or current situations. Children dealing with symptoms of generalized anxiety disorder often present as edgy or restless, tired, irritable, overly focused on worrying stimuli, and often seeking reassurance about upcoming events or their own performance (Chiu, Falk, & Walkup, 2016). There may be sleep disturbance challenges to overcome both with sleep inception and of the major challenges children will face is managing their worry, especially in light of all of the other symptoms they are managing
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