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Articles Childhood Anxiety Disorders - An Interview With Ron Rapee continued Jasmine: What are the factors that contribute to development of an anxiety disorder? Ron: We don't know all the answers to this yet. There are obviously many factors that go to make an individual that we may never fully understand. But research is beginning to uncover some factors that seem to increase the chances of developing an anxiety disorder. First, there is a particular personality or temperament. This is probably largely a genetically based component. Some people are simply born more sensitive, caring, and emotional than others. This obviously has some good aspects to it, but the down side is that these people are at increased risk for later problems with anxiety and depression. Anxious children often have at least one parent who is also anxious. Parenting is a big factor in a child's life and it is very likely that this is also involved in some ways. Our own research is beginning to show that parents of anxious children are more involved in their child's life and are more controlling and protective. This stems out of a basic love for their child and a response to their anxious child's cries for help. But when it happens, it can help to reinforce and increase the anxiety by giving the child the message that the world really is a dangerous place and that she or he is not competent to handle it. Children also learn a great deal from watching their parents. So if a parent of an already anxious temperament child, acts in an anxious way themselves, then the child will learn from this and it might exaggerate their natural anxious style. Friends and relationships at school and elsewhere could possibly also maintain and increase anxiety in a child in much the same way as overprotective parenting. Finally, there are also many individual experiences that can trigger anxiety disorders. These include life stresses, traumatic experiences, and specific learning experiences. For example, being bitten by a dog may produce a fear of dogs in someone who is already vulnerable to an anxiety disorder due to the factors we discussed above. Jasmine: What is the difference between an anxiety disorder and separation anxiety? Ron: Anxiety disorder is a broad term that simply refers to any of several different disorders. Separation anxiety disorder is one of these. The most common anxiety disorders in children and adolescents are simple phobias (e.g. fears of the dark, dogs, etc.), separation anxiety disorder, social phobia, and generalised anxiety disorder. Obsessive compulsive disorder is less common but is certainly seen in a sizable number. Post-traumatic stress disorder, of course, is seen in specific groups - those who have been through some type of trauma, such as sexual abuse, car accidents, assaults, etc. Panic disorder is very rarely found below the age of 16. Anxiety disorders are not some type of "craziness" or "disease". Aspects or features of all anxiety disorders are found in all people. So anxiety disorders differ from non-disordered anxiety only in degree. Therefore, how we decide if someone has an anxiety disorder is a matter of where we draw the cut off - and this is largely arbitrary. All children will go through stages of very normal fears and anxieties. At around 1-2 years, all children will show strong fears of strangers and separation. A little later, fears of the dark will begin. Therefore, whether a child has "normal" separation fears or separation anxiety disorder, is a largely arbitrary decision and one which is probably not that important. The important decision is simply whether a child's degree of fear is so much that it seems to interfere with his or her life. In this case, it may be worth getting help to reduce this fear, regardless of whether one would technically call it a disorder. Jasmine: What are the treatments currently used for anxious children? Ron: Treatment for anxiety in children follows very similar lines to that in adults, including both medication and psychotherapy. In children, the main treatments that have been properly tested experimentally and shown to produce excellent results are the teaching of practical, cognitive behavioural skills. At Macquarie University we run a nine session group program that includes both the anxious child and his/her parents. Children learn how to identify their anxiety, how to think more realistically, and to expose themselves to feared situations. Parents learn the same techniques as the children so that they are in a position to help their child in the coming years, and also learn different ways of handling and interacting with their child and ways of rewarding and motivating their child. Around 80% of children show marked improvement by the end of the program and effects continue for at least one year.  |
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Last modified: June 12, 2007