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Anxiety Disorders in children

Anxiety Disorders – Anxiety/fear is a normal part of development, beginning with stranger’s fear by 6-8 months of age. The term anxiety disorders or neurosis denotes ‘disproportionately excessive anxiety to a real event or undue anxiety to an imaginary cause’. Common anxiety disorders include —

a) Phobia e.g. school phobia or social phobia,

b) Obsessive-compulsive anxiety disorders with repetitive thoughts, acts or rituals e.g. compulsive hand washing, checking of locks etc.,

c) Generalized anxiety disorder with non-specific and unrealistic worry towards future events e.g. examination failure, and

d) Specific anxiety disorders e.g. separation anxiety and post-traumatic stress disorder.

Post-traumatic stress disorder (PTSD) is an anxiety disorders seen in all age groups, including children, in response to any external event experienced or witnessed by an individual and perceived as dangerous.

Etiology

Life-threatening situations with serious injuries or death e.g. riots, natural disasters etc. are frequently associated with PTSD. Younger children, females and individuals with high-anxiety personality trait, are at an increased risk of PTSD. Child/sexual abuse is an important cause of PTSD in children.

Incidence of PTSD depends on the severity of precipitating event. Although only 1% of exposed adults satisfy the DSM criteria for PTSD, >15% are estimated to suffer with more non-specific stress behavior for a variable period of time. Though not documented statistically, children seem to be more vulnerable for PTSD than adults.

Clinical features

PTSD may be acute or chronic. Acute PTSD (type I) is characterized by — a) recurrent recollections and dreams of the traumatic event, b) intense anxiety, c) sleep disturbances with. startle reactions and d) concentration difficulties.

Chronic PTSD (type II) is generally seen in children with prolonged physical/sexual abuse, leading to a) changed-attitude towards life, people, future etc., b) psychologic numbing i.e. forced amnesia and c) isolated life-style.

Management of anxiety disorders

Early identification and management of PTSD is essential to prevent long-term psychotic morbidity and includes —

• Initial evaluation to explore the child’s understanding, vulnerability and reactions to the traumatic event,

• Psychotherapy to provide the child an opportunity to discuss the event and express his/her feelings of helplessness, sadness or anger. He or She should be helped to understand everyday events and distinguish them from past-trauma.

• Family therapy & counseling to make them understand the basis of child’s behavior and encourage their participation in day-to-day management.

• Phannacotherapy with drugs e.g. benzodiazepenes to modify the sleep & arousal anxiety disorders, in selected cases.

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