Children as well as adults experience feelings of anxiousness, worry and fear when facing different situations, especially those involving a new experience. However, if anxiety is no longer temporary and begins to interfere with the child's normal functioning or do harm to their learning, the problem may be more than just an ordinary anxiousness.
Anxiety disorders in children, such as school phobia or separation anxiety, may appear to be different from anxiety disorders in adults, but the basic disposition toward anxiety begins in childhood and continues throughout life.
Anxious children often come into this world with a genetic predisposition or susceptibility towards anxiety. This is evident from the fact that anxiety tends to run in families; a parent or other relatives may have an anxiety disorder, although it may not be the same disorder. Children of anxious parents are at increased risk for anxiety disorders. What children inherit may be a general tendency to being sensitive, emotional, fearful, high-strung and highly reactive, rather than a specific anxiety disorder. No "anxiety gene" has been identified, and the mechanism for inheritance is not fully understood.
For many years fears and anxiety in children were not considered "serious" (Graziano, 1975). As a consequence, parents often were advised by medical and mental health professions not to worry because children would "outgrow" their fears (Graziano, 1975; Poulton et al., 1997). In fact, many children do overcome some fears with time. However, as will be illustrated throughout this book, not every child outgrows or overcomes fear responses, and, in a number of instances, these "fears" are not minor matters.
Similarly, Kashani and Orvaschel (1988) reported the prevalence of any anxiety disorder in a sample of 150 adolescents without clinical impairment at 17.3%. However, when clinical impairment was considered, these percentages dropped to half (8.7%). Furthermore, it has been suggested that these percentages would nearly double if anxiety-related disorders such as school refusal behaviours, selective mutism, and sleep problems were included in the estimates (Kearney et al., 1995). Regardless, anxiety disorders are consistently cited as the most prevalent disorders in children (Anderson, 1994; Anderson et al., 1987; Beidel, 1991; Kashani and Orvaschel, 1988; Messer and Beidel, 1993).
Emminghaus further noted that milder forms of anxiety in children could be manifested in a number of forms, consisting mainly of impulsive actions, such as apparently cheerful whistling, the imitation of animal noises, naughty behavior, and over-affectionate behavior, especially towards the mother. He called these types of behavior "the masks of anxiety," a concept derived from a publication by the adult psychiatrist Dick (1877).
A specific phobia is characterized by a marked and persistent fear that is excessive and unreasonable, of a specific object or situation. The presence of the feared object or situation or the anticipation of it can bring on an almost immediate anxiety response. In children, this anxiety may be expressed by crying, tantrums, freezing, or clinging.
A particular behavior or pattern of behaviors may be diagnosed as emotional disturbance at one age and may fall easily within the range of normality at another. For example, school refusal is considered to be more serious when it occurs during adolescence than when it occurs during the point in early childhood when separation anxiety is a common occurrence (Rodriguez, Rodriguez, & Eisenberg, 1959; Rutter, 1980b).
Selective attention may also play a role in childhood anxiety. Evidence suggests that even young children and infants use attentional disengagement in response to threatening stimuli as a means of regulating fear (Bretherton & Beeghly, 1982; Cortez & Bugental, 1994; Derryberry & Rothbart, 1988; Johnson, Posner & Rothbart, 1991).
Worry is also an essential feature of Separation Anxiety Disorder, that is worry about separation from or possible harm to parents or caretakers. Despite the central role of worry in the clinical picture of anxiety disorders, there are no data supporting the proposed link between anxiety and worry in children.
Anxiety disorders are widely recognized as among the most common psychiatric disorders affecting children and adolescents (Anderson, Williams, McGee & Silva, 1987; Bell-Dolan & Brazeal, 1993; Costello & Angold, 1995; Gurley, Cohen, Pine & Brook, 1996; Kashani & Orvaschel, 1988; Orvaschel & Weissman, 1986), and yet these disorders are not well understood with regard to youths (Zahn-Waxler, Klimes-Dougan, & Slattery, 2000). Transient fears and anxieties are considered part of normal development; however, for some children, this developmental expectation may serve to mask the presence of an emerging or existing anxiety disorder (Muris, Merckelbach, Mayer, & Prins, 2001).