Anxiety is an emotion that all people have in common. It has an adaptive response, when we have anxiety the human organism reacts by increasing the activation of the nervous system in the face of possible threats, helping us in survival.
When anxiety is excessive or appears at times when we do not perceive any cause for alarm, it no longer has the same function that we described above and causes us discomfort and alters physiological and psychosocial functioning.
We can say that children and adolescents have anxiety disorders just like adults, only that there are more common anxiety disorders in childhood and adolescence such as anxiety when separating from parents or other relatives.
Although some reactions of children and adolescents are similar to those of adults with anxiety, we must say that on other occasions children react differently from adults.
The repercussions of children suffering from childhood anxiety are more negative, since they influence the Evolutive development, chronifying on some occasions and generating even more serious pathologies.
In this article I want to emphasize the Generalized anxiety disorder (TAG) and in Separation anxiety disorder (TAS) and the Social Anxiety Disorder.
It is defined as a excessive anxiety whose somatic symptoms are such as muscle tension, stomach pain and complaints of not feeling well. Have a cognitive component very marked to worry, anxiety being an alarm system before the threat, and this worry being anticipatory and in a repetitive and uncontrollable way, without becoming a threat, causing that activation of the nervous system.
According to the DSM-5 (APA, 2013), these characteristics can be observed for the diagnosis of Generalized Anxiety Disorder.
A. Excessive anxiety and worry (apprehensive expectation), present for more days than you have been absent for at least six months, about various events, situations, and activities (such as work or school performance).
B. It is difficult for the individual to control the state of worry.
C. Anxiety and worry are associated with three (or more) of the following six symptoms (and at least some symptoms have been present for more days than they have been absent in the last six months).
Note: in children only one symptom is required:
D. Anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
E. The disturbance is not attributable to the physiological effects of a substance (such as a drug or medication) or to another medical condition (such as hyperthyroidism).
F. The disorder is not better explained by another panic disorder, by negative evaluation in social anxiety disorder (social phobia), by pollution or other obsessions in obsessive-compulsive disorder, by separation of attachment figures in separation anxiety disorder, by memories of traumatic events in post-traumatic stress disorder, by gaining weight in anorexia nervosa, by physical ailments in somatic symptom disorder, by the perception of physical defects in appearance in the body dysmorphic disorder, due to the possibility of suffering a serious illness in illness anxiety disorder or due to the content of delusional beliefs in schizophrenia or delusional disorder).
Generalized Anxiety Disorder is very common in childhood, only it is usually identified instead of as Generalized Anxiety Disorder, as anxious temperament or as a precocious maturity. We must say that children with Generalized Anxiety Disorder are excessively scrupulous, perfectionists, responsible and obedient.
The ability to worry that occurs in Generalized Anxiety Disorder develops with age, to anticipate events, all of this happening with cognitive maturation. From about 8 years of age the ability to worry is limited.
They are usually insecure children, in some cases they come from families who are very demanding to achieve success and they worry excessively what others think of them, seeking the approval of others. Many children show concerns about timeliness or the possibility of a natural disaster or war.
In children with an age in which their ability to express themselves with words is lower, they have symptoms such as headaches, limb or stomach pain, and even nausea or diarrhea. As they age, other more complex symptoms may appear, such as irritable bowel movements, tremors, muscle spasms, sweating or increased startle response. Other symptoms such as tachycardia, breathing difficulties or dizziness are not as common in Generalized Anxiety Disorder..
The excessive worry that children with Generalized Anxiety Disorder suffer from can interfere with the ability to perform tasks both at home and at school. In adolescents this concern has greater consequences, since they do not transmit confidence to others.
Expeleta (2005) highlights that gender differences in the prevalence of excessive anxiety depend on age: while in childhood excessive anxiety is more prevalent in boys than in girls, in adolescence it is the other way around, with child reasons. / girl from 1: 1 to 1: 4.
In order to evaluate the TAG we can find several questionnaires:
To assess the concern of TAG, various inventories can be used such as:
Given that Generalized Anxiety Disorder produces disabling alterations in the short and long term and affects the life of the child and his environment, it would be necessary to intervene at an early age.
We use the Cognitive-Behavioral therapies, since there is great evidence and efficacy of the treatments.
The exhibition live or in imagination, used in systematic desensitization techniques, along with relaxation techniques such as progressive relaxation. We must also use cognitive techniques such as self-instruction training and cognitive restructuring, changing negative thoughts for positive ones..
Separation anxiety disorder (SAD) is characterized by excessive fear of separation from home or the attachment figure. It begins around six months of age and begins to intensify at two years of age.
In the early childhood stage, the fear of the absence of attachment people is a fear for the child, this fear is a protection mechanism against the dangers of the environment, but when that anxiety is disproportionate, exceeding what is expected for the child. evolutionary development of the child and affects its functioning is when we call it SAD.
The child with SAD fears and tries to avoid separation from the attachment figure, even anticipating or imagining possible reasons for separation, causing him to suffer from excessive situations of anxiety and fear..
According to DSM-5, children with SAD must meet these diagnostic criteria:
A. Excessive and developmentally inappropriate fear or anxiety, related to separation from the people with whom the individual is associated, evidenced by at least three of the following symptoms:
B. Fear, anxiety, or avoidance are persistent and last at least four weeks in children and adolescents and typically six months or more in adults.
C. The disturbance causes clinically significant distress or impairment in social, academic or occupational (work) or any other important area of functioning.
D. The disturbance is not better explained by another mental disorder, such as refusal to leave home due to resistance to change in autism spectrum disorder; delusions and hallucinations related to separation in psychotic disorders; refusal to go outside without someone you trust in agoraphobia; concerns about health, illness, or what might affect others in generalized anxiety disorder, or concerns about being ill in illness anxiety disorder.
Attachment is the reason why it can sometimes favor the child to have GAD symptoms, specifically insecure attachment or overprotection.
Sometimes the question arises as to whether excessive separation anxiety should be contextualized as GAD or as an attachment disorder.
SAD occurs when an anxiety occurs in childhood that causes discomfort to the infant at the time of separation from the attachment person, this anxiety being abnormal. The manifestation can be early, even in the preschool stage (from 3 to 5 years), although it is more frequent to start during the school stage (from 6 to 12 years), and very rare in adolescence ( 13 to 18 years) nor is it frequent in adulthood.
In young children, nightmares related to separation usually manifest, older children, with cognitive maturation, appear concrete or anticipatory fears. As age advances, concerns become more frequent, such as concerns about kidnappings, accidents, family threats ..., while in adolescence they tend to have more somatic complaints and in adults excessive concern for their children, partner.
In order to evaluate For this disorder, (semi) structured interviews are used, prepared according to the criteria of the American Psychiatric Association or the World Health Organization. The most used are:
Some scales or questionnaires that can also be used are the following:
According to the Society for Child and Adolescent Clinical Psychology of the American Psychological Association, the only well-established treatment that has more research data in favor is Cognitive-Behavioral Therapy.
This treatment consisting of a live exhibition or imagination, together with progressive relaxation techniques, diaphragmatic relaxation, cognitive restructuring, training in self-instructions, you can also use the program "The brave cat", "Friends" or "Fortius", designed to children of different ages in order to recognize anxiety signs, identify concerns, control anxiety, develop self-control, develop strengths and prevent emotional difficulties.
It is also known as social phobia, being this anxiety one of the most common problems during childhood and adolescence.
Its main characteristic is intense and very persistent fear or anxiety, it occurs before, during and after one or more social situations such as speaking in public or interacting with others..
The child or adolescent tries to avoid all those situations in which he considers that he can be evaluated by other people.
In the school environment, the child avoids oral presentations in class, group work, does not ask questions and with this there is poor school performance and even in some cases abandonment.
They may be at risk for substance abuse and eating problems.
In social anxiety, both the variables that may occur in the learning process during the educational process and the circumstances that may have happened to us throughout our lives can intervene.
According to the studies, the onset is between 14 and 16 years of age, the median age between 12.7 and 16 years of age and the infant age between 11 and 12 years.
According to the DSM-5 we can find the following criteria to diagnose social anxiety:
A. Marked fear and anxiety about one or more social situations in which the subject is exposed to possible evaluation by others. Examples are social interactions (for example, having a conversation, meeting unfamiliar people), being watched (for example, eating or drinking), or acting in front of others (for example, speaking in public).
Note: In children, anxiety must occur in meetings with individuals of the same age and not only in interactions with adults.
B. The individual is afraid of acting in a way or showing anxiety symptoms that will be negatively evaluated (for example, he will be humiliated, embarrassed, rejected or offended by others).
C. Social situations almost always provoke fear or anxiety.
Note: In children, fear and anxiety can be expressed as crying, tantrums, being paralyzed, being very clingy, withdrawing or not speaking in social situations.
D. Social situations are avoided or endured with intense anxiety or fear.
E. The fear or anxiety are disproportionate to the real danger that the social situation appears and the sociocultural context.
F. The fear, anxiety, or avoidance is persistent and lasts for six months or more.
G. Fear, anxiety, or avoidance cause clinically significant distress or impairment in social, occupational, or other performance areas.
H. Fear, anxiety, or avoidance are not attributable to the physiological effects of a substance (e.g., drug of abuse, medication) or another medical condition.
I. Fear, anxiety, or avoidance are not better explained by symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or autism spectrum disorder.
J. If you have another medical condition (for example, Parkinson's disease, obesity, disfigurement from injuries or burns), fear, anxiety, and avoidance are unrelated or clearly excessive.
Specify if:
Acting only: Fear is restricted to speaking or acting in public.
The levels of introversion and neuroticism are relevant so that the child can avoid or escape from situations and develop social anxiety.
In the evaluation of social anxiety in infants and adolescents indirect measures can be used such as questionnaires, interviews, records and self-records…; observational measures with situational tests and objective tests such as psychophysiological records.
Some recommendations for the evaluation of social anxiety can be:
To this evaluation for social anxiety must be added the records and self-records to be able to evaluate social anxiety in the real environment, the observation measures in natural, artificial and simulated situations and the psychophysiological measures to evaluate the heart rate, blood pressure, the sweating, and other alterations such as the level of muscle tension.
The treatments that have been shown to be effective for the treatment of social anxiety are those based on the cognitive behavioral therapy.
The main objective of these treatments is to provide strategies and skills to reduce the level of anxiety in social situations, associated with negative and intrusive thoughts and fear of negative evaluation of their actions..
From the approach based on the multicomponent treatment of the cognitive-behavioral model, they have designed a specific treatment to treat social phobia in the child-adolescent population of great efficacy and consists of:
CBGT-A (Cognitive-Behavioral Group Treatment for Adolescents) (Albano, Marten, Holt, Heimberg, & Barlow, 1995; Hayward et al., 200; Herbert et al., 2009).
Composed of 16 sessions, structured in two parts:
SET-C (Social Effectiveness Training for Children) (Beidel, Turner, & Morris, 2000).
Formed by 24 sessions, whose application is two weekly, these being a group and an individual one that include:
LAFS (Invention in Adolescents with Social Phobia) (Olivares, 2005).
Its original version consists of 12 sessions of 90 min., Which are applied weekly in the school environment. They include:
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