Anxiety is a growing problem in adolescent and pre-adolescent populations.

DEVELOPMENT OF ANXIETY 

The development of anxiety disorders in children is influenced by a complex interplay of factors, including heritable traits, developmental processes, cognitive and learning patterns, neurobiological mechanisms, and social and environmental influences. Efforts to modify risk factors and enhance protective factors in children and adolescents can help mitigate the prevalence of anxiety disorders.  

Parenting styles significantly impact anxiety in children, with overprotection, rejection, and parental conflicts correlating with higher rates of anxiety disorders. Anxious parents may inadvertently model anxious behaviors and hinder their children's autonomy and problem-solving skills, contributing to anxiety development.  

Childhood adversity, such as natural disasters and parental loss, can trigger anxiety disorders, particularly in girls and younger children. Traumatic events like childhood sexual abuse significantly increase the risk of anxiety disorders, with victims exhibiting higher levels of anxiety symptoms, including post-traumatic stress disorder (PTSD).  

Household factors like lower educational attainment and socioeconomic status are associated with higher prevalence of anxiety disorders, though the exact mechanisms remain unclear. Understanding these aetiological factors is crucial for developing effective prevention and intervention strategies for childhood anxiety disorders.  

COMORBIDITIES 

Comorbidity in adolescents with anxiety disorders is common, often involving depression, attention-deficit hyperactivity disorder (ADHD), oppositional defiant disorder, and other psychiatric conditions. The presence of one anxiety disorder increases the likelihood of meeting criteria for another, and anxiety disorders are associated with an elevated risk of substance abuse and eating disorders.  

Clinicians must conduct thorough assessments when treating anxiety in adolescents due to the high levels of comorbidity, as it can impact treatment outcomes. Anxiety disorder is characterised by a primary fear leading to avoidance or distress, emphasising the importance of understanding specific fears to accurately diagnose and treat these conditions. 

Separation Anxiety Disorder (SAD) is unique to adolescence and is marked by excessive fear of separation from attachment figures, resulting in various avoidant behaviors and somatic complaints. SAD typically manifests around 7.5 years of age and can lead to distressing symptoms like school refusal and physical ailments. 

Generalized Anxiety Disorder (GAD), affecting about 3% of children, involves excessive worry about various aspects of life and a sense of impending doom. Adolescents with GAD often worry about the future, school, family, and relationships, and may exhibit physical symptoms like restlessness and muscle tension. GAD typically emerges during adolescence and is associated with harmful interpersonal behaviors, perfectionism, and high levels of comorbid depression. Teens with GAD may engage in self-medication through alcohol use and are at increased risk of suicidal behavior. 

Understanding the distinct characteristics and developmental trajectories of anxiety disorders in adolescents is crucial for accurate diagnosis and effective intervention. Early recognition and intervention can help mitigate the long-term impact of these disorders on adolescents' well-being and functioning. 

Panic disorder (PD) revolves around the dread of experiencing a panic attack, a brief yet intense bout of anxiety characterised by rapid heart rate, chest tightness, and breathing struggles, among other symptoms. These episodes trigger a heightened fear of death, accompanied by autonomic symptoms like rapid heartbeat, sweating, and nausea. Roughly one-third of individuals experience panic attacks at least once, often in stressful situations or after excessive caffeine consumption.  

Beyond PD, panic attacks commonly signal underlying psychiatric issues. Those afflicted with PD are consumed by apprehension over potential attacks and their implications. In adolescence, PD is more prevalent in girls, particularly among those with anxious or avoidant tendencies coupled with depression. Early childhood manifestations include extreme distress, crying, or clinging behavior. Research suggests that teenagers experience panic with cognitive patterns akin to adults. The Panic Disorder Severity Scale for Children aids in assessing PD in this demographic effectively. 

PTSD, an anxiety disorder stemming from harrowing experiences, affects children post-pediatric accidental trauma. Triggered by direct exposure or witnessing of life-threatening events, its symptoms endure beyond a month, unlike acute stress disorder (ASD). Childhood nightmares evolve from specific to general themes, alongside persistent reenactment of trauma. Physical symptoms like stomach aches and heightened arousal manifest, hindering academic progress.  

Adolescent PTSD mirrors adult PTSD, encompassing social and emotional challenges. ASD shares PTSD symptoms but includes dissociative experiences like numbness and depersonalisation. Its prevalence among traumatised adolescents remains unclear, with up to 28% potentially affected. Understanding and addressing these disorders in youth is crucial for their well-being and long-term outcomes.