Anxiety Disorders in Elementary School Children

Anxiety is a generalized term that expresses the fear and worry of a person in addition to the effect on their ability to perform everyday activities (National Institute of Mental Health, 2018). Anxiety is seen as one of the most common disorders and can be prevalent within elementary school children. About 13% of children are affected by an anxiety disorder (Anxiety and Depression Association of America, 2018). When looking at the prevalence of anxiety, it is important for society to understand that there are various types of disorders.

This research highlights the literature on various anxiety disorders in elementary children, focusing on the symptoms, risk factors and treatment/interventions associated with the disorders.

Overview of Anxiety Disorders

Types of Disorders

Anxiety is a common disorder amongst various groups of people. Everyone experiences anxiety at some point in their life, so it is crucial that people are educated on this common disorder. Understanding the different subtypes associated with anxiety disorder is important. These subtypes consist of generalized anxiety disorder (GAD), separation anxiety, test anxiety, social anxiety, etc. Knowledge of these disorders can assist with enhancing the ability to recognize the symptoms of these anxiety disorders. This grants the opportunity to recognize the risk factors, treatments, and implications connected to these various disorders.

GAD is a disorder associated with those who have a sense of worry about everyday activities (American Psychiatric Association, 2013). This disorder can be connected with elementary school children when examining their sense of success. Some children with this disorder may focus primarily on their performance in school. They have a sense of worry that they are not doing well enough, leading to excessive studying. Jarrett, Black, Rapport, Grills, and Ollendick (2015) found that younger children with GAD had a higher intelligence quotient than older elementary children. Both younger and older elementary school children possessed similar levels of worry excluding school-related worry. Children with GAD are expected to meet established criteria. In addition to symptoms of anxiety, children with GAD convey various additional symptoms such as restlessness, irritability, and muscle tension. A child with GAD may also struggle with concentrating and sleeping (American Psychiatric Association). Remaining in the constant state of worrying can be emotionally draining for children. Society can infer that children with GAD may feel a lack of power due to their lack of control.

Separation anxiety (SAD) is a disorder associated with the separation of a child from his/her parents or caregivers (American Psychiatric Association). Children develop an emotional attachment to their parents/caregivers, so being separated from them can cause distress. About thirty-two percent of children suffer from SAD (Tamayo, 2013). Children desire the sense of belongingness and affection. Wood, Kiff, Jacobs, Ifekwunigwe, and Piacenti (2007) found that attention provided by the parents and caregivers have an effect on their child. Children began to also search for the attention within their teachers.  As children mature, their association with SAD decreases. Undergoing SAD can be challenging for children due to their transition into school or unfamiliar atmospheres. Identifying symptoms of SAD helps us to determining when a child is struggling with the disorder or condition. Some symptoms associated with this disorder are refusing to attend school alone, seeking a great deal of attention from parents, expressing physical complaints (e.g. stomachaches, headaches), and distressed caused by fear of separation (American Psychiatric Association). The ability to recognize these symptoms can help obtain a finer understanding of the actions performed by the children.

Test anxiety (TA) is a condition referring to a state of distress and inability to perform properly during test because of the fear of failure (Lohbeck, Nitkowski, & Petermann, 2016). Children may arrive to a test feeling confident, but when given the test they begin to lose concentration and are faced with a fear of failure. The fear can cause a child to perform poorly on a test because of their constant state of worry. Lohbeck et. al. (2016) stated, those that struggle with TA face many physical, cognitive and emotional symptoms such as headaches, nausea, rapid heartbeat, difficulty concentrating, negative thoughts, anger, fear, helplessness and disappointment. Knowledge of these symptoms present the opportunity for society to recognize students who may experience TA. It is important that we possess that ability so that we can appropriately assist those students in need.

Lastly, social anxiety (SA) is perceived as a disorder that focuses on the inability to socially interact with others based on a person's fear of judgement by others (American Psychiatric Association). Those that struggle with SA often avoid social situations. They avoid social interaction with others based on their fear of judgment and lack of understanding. Researchers found that children whose peers identified them as anxious solitary (searching for peer interaction, but desire to be alone) were more likely to display symptoms of SA (Gazelle, Workman & Allan, 2010). SA can be an ongoing disorder that can develop anytime throughout your life. Children with SA in elementary schools, struggle to interact or play with other kids. It is important that society understand the symptoms. The symptoms of SA are rapid heartbeat, sweating, nausea and experiencing an attack when facing a social situation (American Psychiatric Association). Children that suffer from SA focus on how other children will view them based on their interaction. It is important that we understand how SA can affect children so that we can take the appropriate steps needed to help them manage their disorder.

Risk Factors

Anxiety disorders are the most common psychiatric disorders in children. About 5-18% of children and adolescents have an anxiety disorder. Some children have a disorder that is comorbid with another anxiety or psychiatric disorder (Kliegman & Chiriboga, 2016). This means a child may have an anxiety disorder in addition to another disorder. Anxiety has a greater effect on children when it impairs their daily functioning. Determining the common risks factors associated with the various anxiety disorders is important. The risk factors are family history, tempermental, environmental, and gender differences. Once society absorbs the ability to recognize the risk factors of the various anxiety disorders, the appropriate help will be provided.

The first major factor in anxiety disorders is the family history of an individual. Family history is seen as a factor that is heritable. This means that they can be inherited by the family of a child. For example if a parent is seen to have an anxiety disorder, it is possible for their child to develop the disorder too. When analyzing the family history of a child it is important to understand the probability of the child developing the disorder. Researchers found that anxiety disorders can be comorbid with other disorders. These common disorders are mood disorders. Children with anxiety disorders don't always have family members with anxiety disorders. Since anxiety disorders can be comorbid with mood disorders, the family of a child may possess a mood disorder while the child possesses an anxiety disorder. One of the most common mood disorders that is comorbid with anxiety disorders is bipolar disorder (Duffy, Horrocks, Doucette, Keown-Stoneman, McCloskey, & Grof, 2013). Parents who have bipolar disorder are more likely to have children with an anxiety disorder than parents who have any other mood disorder. Children who have a childhood anxiety disorder are more likely to produce children with a major mood disorder than those who do not possess an anxiety disorder as a child. Those children who possess an anxiety disorder within their childhood are not the only determinant of their future offspring's' development of a disorder, rather they are the precursor (Duffy et. al., 2013). This means that a child having a childhood disorder do not determine fully on whether their future offspring will have a disorder. Their disorder is only one aspect of what determines the likelihood of their future offspring having a disorder. There are other aspects that also help determine the likelihood too. It is important that based on research society understands the impact that the family history of a child can have on the development of an anxiety disorder.

The second major factor in anxiety disorders of children are temperamental factors. Temperamental factors are factors are biologically noted differences of individuals that appear later on in life and remain stable across various situations (Viana, Kiel, Alfano, Dixon, & Palmer, 2017). When examining the temperament factors, society must understand the dimensions. These dimensions are behavior inhibition (BI), and negative affect (NA). The first dimension BI is seen as the most critical factors in developing anxiety. BI is a trait that is heritable that causes children who show autonomic reactivity to be unrevealing of their thoughts or feelings. Since BI is moderately stable across childhood, children who possess BI are at higher risk for developing anxiety disorders (Viana, Kiel, Alfano, Dixon, & Palmer, 2017).

The second-dimension negative affect (NA) have similar findings as BI. Children who experience NA suffer from negative emotions leading to fear, anxiety, disgust and sadness. Those that have high NA are at a greater chance of developing an anxiety disorder. NA is a large predictor of the childhood of a child. Those who have NA early in their life have a greater chance of maintaining it in later childhood (Viana, Kiel, Alfano, Dixon, & Palmer, 2017). NA is a large dimension of the temperamental factors within anxiety. It is not only important that society understands the NA affect, but society must understand the effect of anxiety sensitivity.

Anxiety sensitivity (AS) is the idea that anxiety-related cues are threatening. AS can have a large effect on the arousal of children and through the sensitivity, can elevate the symptoms in anxiety (Viana, Kiel, Alfano, Dixon, & Palmer, 2017). Understanding the connections between BI, NA, and AS can help society connect the impact of the temperament vulnerabilities for childhood anxiety. Researchers determined that children with high BI and NA have high AS. This means that that children who inherit the sense of unrevealing their thoughts/feelings and experience negative emotions leading to NA.

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