Anxiety is a physical and emotional reaction to a threat that is vague and difficult to identify. The fear may be either real, based on a reasonable assumption and logical justification, or unreal, based on false assumptions, wrong reasons or on assessment that does not match the actual situation.
Factors Usually Causing Anxieties in Children
An important factor that needs to be considered is the age of the child, i.e. the stage of development. It is also necessary to consider how far the child’s brain is capable of rational or irrational threat construct. Furthermore also the factor when the child has to cope with categories known vs. unknown, animate versus inanimate, etc.
Specific Characteristics of Children's Anxiety
Psychologists consider conditions when children experience anxiety as a warning signal that something in the family doesn't work the way it should. Children are the barometer of the family environment; they perceive very sensitively even the smallest misunderstandings, tension and discord between their parents. Children's anxieties are not to be ignored as they can develop into pathological conditions when the child will need professional help.
Shyness in childhood may be a precursor to a social anxiety disorder in adulthood. The specific sensitivity is a risk factor for development of neurotic disorders in adolescence and adulthood and also for temperamentally stable characteristics.
Separation Anxiety in Children and Its Stages
The separation anxiety becomes to show naturally and manifest as the first fear in life of a child around the seventh month of life. In some children, it doesn't occur until a year and a half of their age. Both effects and consequences of experienced separation anxiety may vary. They are determined by the age of the child, form of separation, separation environment, present persons who distract the child from the present mother, child's temper, previous separation experience.
- Age: The younger the child, the more intense the separation anxiety; however, it can contribute to the child's gaining independence during pre-school period.
- Separation form: It depends on whether the separation is short-term, long-term, gradual, sudden or complete. We also discern active separation when the child separates from the mother on his/her own and sets to explore the environment and passive separation when the child wants to stay with the mother but is separated anyway.
- Separation environment: It can be a stay with friends, grandparents or other babysitters, but also a stay at a hospital.
- Present and accompanying persons: Their behaviour and relationship with the child is also important as well as their efforts to calm and distract the child from the absence of the mother.
- Previous experience with separation from the mother: Previous separation experience determines how the child experiences the next separation.
Separation Anxiety Stages
When the mother leaves, the child screams, cries and vigorously refuses other adults. This protest defensive stage may take several hours or days. Not all children manifest their protest with loud screaming. It is necessary to realise that even though the child acts calmly and quietly, he/she experiences internal suffering and feels the loss of the mother very intensely. It may seem as if the child skipped the protest stage and went directly to the desperation stage.
The child loses hope of the mother returning, cries repeatedly or stops screaming. He/she feels anxious, gets quiet, often becomes apathetic, and refuses communication as well as food or drinks. Regression to a lower developmental level may also occur as a means of defence - e.g. return to pacifier or bed-wetting. This defensive stage may take several hours, days or even weeks. Patience of surrounding people, sufficient care for the child and maximum effort for their adaptation to the situation are necessary particularly at this time.
Disengagement or Finding a New Object
We can view this stage as a healing stage. The child does not desperately seek his/her mother any more, does not refuse contact of other adults in the surroundings any more, but creates a similar relationship to them as he/she had with the mother. After a long-term separation ends, a paradoxical situation of refusing the mother may occur. On the other hand, this may lead to long-term or permanent mental disorders - night bed-wetting, night terrors and nightmares, stuttering, twitches, anxieties, nail-biting, etc.
Similarly to a child experiencing separation, the mother also experiences separation from her child. Even entirely reasonable parents may behave irrationally and unreasonably e.g. during the time their child is hospitalized.
How to Mitigate Separation Anxiety in Children
- Leave the child with other persons to babysit him/her for a short time even before the separation anxiety develops. The child will get used to the presence of other people at the time when they still receive anyone well as long as the person acts lovingly.
- Leave the child only after a meal and sleep. Hungry or sleepy children experience separation anxiety more intensely. If possible, do not leave the child when he/she is sick or at a time when he/she feels that something is wrong, something hurts, etc.
- If possible, leave the child in the care of the same person whom the child knows. Continuously alternating babysitters are frustrating for most children.
- Train leaving the child with a babysitter for a short amount of time and gradually increase the length of your absence. If your child leaves you on his/her own (e.g. to another room safe for them), leave him/her alone for a little while. You will support his/her feeling of independence.
- Leave the child with a babysitter in your home environment.
- If you leave the child elsewhere, try to make it at least a known environment for the child where the child has already been with you and liked it. Stay with the child until he/she gets familiar with the new environment. Then leave. You can also bring your child's favourite toy to keep him/her company.
- When leaving, stay calm and positive. Children react to your mood very sensitively and they discern any stress in your voice or face immediately.
- Upon your departure, tell your child that you are leaving and reassure him/her that you will come back. It is advisable to create a sort of ritual involving always the same words and gestures; the child will get used to them and gradually learn what they mean. Your departure won't be so stressful and surprising for them.
- After saying goodbye to the child, do not come back or react to the child crying. If you keep coming back or decide not to go at all, you will only strengthen the anxious behaviour of the child and the situation will repeat the next time as well.
- Never leave without saying goodbye (e.g. at the moment when the child is absorbed in playing). The child will then gain a feeling he/she cannot rely on you and grow even more anxious.
- Listen to the feelings of your child. Reassure your child you understand his/her feelings and that you will come back. It is more suitable to tell the child you understand how they feel and that you will miss him/her too than telling them they are overreacting and it is no big deal. Never mock the child for how he/she feels.
- Strengthen the children's self-confidence. Praise them every time they manage something on their own or do something brave. Remind them of their successes later.
- Keep the deals you have made with the child. Do your best to pick up the child at the agreed time or make it home in time. If you're going to be late, tell the babysitter so they are able to explain it to the child if necessary.
Separation Anxiety Disorder
Separation anxiety disorder in childhood is related to agoraphobia and panic disorder in adulthood. Social anxiety disorder in childhood is related to social phobia and generalized anxiety disorder in adults.
The basic symptom of this disorder is rather excessive developmentally inappropriate anxiety. Ti may result in worsening of all functions including appropriate social, school and work grades. Its early beginning occurs during the pre-school period of age but it may appear at any time after the sixth year of age. When separated from an emotionally important caregiver - most frequently mother - children experience intense anxiety combined with worries that something terrible will happen to them or to the mother - e.g. kidnapping, physical injury, death.
Children suffer from permanent anxiety and fear that the caregiver may leave and never come back, that they will remain alone with nobody close to them, put to the hospital or lost. Fear of the dark, fear of falling asleep, frequent night terrors involving the separation may also occur. Sometimes children don't even want to go to school in order not to leave the mother. They require her continuous active presence. Parents tend to be hyperprotective when raising a child; mothers suffer from the panic disorder more frequently. Children somatise the anxiety and even when they anticipate the separation, stomach ache, headache, vomiting and increased temperature may occur.
Other Anxiety Disorders Occurring During Childhood
Phobic Anxiety Disorder in Childhood
Between their third and fourth year of age, children start experiencing developmentally a certain fear of certain objects, subjects and situations. The developmental process of learning and categorizing includes such fear. However, these fears should not be excessive.
The school phobia occurs in the first grade and then between the ninth and eleventh year of age. The child anticipates undesirable situations at school and is afraid to leave the person of his/her emotional bond. However, even adult bonds to children tend to be abnormal. They manifest by stomach ache, headache, morning sickness, self-evaluation disorder, relative social isolation in a group of people of the same age... In terms of therapy, putting the child into the school environment fast is most important.
Social Anxiety Disorder in Childhood
In all children who only start forming relationships with people, social interaction is complex and burdening. Before the sixth year of age, this disorder is characterized by fear and avoidance of strangers, effort to minimize contact with adults and avoidance of social contact. Sometimes children suffer from an unreal worry that their closest ones will abandon them, stop caring for them, etc.
In social anxiety disorder, children frequently manifest with anxiety symptoms, crying, tantrums, refusal to communicate, sometimes even mutism, sleep disorders, various physical troubles such as stomach ache, headache, vomiting, etc. Sometimes, there are even regressive reactions. These symptoms may lead to disruption of social activities.
This disorder may occur already before the tenth year of age, however it peas around the age of fifteen to nineteen. The disorder peak is determined by sexual maturity (related to the development of secondary sexual characteristics. It is more frequent with girls than with boys. It manifests with repeated, unforeseeable attacks of massive anxiety. Suicidal thoughts occur three times more often and the number of suicide attempts is twice as high as in common population.
Social phobia starts between 11-15 years and its frequence is the same in girls and boys. The primary anxiety is related to social situations (e.g. fear of tremor, vomiting, stares, criticism, reading aloud at school, using the WC, eating at the school cafeteria and everywhere where attention is paid to performance, showing off, etc. (so-called performance anxiety). The disorder leads to evasive behaviour or even social isolation with danger of suicidal activity and development of addiction on psychoactive substances. The course is usually chronic.