Anxiety is a common emotion we have all experienced. At some stage in their life every individual will feel anxious when faced with a difficult situation. Sweating, increased heart rate, shallow breathing, butterflies in the stomach, and a dry mouth, are typical symptoms of anxiety.

Anxiety is best understood when compared with the emotion of fear. We experience fear in the presence of real, immediate danger. For example, being chased by a vicious dog. Alternatively, anxiety is a more general response that may be out of proportion to environmental threats. Specifically, anxiety tends to be associated with worrying about future or past difficulties, rather than an immediate situation. For example, an individual worrying before an examination represents an anxious response (Oltmanns & Emery, 1995).

All children experience anxiety, as part of their normal development. However what may be considered an appropriate fear at an early stage of development, for instance a fear of the dark at age three, or a fear of going to school in grade 1, may be considered less appropriate, when a child reaches adolescence. In other words, an individual’s age must be taken into account when thinking about anxiety responses.

Children and youth experience different levels of anxiety, and cope with anxiety in more, or less effective ways. Anxiety becomes a problem when it prevents individuals from enjoying normal life experiences for a long period of time.

Types of Anxiety Disorders
Anxiety difficulties may be manifested in different forms. The most common anxiety disorders are:

• Generalised Anxiety Disorder is characterised by excessive worry and fear about future or past events. This disorder is usually accompanied by somatic symptoms like headaches, stomach aches, vomiting, and sleep disturbance.

• Separation Anxiety Disorder is the fear of separating from primary caregivers, home or other familiar surroundings.

• Specific Phobia is a fear associated with a specific object or situation, such as fear of needles, dogs, heights, or the dark.

• Post-Traumatic Stress Disorder is characterised by the presence of severe anxiety reactions or feelings, following a traumatic event, such as witnessing a death or being involved in a near death experience.

• Social Phobia is the fear of being humiliated or embarrassed in front of other people. For instance, meeting new people, being at the centre of attention, or in a group social situation.

• Obsessive Compulsive Disorder is characterised by intrusive, obsessive thoughts which are usually alleviated by compulsive actions (e.g. washing hands 60 times a day), and checking behaviours (e.g. checking bag 20 times before going to school in case they have forgotten something). This disorder is extremely rare in children.

• Panic Attack is a discreet period in which there is a sudden onset of intense apprehension, fearfulness or terror often associated with feelings of impending doom. These feelings are accompanied by physical symptoms such as palpitation, chest pain or discomfort, difficulty breathing, and choking smothering sensations.

Agoraphobia is essentially anxiety about, or avoidance of, places or situations from which it may be difficult and/or embarrassing to escape, and/or help may not be available if a panic attack should occur. For instance, being outside the home alone, being in a crowd, travelling in bus or being on a bridge.

Please note that the purpose of the information above is NOT to classify children according to a particular disorder. Rather this section simply aims to provide background information on Anxiety.

Prevalence of Anxiety Disorders
Anxiety disorders represent the most common form of psychological distress in childhood and youth. Research has consistently found high rates of anxiety disorders in children and youth: 8 years old 25.7%,12 years old 15.7%, 17 years old 21.4%. Although specific figures differ, gender differences appear to exist for the reported levels of anxiety disorders. Specifically, girls tend to report more anxiety disorders compared with boys.

 

Depression is an emotional state marked by great sadness and apprehension, feelings of worthlessness and guilt, withdrawal from others, loss of sleep, appetite, and sexual desire, or loss of interest and pleasure in usual activities. Just as most of us experience anxiety, so too, we will probably have more than an ample amount of sadness during the course of our lives, although perhaps not to a degree or with a frequency that warrants the diagnosis of depression. Often depression is associated with other psychological problems and with medical conditions. For example, when conflict within a family increases, a child often withdraws from others and may become depressed. When this is the case, depression is best viewed as secondary to the other condition.

Paying attention is an exhausting effort for the depressed. They cannot take in what they read, and what other people say to them. Conversation is also a chore, for many people prefer to be alone and remain silent. They may speak slowly, after long pauses, using a monotonous voice. Others, especially children, may appear agitated, and cannot sit still. When depressed individuals are confronted with a problem, no ideas for its solution occur to them. Their thoughts are predominantly focused upon self-recriminations, and they may neglect personal appearance. Utterly dejected, and completely without hope and initiative, they may appear apprehensive, despondent, and anxious much of the time.

There is some variation in the symptoms and signs of depression across the life span. Depression in children sometimes results in their being overly active and aggressive; in adolescents, it is sometimes manifested by negativism, antisocial behaviour, and a feeling of being misunderstood; and in older adults, depression is often characterised by distractibility and memory loss. Furthermore, an individual seldom shows all aspects of depression: the diagnosis is typically made if at least a few signs are evident, particularly a mood of profound sadness that is out of proportion to the individual’s life situation and a loss of interest or pleasure in previously enjoyable activities.

The Link Between Anxiety and Depression
The existence of a strong relation between depression and anxiety in children and adolescents is beyond dispute (Cole, Peeke, Martin, Truglio & Seroczynski, 1998). Equally clear, however, is the existence of noteworthy differences between these disorders, especially with regard to age of onset, duration, or associated features. Children with both anxiety and depression tend to be older than their anxious only, or depressed only counterparts. They also seem to be more symptomatic, with anxiety symptoms typically predating the depressive symptoms. Research in the United States and the Netherlands is now beginning to provide support for a temporal, if not causal, relation between anxiety and depression.

Importance of Early Intervention and Prevention Programs
Given the high prevalence of anxiety disorders in childhood and youth, and the important link between anxiety and depression, early intervention programs represent an important and necessary step to benefit individuals, families and communities at large. These programs are designed to prevent the development of anxiety and depressive disorders by increasing individuals’ emotional resilience, and promoting positive coping skills.

The importance of early intervention programs is accentuated by research that suggests children who suffer from high anxiety are more likely to become anxious adults (Mattison, 1992). Early anxiety intervention programs have been shown to reduce the number of children and youth developing anxiety disorders (the full report of this research is published in The Journal of Consulting and Clinical Psychology (Dadds, Spence, Holland, Barrett, & Laurens,1997). Furthermore, such programs are cost-effective by reducing the cost for future professional services, as well as targeting large groups of individuals, over a short period of time. In short, effective early intervention and prevention programs represent a significant opportunity to prevent a great deal of suffering for individuals and their families.

Importance of Early Anxiety Intervention Programs
Given the high prevalence of anxiety disorders in childhood and youth, early intervention programs represent an important and necessary step to benefit individuals, families and communities at large. These programs are designed to prevent the development of anxiety disorders, by increasing individuals’ emotional resilience and coping skills. The importance of early anxiety intervention programs is accentuated by research that suggests children who suffer from high anxiety are more likely to become anxious adults (Mattison, 1992). Early anxiety intervention programs have been shown to reduce the number of children and youths developing anxiety disorders. Furthermore, such programs are cost-effective by reducing the cost for future professional services, as well as targeting large groups of individuals, over a short period of time. In short, effective early anxiety intervention programs represent a significant opportunity to prevent a great deal of suffering for individuals and their families.