Anxiety disorders in children

Some measure of anxiety is a normal aspect of a child's development. For example, most children aged 1-2 years are afraid of separation from their mother, especially in an unfamiliar place. Fear of darkness, monsters, beetles and spiders is often noted in children 3-4 years old. For shy children, the first reaction to new situations may be fear or rejection. Fear of trauma and death is common in older children. Older children and adolescents often worry when speaking in front of the class with a message about the book they read. Such difficulties should not be considered as manifestations of a disorder. Nevertheless, if these otherwise normal manifestations of anxiety become so severe that the normal way of life is significantly disturbed or the child experiences severe stress, one should think of an anxiety disorder in the child.

Epidemiology

In different childhood periods, approximately 10-15% of children have an anxiety disorder (eg, generalized anxiety disorder, fear of separation, social phobia, obsessive-compulsive disorder, specific phobias, acute and post-traumatic stress disorder). For all anxiety disorders, a state of fear, anxiety or anxiety is common, which significantly disrupt the child's way of life and do not correspond to the circumstances that caused them.

[1], [2], [3], [4], [5], [6]

Causes of the anxiety disorders in the child

The cause of anxiety disorders has a genetic basis, but is largely modified by psycho-social experience; the type of inheritance is polygenic, and only a small number of specific genes have been described to date. Disturbing parents tend to have disturbing children, which presents a probability of making the problems of the child worse than they might be. Even a normal child is difficult to remain calm and collected in the presence of anxious parents, and for a child genetically predisposed to anxiety, this is much more problematic. In 30% of cases, the effect in the treatment of anxiety disorders is achieved in the treatment of parents in combination with the treatment of the child.

[7], [8], [9], [10], [11], [12], [13]

Symptoms of the anxiety disorders in the child

Probably the most common manifestation is the refusal to go to school. "Denial of school" is largely replaced by the term "school phobia". True fear of the school is extremely rare. Most children who refuse to go to school probably have a separation fear, social phobia, panic disorder, or a combination of them. Refusal to go to school is also sometimes noted in children with specific phobias.

Some children complain directly about the anxiety, describing it as anxiety about something, for example "I'm afraid that I will never see you again" (fear of separation) or "I'm afraid that children will laugh at me" (social phobias). At the same time, most children describe discomfort as somatic complaints: "I can not go to school, because my stomach hurts." Such complaints can lead to some confusion, since the child often speaks the truth. Stomach upset, nausea and headache often develop in children with anxiety disorders.

[14], [15], [16]

Diagnostics of the anxiety disorders in the child

Diagnosis differs depending on the particular anxiety disorder.

[17], [18], [19], [20], [21]

Treatment of the anxiety disorders in the child

Anxiety disorders in children are treated with the use of behavioral therapy (on the basis of the effect of an alarming factor and preventing a reaction) sometimes in combination with drug treatment. In behavioral therapy, the child systematically finds himself in an alarming situation, gradually changing in strength of impact. Helping a child stay in an alarming situation (preventing a reaction), therapy allows him to gradually become less susceptible to such situations, and anxiety decreases. Behavioral therapy is most effective if an experienced specialist, familiar with the development of the child, individualizes these principles.

In mild cases, only behavioral therapy is usually sufficient, but drug therapy may be required in more severe cases or in the absence of an experienced psychotherapist specializing in behavioral therapy in children. As a rule, selective serotonin reuptake inhibitors (SSRI) are the drugs of first choice when pharmacological therapy is necessary.

Most children without complications suffer SSRI therapy. Sometimes there may be unpleasant sensations from the stomach, diarrhea or insomnia. Some children experience side effects in the form of behavioral changes, including excitation and disinhibition. A small proportion of children do not tolerate SSRI, in which case serotonergic tricyclic antidepressants, such as clomipramine or imipramine, are an acceptable alternative; both drugs are given at the starting dose of 25 mg orally before bedtime, this dose is often enough. If you want to use a higher dose, you should monitor the serum level of the drug, as well as the ECG. The level of the drug in the blood should not exceed 225 ng / ml, since a higher level is often associated with an increased risk of side effects with a relatively small increase in the therapeutic effect. Since the absorption and metabolism of drugs vary greatly, the doses necessary to achieve the therapeutic level are very different. In some cases, to reduce side effects, it may be necessary to divide the dose of the drug into two or three doses.

SSRI, used in older children and adolescents

A drug	Starting dose	Maintenance dose	Comments
Citalopram	20 mg once	40 mg once daily	Analogue of escitalopramoma
Escitalopram	10 mg once	20 mg once daily	The most selective of SSRIs
Fluoxene	10 mg once	40 mg once daily	Long half-life; the most exciting SSRI; in some patients there may be accumulation of the drug
Fluvoxamine	50 mg once	100 mg twice daily	Can increase the level of caffeine and other xanthines
Paroxetine	10 mg once	50 mg once daily	Has the most pronounced sedative effect among all SSRI; some patients may develop withdrawal symptoms
Sertraline	25 mg once	50 mg once daily	Approved by the Office of Medicines and Food Products (FDA) for obsessive-compulsive disorders in children younger than 6 years

¹ Side effects from behavior can be noted, such as disinhibition and agitation. Most often they are of mild to moderate severity; to stop the side effects of behavior, as a rule, it is enough to reduce the dose or change the drug to a similar one. In rare cases, severe side effects, such as aggressiveness and suicidal behavior, can develop. These adverse reactions are associated with idiosyncrasy and can occur with the use of any antidepressant and at any time of treatment. As a consequence, children and adolescents receiving treatment with these drugs should be monitored.

The range of doses is approximate. There is considerable variability in both the therapeutic effect and in adverse reactions; The starting dose is exceeded only if necessary. This table does not replace the full information on the use of drugs.

Forecast

The prognosis depends on the severity, availability of competent treatment and the child's ability to recover. In most cases, children struggle with symptoms of anxiety until reaching adulthood and longer. Nevertheless, with the early onset of treatment, many children learn how to control their fear.

[22], [23], [24], [25]