Hannah, an anxious child
This article
presents a case study of an anxious child, and highlights some common symptoms
for parents and teachers to be watchful for. The case study involves a
fictitious identity; any resemblance to a real person is completely
coincidental.
Hannah (not a real person) was a 10-year-old girl from a close, supportive
family who was described as 'anxious from birth'. She had been a shy, reserved
young girl at pre-school, but she integrated well in grade 1 and began making
friends and succeeding academically. She complained several times of severe
abdominal pain that was worst in the morning and never present at night. She had
missed about 20 days of school during the previous year because of the pain. She
also avoided school excursions, fearing the bus would crash. She had difficulty
falling asleep and frequently asked her parents for their reassurance.
Hannah was worried that she and members of her family might die. She was
unable to sleep at all before a test. She could not tolerate having her parents
on a different floor of the house from herself, and she insisted on securing the
house to an unnecessary extent in the evenings, fearing intruders. Her
insecurity, need for constant reassurance, and school absenteeism were
frustrating and upsetting for her parents.
Hannah had no personal history of traumatic events. She exhibits symptoms
typical of childhood anxiety disorder, which is thought to occur in about 10% of
children, equally in boys and girls before puberty. This type of disorder is
diagnosed when anxiety is sufficient to interfere with daily functioning, for
example Hannah's school attendance and sleep. These effects can increase and
interfere to a progressively greater extent with age-appropriate functioning at
home, at school and with peers, and also places sufferers at risk of developing
mood disorders or substance abuse disorders in the future.
Many children experience fears; fears that are developmentally normal.
Children with anxiety disorders, however, experience persistent fears or other
symptoms of anxiety for months. Children can experience all the anxiety
disorders experienced by adults. However, they can also experience separation
anxiety disorder and selective mutism (failure to speak in certain social
situations, thought to be related to social anxiety), which are unique to
children. The duration of Hannah's difficulties and the symptoms, including
inability to sleep, attend school regularly, go on school excursions, or face
tests without extreme distress are all developmentally inappropriate, suggesting
an anxiety disorder.
There is a range of common symptoms seen in anxious children. Symptoms
involving thoughts include worrying, requests for reassurance, 'what if.'
questions, and upsetting obsessive thoughts. Common symptoms involving
behaviours include difficulty in separation, avoiding feared situations,
tantrums when faced with fear, 'freezing' or mutism in feared situations, and
repetitive rituals, or compulsions. Common symptoms involving feelings include
panic attacks, hyperventilation, stomachaches, headaches and insomnia.
To screen quickly for one or more anxiety disorders in children, four
questions are often useful:
- Does the child worry or ask for parental reassurance almost every day?
- Does the child consistently avoid certain age-appropriate situations or
activities, or avoid doing them without a parent?
- Does the child frequently have stomachaches, headaches, or episodes of
hyperventilation?
- Does the child have daily repetitive rituals?
These questions address the main thoughts, behaviours and feelings related to
anxiety seen in children.
Megan Rodgers wishes to acknowledge an article entitled 'Childhood Anxiety
Disorders' written by Dr Manassis, a Staff Psychiatrist at the Hospital for Sick
Children and the Center for Addiction and Mental Health in Toronto, Ontario, on
which this article is based.
Written by Megan Rodgers
ADAVIC Volunteer
June 2004