Information for Health care professionals

Fear is a normal and useful emotion that alerts you to danger. At certain age stages, it is also quite normal for a child to experience certain fears. For example, young children are more likely to be afraid of strangers or the dark, while slightly older children experience more fears on the social aspect. Fears common for a certain age stage often go away by themselves. For some children, however, their fears grow into impregnable barriers and even more problems.

When a person is regularly very anxious, this anxiety is out of proportion to the danger and causes significant limitations that can greatly disrupt life, we speak of an anxiety disorder.

Anxiety and stress symptoms are the most common mental problems worldwide and often start as early as childhood. These symptoms often do not go away by themselves and can in turn lead to other problems such as loneliness, substance use, social problems, worsening school performance or school dropout.

Anxiety symptoms are often not recognised in time because they can express themselves in many different ways. For example, it can manifest itself in physical symptoms, withdrawn behaviour, or in other behavioural problems or school refusal. Underlying anxieties are not always looked at with these behaviours.

When young people do not get help until the symptoms have escalated, a long and expensive treatment process is often needed, for which there are also long waiting lists. With early intervention, most anxiety symptoms can be remedied with proven effective interventions. Thus, it is important to get there as early as possible.

Health care professionals

What is anxiety and when does it become an anxiety disorder?

Everyone feels anxious or stressed from time to time. Anxiety is a normal and useful emotion that helps us respond to danger. It allows us to react quickly in threatening situations, for example through the fight-or-flight response.

However, sometimes people experience intense fear in situations that are not actually dangerous. This fear can be so overwhelming that it interferes with daily life — for example, by avoiding certain places or activities, or feeling so tense that it becomes difficult to concentrate or carry out everyday tasks.

When fear lasts for a long time and is out of proportion to the actual danger, and it causes significant distress, it may be a sign of an anxiety disorder.

What are the different anxiety disorders?

Separation anxiety disorder

Someone with separation anxiety, also called abandonment anxiety, is extremely afraid of being separated from the person they are attached to. Often these are the parents or caregivers. When they are separated, they often experience homesickness and are extremely worried about the safety and health of their parents or themselves. Separation anxiety in children between the ages of 8 and 18 months is a normal step in emotional development. Separation anxiety disorder only occurs when the behavior is no longer age-appropriate.

Social anxiety disorder

Children with social anxiety disorder have a persistent fear of failing or being criticized in social situations, such as when giving a speech or interacting with others, especially peers. In such situations, these children may experience palpitations, tremors, sweating, blushing, diarrhea, and sometimes a panic attack. Children with social anxiety disorder therefore avoid social situations with peers, which can lead to school refusal. 

Specific phobia

A specific phobia is a clear and unrealistic fear of a specific object or situation, which significantly disrupts normal functioning. Someone with a phobia has a strong tendency to avoid the stimulus that causes the fear. In a child with such a phobia, it is not always clear to those around him that the child is afraid. Especially in young children, symptoms of a specific phobia can be masked by crying fits, tantrums or clinging behaviour. Exposure to the feared object or situation can lead to a panic attack. The different types of specific phobias can be roughly divided into specific fear of animals, natural phenomena such as storms and floods, fear of blood, injections or injuries, fear of specific situations, for example unknown company, and other types of fear.

Generalized anxiety disorder

Someone with generalized anxiety disorder is excessively anxious and worried about everyday issues. Without any direct cause, they worry a lot about things that could happen. For example, they worry about what is happening in the world, money, their own health and that of their loved ones, school or work performance, friends or a possible divorce of their parents.

Panic disorder/agoraphobia

Children and adolescents with a panic disorder regularly have panic attacks without a clear cause. These attacks come unexpectedly. A panic attack consists of, for example, an increased heart rate, sweating, dizziness, fainting and nausea. Often these panic attacks are so unpleasant that a fear of having a panic attack also develops. This can cause you to avoid busy situations from which you cannot easily escape. For example, you no longer dare to use public transport, go shopping or go to a busy square. Some people even do not dare to go outside at all. This is also called agoraphobia (fear of open spaces).

Selective mutism

Someone with selective mutism can talk, but does not talk in certain situations because they are afraid. It is also called speech anxiety. Someone with selective mutism often talks at home, but in other situations such as at school or in the store they do not. So they are selective with whom they do and do not talk. Selective mutism is not a hearing, speech, language, or mental disorder such as autism, but an anxiety disorder.

How can anxiety be treated?

In children and adolescents, cognitive behavioural therapy (CBT) is the most commonly used and effective treatment for preventing and reducing various anxiety disorders. CBT involves identifying and challenging anxious thoughts, as well as addressing avoidance behaviours. People who are afraid often try to avoid the situations that trigger their anxiety. While this may reduce anxiety in the short term, it reinforces the fear in the long term and prevents it from being resolved.

During CBT, children learn to replace anxious thoughts with more helpful and realistic ones. A key component of CBT is exposure therapy, in which the child is gradually exposed to the feared situation or object in a controlled way, helping them to overcome their fear. This process involves practicing how to break avoidance patterns. It is essential that the child continues to practice these skills at home between therapy sessions.

Tips

Tips
  • Take the child's fear seriously
  • Talk to the child about the fear
  • Encourage the child to face the feared situations, without forcing them to do so.