All children experience anxiety. Anxiety in children is expected and normal at specific times in development. For example, from approximately age 8 months through the preschool years, healthy youngsters may show intense distress (anxiety) at times of separation from their parents or other persons with whom they are close. Young children may have short-lived fears, (such as fear of the dark, storms, animals, or strangers). If anxieties become severe and begin to interfere with the daily activities of childhood, such as separating from parents, attending school and making friends, parents should consider seeking the evaluation and advice of a child and adolescent psychiatrist.

One type of anxiety that may need treatment is called separation anxiety. This includes: o

• constant thoughts and fears about safety of self and parents
• refusing to go to school
• frequent stomachaches and other physical complaints
• extreme worries about sleeping away from home
• overly clingy
• panic or tantrums at times of separation from parents
• trouble sleeping or nightmares

Another type of anxiety (phobia) is when a child is afraid of specific things such as dogs, insects, or needles and these fears cause significant distress.

Some anxious children are afraid to meet or talk to new people. Children with this difficulty may have few friends outside the family.

Other children with severe anxiety may have:

• many worries about things before they happen
• constant worries or concern about school performance, friends, or sports
• repetitive thoughts or actions (obsessions)
• fears of embarrassment or making mistakes
• low self esteem

Anxious children are often overly tense or uptight. Some may seek a lot of reassurance, and their worries may interfere with activities. Because anxious children may also be quiet, compliant and eager to please, their difficulties may be missed. Parents should be alert to the signs of severe anxiety so they can intervene early to prevent complications. It is important not to discount a child's fears.

If you are concerned that your child has difficulty with anxiety you should consult a child and adolescent psychiatrist or other qualified mental health professional. Severe anxiety problems in children can be treated. Early treatment can prevent future difficulties, such as, loss of friendships, failure to reach social and academic potential, and feelings of low self-esteem. Treatments may include a combination of the following: individual psychotherapy, family therapy, medications, behavioral treatments, and consultation to the school.

Panic disorder is a common and treatable disorder. Children and adolescents with panic disorder have unexpected and repeated periods of intense fear or discomfort, along with other symptoms such as a racing heartbeat or feeling short of breath. These periods are called "panic attacks" and last minutes to hours. Panic attacks frequently develop without warning. Symptoms of a panic attack include:

• Intense fearfulness (a sense that something terrible is happening)
• Racing or pounding heartbeat
• Dizziness or lightheadedness
• Shortness of breath or a feeling of being smothered
• Trembling or shaking
• Sense of unreality
• Fear of dying, losing control, or losing your mind

More than 3 million Americans will experience panic disorder during their lifetime. Panic disorder often begins during adolescence, although it may start during childhood, and sometimes runs in families.

If not recognized and treated, panic disorder and its complications can be devastating. Panic attacks can interfere with a child's or adolescent's relationships, schoolwork, and normal development. Children and adolescents with panic disorder may begin to feel anxious most of the time, even when they are not having panic attacks. Some begin to avoid situations where they fear a panic attack may occur, or situations where help may not be available. For example, a child may be reluctant to go to school or be separated from his or her parents. In severe cases, the child or adolescent may be afraid to leave home. This pattern of avoiding certain places or situations is called "agoraphobia." Some children and adolescents with panic disorder can develop severe depression and may be at risk of suicidal behavior. As an attempt to decrease anxiety, some adolescents with panic disorder will use alcohol or drugs.

Panic disorder in children can be difficult to diagnose. This can lead to many visits to physicians and multiple medical tests which are expensive and potentially painful. When properly evaluated and diagnosed, panic disorder usually responds well to treatment. Children and adolescents with symptoms of panic attacks should first be evaluated by their family physician or pediatrician. If no other physical illness or condition is found as a cause for the symptoms, a comprehensive evaluation by a child and adolescent psychiatrist should be obtained.

Several types of treatment are effective. Specific medications may stop panic attacks. Psychotherapy may also help the child and family learn ways to reduce stress or conflict that could otherwise cause a panic attack. With techniques taught in "cognitive behavioral therapy," the child may also learn new ways to control anxiety or panic attacks when they occur. Many children and adolescents with panic disorder respond well to the combination of medication and psychotherapy. With treatment, the panic attacks can usually be stopped. Early treatment can prevent the complications of panic disorder such as agoraphobia, depression and substance abuse.

For more information about panic disorder, contact the National Institute of Mental Health Panic Campaign, Room 7C-05, 5600 Fishers Lane, Rockville, MD, 20857, or call, 1-800-64-PANIC.

Teenagers, like adults, may experience stress everyday and can benefit from learning stress management skills. Most teens experience more stress when they perceive a situation as dangerous, difficult, or painful and they do not have the resources to cope. Some sources of stress for teens might include:

• school demands and frustrations
• negative thoughts and feelings about themselves
• changes in their bodies
• problems with friends and/or peers at school
• unsafe living environment/neighborhood
• separation or divorce of parents
• chronic illness or severe problems in the family
• death of a loved one
• moving or changing schools
• taking on too many activities or having too high expectations
• family financial problems

Some teens become overloaded with stress. When it happens, inadequately managed stress can lead to anxiety, withdrawal, aggression, physical illness, or poor coping skills such as drug and/or alcohol use.

When we perceive a situation as difficult or painful, changes occur in our minds and bodies to prepare us to respond to danger. This "fight, flight, or freeze" response includes faster heart and breathing rate, increased blood to muscles of arms and legs, cold or clammy hands and feet, upset stomach and/or a sense of dread.

The same mechanism that turns on the stress response can turn it off. As soon as we decide that a situation is no longer dangerous, changes can occur in our minds and bodies to help us relax and calm down. This "relaxation response" includes decreased heart and breathing rate and a sense of well being. Teens that develop a "relaxation response" and other stress management skills feel less helpless and have more choices when responding to stress.

Parents can help their teen in these ways:

• Monitor if stress is affecting their teen's health, behavior, thoughts, or feelings
• Listen carefully to teens and watch for overloading
• Learn and model stress management skills
• Support involvement in sports and other pro-social activities

Teens can decrease stress with the following behaviors and techniques:

• Exercise and eat regularly
• Avoid excess caffeine intake which can increase feelings of anxiety and agitation
• Avoid illegal drugs, alcohol and tobacco
• Learn relaxation exercises (abdominal breathing and muscle relaxation techniques)
• Develop assertiveness training skills. For example, state feelings in polite firm and not overly aggressive or passive ways: ("I feel angry when you yell at me" "Please stop yelling.")
• Rehearse and practice situations which cause stress. One example is taking a speech class if talking in front of a class makes you anxious
• Learn practical coping skills. For example, break a large task into smaller, more attainable tasks
• Decrease negative self talk: challenge negative thoughts about yourself with alternative neutral or positive thoughts. "My life will never get better" can be transformed into "I may feel hopeless now, but my life will probably get better if I work at it and get some help"
• Learn to feel good about doing a competent or "good enough" job rather than demanding perfection from yourself and others
• Take a break from stressful situations. Activities like listening to music, talking to a friend, drawing, writing, or spending time with a pet can reduce stress
• Build a network of friends who help you cope in a positive way

By using these and other techniques, teenagers can begin to manage stress. If a teen talks about or shows signs of being overly stressed, a consultation with a child and adolescent psychiatrist or qualified mental health professional may be helpful.