Children’s Mental Health Week: Understanding anxiety with Dr. Suneeta Monga

In recognition of Children’s Mental Health Week, we asked Dr. Suneeta Monga, Interim Associate Psychiatrist in Chief, Department of Psychiatry, Brain and Mental Health Program, to explain anxiety in children and youth.

What is anxiety?

We all feel anxious from time to time.  At all ages, even in young children, anxiety is a common emotion. Despite the negative connotation, anxiety is an important emotion and from an evolutionary perspective, anxiety has played a protective role in our survival by forewarning of threat and allowing our ancestors to ‘fight or flight’ predators. When faced with a physical threat, chemicals such as adrenaline, noradrenaline, and cortisol are released into the bloodstream and the ‘fight or flight’ response is activated.  Our respiration and heart rate increases and blood is diverted away from the digestive tract and into muscles in order to prepare the body to either fight the threat (or predator) or to take flight (and run as fast as possible away from the predator).

Why do we still feel anxious even when there is no physical threat to our safety?

Well, yes, today most humans usually no longer need to worry about such extreme physical threats as fighting or fleeing from predators. However still, in response to present day threats, either real or perceived, our body continues to use the ‘fight or flight’ response.  And even in present times, anxiety plays a beneficial role by forewarning threat and triggering the physiological ‘fight or flight’ response - this can be seen, for example, when our anxiety pushes us to study harder for an upcoming exam, or practice harder for a performance. As long as anxiety does not interfere in day-to-day functioning it remains normative. And with children, it is also important to look at anxiety from a developmental viewpoint, as many children experience age-appropriate, normative fears, such as fear of the dark, monsters, and separation from their caregivers.

When should we become concerned about children feeling anxiety? When is it too much?

Anxiety remains normative as long as it is circumscribed, short-term, and does not cause significant interference in functioning.  An anxiety disorder, on the other hand, means that our fears and worries have become excessive and/or prevent us from doing normative activities, such as socializing with others, or performing to our full capacity. When anxiety prevents children from completing age-appropriate activities, such as getting to, or functioning at school (e.g., speaking comfortably to teachers and peers, being dropped off without excessive distress), socializing with peers (e.g., going on play dates, participating in extra-curricular activities), or functioning at home (e.g., separating from parents, sleeping in their own bed) by definition it meets criteria for an anxiety disorder.

How common are anxiety disorders among children and youth?

It may be hard to believe, but anxiety disorders are the most common mental health condition in children and adolescents. One to two in ten children will suffer from an anxiety disorder, and this high prevalence rate is seen even in children as young as four years of age! Unfortunately, child and youth anxiety disorders remain poorly recognized, and are often misdiagnosed or undiagnosed. Furthermore, without treatment anxiety disorders do not remit – anxious children become anxious adolescents and anxious adults, and furthermore, anxious children are at risk for developing depression and substance abuse in adolescence.

I am concerned about my child’s anxiety level. What should I do?

If you think your child has an anxiety disorder the first step is to see your family doctor or paediatrician. Additionally, excellent information about anxiety disorder for parents, caregivers, and youth can be found on the mental health learning hub on the AboutKidsHealth website.