Anxiety in childhood and adolescence

Childhood and adolescence are the stages of the life cycle in which most of the changes that a human being undergoes throughout their life trajectory are experienced at great speed, making them a period of great vulnerability in relation to health and disease.

Anxiety disorders are the most prevalent mental health problems affecting adolescents today, and they often go undetected in this group. This is especially concerning given that, if not detected and treated early, anxiety disorders in adolescence can persist into adulthood in more severe forms. We now have a wealth of data from scientific studies that support the effectiveness of various evidence-based psychological interventions.

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Everyone experiences anxiety. In fact, anxiety is normal and healthy. The anxiety response, as an instinctive defensive reaction to danger, serves a protective function in different species and has protected humanity for thousands of years. All children experience anxiety. Anxiety is even expected at specific developmental stages. For example, from about eight months old until preschool age, children may exhibit intense distress when separated from their parents or primary caregivers. They may fear specific situations or objects, such as storms, animals, or strangers. These are known as evolutionary fears.

Developmental fears become problematic if they do not disappear over time or if they are so intense that they interfere with the child's daily functioning, causing significant suffering.

In pathological (problematic) anxiety, there is a tendency to focus disproportionately on threatening stimuli and to exhibit conditioned, generalized, and indiscriminate fear responses to both threatening and safe stimuli. Thus, anxiety disorders arise when our anxiety response is so intense that our coping strategies are not effective enough to manage it and allow us to adapt appropriately to the situation.

Differentiating between normal anxiety and problematic and pathological anxiety

Some authors distinguish four aspects that can help us differentiate normal anxiety from problematic and pathological anxiety:

• Intensity, frequency and duration of anxiety.
• Ratio between the objective severity of the situation and the intensity of the anxiety response.
• Degree of suffering it produces in the person.
• Degree of negative interference in the adolescent's daily life (academic functioning, social and family relationships, leisure activities).

Of all psychiatric disorders, anxiety is one of the most common mental health diagnoses worldwide: prevalence studies in the United States show that 32% of adolescents between the ages of thirteen and eighteen experience some form of anxiety, and between 5% and 18% of them have an anxiety disorder. Therefore, anxiety is a much more prevalent problem than other mental health disorders in adolescence.

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Furthermore, these disorders appear earlier than other typical adolescent disorders, with an average onset around puberty. All anxiety disorders are more common in girls than in boys: for every boy, there are approximately two girls with anxiety. This difference appears very early, around the age of five.

Of the different anxiety disorders, the National Comorbidity Study-Adolescent Supplement of the United States (NCS-A, 2010), detected the following prevalences :

• 2.2% for generalized anxiety disorder (GAD)
• 2.3% for panic disorder
• 2.4% for agoraphobia
• 5% for post-traumatic stress disorder (PTSD)
• 7.6% for separation anxiety disorder (SAD)
• 9.1% for social phobia (SF)
• 19.3% for specific phobias

Recent studies have also detected an increase in cases of post-traumatic stress disorder, social phobia, and generalized anxiety disorder. The NCS-A study found that 8.3% of adolescents have a severe anxiety disorder, most of which is due to agoraphobia and PTSD.

Despite these figures, the proportion of young people receiving treatment for an anxiety disorder barely reaches 20%. This is alarming, especially considering that we now have data supporting the effectiveness of evidence-based interventions for managing anxiety disorders at these ages, and that failing to detect and address anxiety disorders at this stage is associated with persistent difficulties and increasing distress in adulthood.

Anxiety in children and adolescents causes distress in various areas of their lives, interfering with family and peer relationships. Furthermore, it negatively impacts their quality of life, leading to low self-esteem and decreased academic performance.

Therefore, detecting early warning signs of anxiety problems during a highly vulnerable stage like adolescence can help prevent and improve the health and quality of life of young people, and prevent difficulties in adulthood.

This is an original article from the Escola de Salut de l'Hospital Sant Joan de Déu Barcelona , from the 12th FAROS Report "A look at the mental health of adolescents - Keys to understanding and supporting them".