Anxiety (Children)

Shatkin & Karp, Child & Adolescent Mental Health: A Practical, All-in-One Guide

Yerkes and Dodson describe that an increase in one's arousal/anxiety is necessary for optimal performance, but performance begins to decline once their arousal/anxiety level gets too high.

Because young children have trouble recognizing and describing their emotions, those suffering from anxiety disorders often present with somatic symptoms (e.g., headaches, stomachaches, diarrhea, constipation, dizzines, chest pain, fear of choking, globus hystericus, fatigue, sleep disturbance).

Etiology. Behavioral inhibition is "the tendency to be unusually withdrawn and or timid and to show fear and avoidance in novel or unfamiliar social and nonsocial situations." Behaviorally inhibited children exhibit many physiological signs associated with anxiety (e.g., enhanced sympathetic nervous system tone, increased tension in vocal cords and larynx, elevations in urinary catecholamines). Behavioral inhibition is heritable (due to either genes or environment) and predicts the later onset of anxiety disorders.

Epidemiology. Between 6 and 20 percent of children have at least one major anxiety disorder before the age of 18. Many other children experience subclinical anxiety that does not meet DSM-5 criteria that still causes significant impairment. "Untreated anxiety leads to increased risk of additional anxiety disorders, depression, educational underachievement, and substance abuse in childhood and an increased risk of anxiety and depression in adulthood."

Diagnosis. Parents tend to overreport symptoms of externalizing disorders, while children tend to overreport symptoms of internalizing disorders. Two scales used for Generalized Anxiety Disorder: the Screen for Child Anxiety Related Emotional Disorders (SCARED) and MASC. For children with obsessive-compulsive symptoms: the Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS).

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Social Anxiety Disorder

Diagnostic Criteria:

1. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others -- e.g., social interactions, being observed, performing in front of others. (In children, the anxiety must occur in peer settings.)
2. The individual fears that he/she will act in a way or show anxiety symptoms that will be negatively evaluated. 
3. The social situations almost always provoke fear/anxiety. (In children, the fear/anxiety may be expressed by crying, tantrums, freezing, clinging, shrinking, or failing to speak in social situations.)
4. The social situations are avoided or endured with intense fear/anxiety. 
5. The fear/anxiety is out of proportion to the actual threat. 
6. The fear/anxiety/avoidance is persistent, typically lasting at least 6 months. 
7. The fear/anxiety/avoidance causes clinically significant distress or impairment in social, occupational, or other important areas of functioning. 
8. The fear/anxiety/avoidance is not attributable to the physiological effects of a substance or another medical condition. 
9. The fear/anxiety/avoidance is not better explained by the symptoms of another mental disorder, such as panic disorder, body dysmorphic disorder, or ASD.

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OCD

• Presence of obsessions, compulsions, or both. 
• Obsessions are (1) Recurrent and persistent thoughts, urges, or images that are experienced, at some time during the disturbance, as intrusive and unwanted, and that in most individuals cause marked anxiety or distress and (2) The individual attempts to ignore or suppress such thoughts/urges/images or to neutralize them with some other thought or action (i.e., by performing a compulsion). 
• Compulsions are (1) Repetitive behaviors (e.g., hand-washing) or mental acts (e.g., praying, counting) that the individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly and (2) The behaviors or mental acts are aimed at preventing or reducing anxiety or preventing some dreaded situation; however, these behaviors or mental acts are not connected in a realistic way with what they are designed to neutralize or prevent.
• The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment. 
• Not attributable to a substance or medical condition or another mental disorder.