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 Interview With Ron Rapee
Childhood Anxiety Disorders

Ron Rapee is a Clinical Psychologist (B.Psych M.Psych PhD)) who specialises in Anxiety Disorders.
He works with children who develop an Anxiety Disorder. He currently Director of a Child and Adolescent Anxiety Clinic.

Q. What are the statistics for childhood anxiety in Australia?

A. There is no data on the prevalence of anxiety disorders in children in Australia. However, there is data from New Zealand and the USA and there is no reason to believe that Australia should be dramatically different. Overall, anxiety disorders are as common, or more so, as so-called oppositional and conduct disorders combined. In other words, as a group, anxiety disorders are the most common problems in children and adolescents. In fact, one recent study of 13-18 year old Dutch adolescents, found that the two most common disorders of all were simple phobia and social phobia, being diagnosed in 12% and 9% respectively. In that study, a diagnosis of any anxiety disorder was found in 24% of the sample, while disruptive disorders were found in only 8%, mood disorders in 7%, and substance abuse in 4%. Despite the fact that suicide and drug abuse grab all the publicity, anxiety is far more common.


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Q. At what age can a child develop an anxiety disorder?

A. There is no particular age, but anxiety and fears are often obvious from a very early time. Obsessive Compulsive Disorder (OCD) is seen in children as young as 5. Specific phobias, such as phobias of spiders, the dark, dogs, etc. are common in young children anywhere from 7-9 years.

Social fears and shyness can often show signs from very early ages - 5,6, or 7 and up, even though this problem then often becomes more common and more intense in the teenage years. Separation fears are more common at younger ages, and become obvious whenever separation from a care giver is begun (say, with the beginning of school, or even day care).

The main disorder which is not typically seen in young children is panic disorder. Panic attacks are very rare in young children, become a little more seen in adolescents (although still not common) and are most likely to begin in the 20's. One of the main issues, however, is to distinguish what we might call an actual "anxiety disorder" from a general tendency to be anxious. Researchers have found that it is possible to identify children as early as 18 months who show anxious behaviours that increase the chances of developing later anxiety disorders. These children who are high on what is called an "anxious temperament" show crying, clinging, and avoidance in the face of new, or unusual events. They are shy with strangers (more than the average) and are slow to warm up in groups.

So, in a sense we can say that anxiety is a general personality style and a life-long pattern that can be seen to some extent very early. At Macquarie University we are just beginning a large research project to examine the effectiveness of teaching parents of high anxious temperament 4 year old children strategies to help their child control his or her anxiety. In the next one to two years we can begin to report on how this has gone.

Q. How can a parent tell if their child has an anxiety disorder?

A. Most parents will know if their child has a problem with anxiety. Anxious children fear particular things (e.g. other people, separation) and this fear is more than is seen in other kids of their age. Anxious children will talk about their fears if asked, so as parents we need to ask and listen. They will describe worries just like adults do and will avoid situations and activities. The bottom line is to ask yourself whether the degree of anxiety that your child shows is interfering with his or her life - is it reducing opportunities, is it reducing academic work, is it interfering with friendships or social activities? If so, then it would be good to do something about it. Whether it is technically called an "anxiety disorder" or not, is irrelevant.

Q. What are the factors that contribute to development of an anxiety disorder?

A. We don't know all the answers to this yet and there are obviously many factors that go to make an individual that we may never fully understand. But research is beginning to uncover some factors that seem to increase the chances of developing an anxiety disorder. First, there is a particular personality or temperament. This is probably largely a genetically based component. Some people are simply born more sensitive, caring, and emotional than others. This obviously has some good aspects to it, but the down side is that these people are at increased risk for later problems with anxiety and depression. Anxious children often have at least one parent who is also anxious. Parenting is a big factor in a child's life and it is very likely that this is also involved in some ways. Our own research is beginning to show that parents of anxious children are more involved in their child's life and are more controlling and protective. This stems out of a basic love for their child and a response to their anxious child's cries for help. But when it happens, it can help to reinforce and increase the anxiety by giving the child the message that the world really is a dangerous place and that she or he is not competent to handle it. Children also learn a great deal from watching their parents. So if a parent of an already anxious temperament child, acts in an anxious way themself, then the child will learn from this and it might exaggerate their natural anxious style. Friends and relationships at school and elsewhere could possibly also maintain and increase anxiety in a child in much the same way as overprotective parenting. Finally, there are also many individual experiences that can trigger anxiety disorders. These include life stresses, traumatic experiences, and specific learning experiences. For example, being bitten by a dog may produce a fear of dogs in someone who is already vulnerable to an anxiety disorder due to the factors we discussed above.

Q. What is the difference between an anxiety disorder and separation anxiety?

A. Anxiety disorder is a broad term that simply refers to any of several different disorders. Separation anxiety disorder is one of these. The most common anxiety disorders in children and adolescents are simple phobias (e.g. fears of the dark, dogs, etc.), separation anxiety disorder, social phobia, and generalised anxiety disorder. Obsessive compulsive disorder is less common but is certainly seen in a sizable number. Post-traumatic stress disorder, of course, is seen in specific groups - those who have been through some type of trauma, such as sexual abuse, car accidents, assaults, etc. Panic disorder is very rarely found below the age of 16.

Anxiety disorders are not some type of "craziness" or "disease". Aspects or features of all anxiety disorders are found in all people. So anxiety disorders differ from non-disordered anxiety only in degree. Therefore, how we decide if someone has an anxiety disorder is a matter of where we draw the cutoff - and this is largely arbitrary. All children will go through stages of very normal fears and anxieties. At around 1-2 years, all children will show strong fears of strangers and separation. A little later, fears of the dark will begin. Therefore, whether a child has "normal" separation fears or separation anxiety disorder, is a largely arbitrary decision and one which is probably not that important. The important decision is simply whether a child's degree of fear is so much that it seems to interfere with his or her life. In this case, it may be worth getting help to reduce this fear, regardless of whether one would technically call it a disorder.


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