Mrs Walitza, how do you recognise children's fears?

Mrs Walitza, anxiety is one of the most common mental disorders in children and adolescents. Do you notice this in everyday clinical practice?

Interestingly, we treat children and adolescents with ADHD more frequently, although twice as many children have an anxiety disorder that requires treatment. We know from surveys of school health services that around 30 per cent of pupils have anxiety, around 10 per cent of whom require clinical treatment.

How does this discrepancy come about?

In the past, anxieties and compulsions were grouped together for diagnostic purposes. In the case of anxiety and obsessive-compulsive disorders, we know that sufferers often wait up to eight years before seeking treatment for the first time. Children don't talk about their anxiety. In addition, a child with an anxiety disorder stands out less at school. In contrast to a child with ADHD, they behave in a calm and well-adjusted manner. Anxiety is an invisible illness. This leads to this gap between those affected and those receiving treatment.

How do children hide their fear so that they don't attract attention?

Let's take social phobia, which is common among young people: 70 per cent of anxiety situations take place at school. It is usually about what others think of the young person. They develop safety strategies to avoid the fear: For example, he only raises his hand when the teacher has already started to call someone out. He speaks quietly and thinks long and hard about how he can summarise an answer in a short sentence. So that he doesn't have to spend breaks with others, he pretends, for example, that he still has a homework assignment to hand in. These and other strategies are extremely stressful for the young person.

Can fears grow?

What grows on its own are developmental fears. They occur parallel to cognitive development. In the first year of life, for example, this is the fear of strangers - when the child suddenly realises that this is not my caregiver who is carrying me around. From the age of four to six, it's the monsters in the cellar, for example. Such fears come and go. But if the anxiety is excessive compared to peers and interferes with everyday life, then professional help is needed. If children are unable to fulfil their everyday tasks, they may miss out on important developmental steps. Untreated anxiety has a much greater impact on a child than on an adult.

Is the anxiety disorder in children different from that in adults?

Children usually have unspecific symptoms. They complain of abdominal pain, are lethargic or aggressive. The form also differs: generalised anxiety disorder is less common in children. Panic attacks are also less common. Separation anxiety is the most common anxiety in children.

The child's fear of being separated from its parents?

Yes, but the most important thing is the fear for the parents. If they are not at home, something could happen to them. Some children become aggressive in the separation situation, even towards themselves: They cling to their mum, pull their hair, scream.

I once had a child who wanted to bang his head against the wall when his mother was about to leave the room. You have to be able to endure that when you see it, and you have to help the mother and child to separate. Aggression can also mask fear, which is quickly interpreted as oppositional behaviour in boys. But there is a huge fear behind it.

And what do you do if a child wants to bang its head against the wall?

First, I separate the mother and child. It is important to let the mother know beforehand that the child will calm down as soon as she is outside. I have never experienced it any other way. You can also send the mother a mobile phone photo so that she can see that her child is happy again. If the separation takes place at home, we advise the parents or make home visits in an emergency. We treat in all variations, always individually. Sometimes parental counselling is enough.

And if not?

If the situation is complicated - for example, if the child has been truant from school for a long time and has multiple anxieties or even depression - the child may need to be hospitalised. We have a school where lessons are taught according to the curriculum. The child is then gradually returned to their home school.

Are there children whose character makes them more susceptible to anxiety disorders than others?

There are various factors that favour an anxiety disorder. In terms of character, sometimes the whole family is characterised by reserve and anxiety. There is also a biological vulnerability or susceptibility. It manifests itself in rather anxious behaviour and reticence when it comes to getting to know oneself and trying out new things.

How successful is the cure for anxiety disorders?

The prognosis is good. We complete the therapy as soon as the anxiety is reduced to such an extent that the child can perform everyday tasks and is stable. This refers to treatment with behavioural therapy. If only medication is used, the child will probably no longer be stable once the medication has been discontinued. Psychotherapy is always the first choice and medication is always used as part of multimodal treatment.

How long does therapy take?

This varies depending on the child and the type of anxiety. On average, therapy lasts around 20 hours. In the case of specific phobias, it is quicker if the anxiety situation can be practised easily. However, if the child is afraid of vomiting, for example, it is difficult to create a practice situation. In principle, the following applies: The earlier those affected receive treatment, the better the success of their recovery. But: It is never too late for therapy.