Our three part Cerebra Anxiety Guide: A Guide for Parents has been developed to give up to date information on how to spot the signs of anxiety and anxiety disorders in children with an intellectual disability and looks at what can be done to help.
This is the second of a series of articles taking extracts from the Guide and will look at Anxiety Disorders. The full Anxiety Guide can be downloaded free of charge here.
Everyone experiences anxiety from time to time, particularly in response to difficult or stressful situations. However, this anxiety usually reduces with time or once the stressful situation is over. For example, children may experience anxiety when starting a new school but this gets better once they are used to their new surroundings. Anxiety starts to become problematic when it gets in the way of everyday life, when there is no obvious reason for the anxiety, when it is out of proportion to the threat of a situation, or when it continues for a long time.
When anxiety is identified as being problematic, a professional may diagnose an anxiety disorder. In the general population, anxiety disorders are known to affect around 3 in 100 children aged 5-16 years. In comparison, around 3-22% of children with an intellectual disability meet criteria for an anxiety disorder. Researchers are still trying to agree on these estimates, however, it is generally believed that individuals with intellectual disability are more likely to experience anxiety.
There are a number of different types of anxiety disorders, however, it is important to remember that every person is different and there are often cases where a person’s symptoms do not fit exactly with a specified disorder category, particularly when they have an intellectual disability. Therefore, a professional will sometimes diagnose an anxiety disorder without assigning a specific category. Some of the anxiety disorders are described below:
- Specific Phobias: The person has a very specific fear, such as a fear of objects, events or situations. This could be a fear of animals, doctors or heights for example. A person with a specific phobia will be anxious about situations where they may encounter the feared object or situation and they will try and avoid these situations.
- Generalised Anxiety Disorder: Unlike a specific phobia this is a non-specific anxiety about a variety of situations, including events that occur on a daily basis. People may find it difficult to control their anxiety and switch it off. In generalised anxiety disorder the focus of anxiety can change frequently and be quite fleeting.
- Social Anxiety Disorder: A person is fearful when faced with everyday social situations and settings, so experiences anticipatory anxiety about being in these situations. Often individuals will try to avoid social situations completely or may withdraw
- Panic Disorder: A person experiences attacks of extreme anxiety which occur unpredictably. During an attack a person’s heart rate may increase and they may feel as if they are struggling to breathe. This is often accompanied by anxiety of dying or losing control. A person who has panic attacks may experience anxiety about having another attack and avoid situations in which they have previously occurred. Panic attacks are fairly uncommon in children.
- Agoraphobia: A person experiences fear of open or public places that occurs across at least two settings. It is usually an anxiety of situations where escape would be difficult or embarrassing. Therefore, the person may avoid these places.
- Illness Anxiety Disorder: Individuals have heightened awareness and are anxious about having an illness despite the absence of a diagnosable condition. They may spend a long time checking out the possibility of having a health condition. This checking behaviour is part of the maintenance of the difficulty because it leads to a short-term reduction in anxiety; however, the person continues to believe that continuous checking is required to avoid a serious health condition.
- Obsessive Compulsive Disorder (OCD): The person is anxious about causing harm to themselves or others which leads to obsessive thoughts and compulsive rituals that they believe will reduce this threat (e.g. repeatedly washing hands or counting in specific patterns). These compulsions and rituals reduce anxiety in the short-term but means the person avoids being exposed to the perceived threat (e.g. germs) so their anxiety does not reduce in the long-term. It is important to remember that ritualistic/repetitive behaviours are often characteristic of people with an intellectual disability and/or genetic syndrome. This may mean that behaviours that look like symptoms of OCD may have other causes.
- Post-Traumatic Stress Disorder: PTSD develops after a distressing or traumatic event. Examples of this include an unexpected death of a loved one or being in a car accident. The person may experience flash-backs to the event and may try and avoid activities or situations that remind them of the trauma due to anxiety about experiencing these memories.
Anxiety Disorders in Intellectual Disability
The most common forms of anxiety disorders in children with intellectual disability are specific phobias and separation anxiety. Prevalence rates for both these disorders range between 2-18%. Social Anxiety is slightly less prevalent, with rates ranging between 1-5%. Rates for Panic Disorder, Agoraphobia and Generalised Anxiety Disorder are all reported to be below 2%. Around half of children who have an anxiety disorder are also diagnosed with a mood or other disorder. However, it is not yet fully understood how anxiety and other disorders are related and whether having one type of disorder increases the likelihood of another.
To read more about anxiety disorders, spotting the signs of anxiety, assessment and diagnosis and what can be done to help, download the full guide here.