Diagnosing Anxiety Disorders in Children vs. Adults

Anxiety disorders include a spectrum of mental health conditions marked by persistent fear, worry, and changes in behavior. They’re one of the most common mental illnesses in the US, affecting one in every five adults.

Although the core features of anxiety remain consistent across age groups, the way symptoms present can differ significantly between children and adults.

This article explores the differences and similarities in diagnosing anxiety disorders in children vs. adults, backed by scientific literature and clinical studies.

Types of Anxiety Disorders

Anxiety disorders, as outlined in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), cover a range of conditions that involve intense fear, worry, or behaviors that stem from those feelings. These disorders include:

• Separation Anxiety Disorder: This is characterized by overwhelming fear or distress when separated from loved ones or primary caregivers.
• Selective Mutism: Inability to speak in specific social situations despite being able to communicate effectively in other settings, like at home.
• Specific Phobia: Refers to an intense and irrational fear of specific objects, situations, or activities, such as a fear of heights (acrophobia) or spiders (arachnophobia). Specific phobias fall into five categories:

• Social Anxiety Disorder: Previously known as social phobia. This involves extreme fear of social situations due to concern about being judged, embarrassed, or humiliated.
• Panic Disorder: Characterized by abrupt, recurring panic attacks with physical symptoms like heart palpitations, dizziness, or shortness of breath.
• Agoraphobia: Fear and worry of being in situations where escape might be difficult like crowded places or public transportation.
• Generalized Anxiety Disorder (GAD): Involves persistent and uncontrollable worry about work, relationships, health, and other aspects of daily life.
• Substance/Medication-Induced Anxiety Disorder: Anxiety that develops as a direct result of substance use, withdrawal, or exposure to certain medications.
• Anxiety Disorder Due to Another Medical Condition: Fears and worries that are linked to a medical condition like thyroid issues or heart disease.

If you meet most but not all the criteria for a specific anxiety disorder, you might be diagnosed with “other specified anxiety disorder.” If doctors don’t have enough information to make a full diagnosis, they might call it “unspecified anxiety disorder.”

Anxiety Disorders in Children, Adolescents, and Adults

Anxiety disorders can start earlier than you might think, often around the age of 10. Epidemiological data reveals two periods in life when new cases of anxiety disorders are most common:

• 10 to 14 years old: Suggesting anxiety often starts in adolescence.
• 35 to 39 years old: Indicating another period of increased vulnerability in adulthood.

Another research that looked at data from 14 studies and 7,443 participants also found the average age when different types of anxiety disorders usually start:

These patterns emphasize that anxiety disorders can develop at any stage of life, with certain types more likely to appear during specific phases.

Developmental Stages of Anxiety Disorders

Most anxiety disorders often start in childhood or early adolescence. If not treated, these disorders can become chronic and have a high likelihood of recurring over time.

Early Infancy (Within the First Weeks to 6 Months)

During early infancy, it is normal for babies to exhibit a fear of losing physical contact with their caregivers. Additionally, they may react to loud noises or other strong sensory stimuli, such as bright lights, which can startle them.

These fears are typical at this stage and do not usually indicate any psychological issues.

Late Infancy (6-8 Months)

As infants grow, they begin to show signs of shyness or anxiety when interacting with strangers. This fear, commonly referred to as "stranger anxiety," is a normal part of development as babies learn to differentiate between familiar and unfamiliar faces.

In some cases, extreme or prolonged fear around strangers may indicate early signs of separation anxiety disorder. However, for most infants, these fears fade naturally as they gain confidence and familiarity with their surroundings.

Toddlerhood (12-36 Months)

Between 12 and 18 months, many toddlers experience separation anxiety, where they become distressed when separated from their parents or caregivers. This is a natural stage of development, but in some children, this may escalate.

By ages 2 to 3 years, fears of thunderstorms, darkness, water, and nightmares often emerge. These fears are linked to a toddler's expanding imagination and limited ability to differentiate between reality and fantasy.

Some toddlers also develop fears of animals, which is another typical response to unfamiliar or unpredictable stimuli. For most toddlers, these fears resolve with time and reassurance. However, if the fears cause extreme avoidance or distress, they might develop into specific phobias, such as an intense fear of animals or environmental stimuli.

Early Childhood (4-5 Years)

Around the ages of 4 to 5, children begin to comprehend the concept of death, which may result in fears of dying or seeing dead people. These existential fears reflect a child's growing awareness of the world and their own vulnerability.

While these fears are normal, they can sometimes become overwhelming and may develop into generalized anxiety disorder or panic attacks if left unaddressed.

Primary/Elementary School Age (5-7 Years)

During the early school years, children may experience a range of specific fears, such as:

• Animals
• Monsters or ghosts
• Getting serious illness
• Natural disasters or accidents

In addition to these fears, many children begin to experience performance-related anxiety, such as worrying about schoolwork or social interactions.

Adolescence (12-18 Years)

As children transition into adolescence, their fears often center around social interactions and peer acceptance. Adolescents may become highly sensitive to rejection or judgment from peers, which is a natural part of their social development.

For some teens, these fears may intensify, leading to social anxiety disorder. This stage is particularly important since adolescents with anxiety disorders are 2 to 3 times more likely to have anxiety disorders as adults.

Adulthood

Anxiety disorders in adulthood often develop through a combination of genetic, environmental, and psychological factors. Early life experiences, such as childhood trauma, social isolation, and stressful life events, can increase vulnerability, especially during the teenage years and early adulthood.

A study from 2014 found that adolescent-onset anxiety disorders led to more negative psychosocial outcomes at age 30 than those that began in childhood. These included:

• Daily responsibilities
• Poor work performance
• Family conflict
• Low life satisfaction
• Difficulty coping with stress
• Increased risk of substance abuse, alcohol problems, and recurring anxiety in adulthood

Diagnosing Anxiety Disorders in Children vs. Adults

Source: Pexels

Because anxiety manifests differently across developmental stages, diagnosing anxiety disorders in adults and children is not the same.

According to the latest update from the Diagnostic and Statistical Manual of Mental Disorders (DSM), here’s how anxiety disorders are diagnosed in children vs. adults:

1. Social Phobia or Social Anxiety Disorder

In adults, social phobia is typically diagnosed when an individual experiences intense fear or anxiety in social or performance situations, fearing they’ll be judged or embarrassed.

In children, DSM-5 specifies that the anxiety must also occur in peer settings, not just around unfamiliar adults.

For instance, if a child is only afraid of speaking to adults, like teachers or strangers, they may not meet the full criteria. But if the fear also involves interacting with other children, such as during recess or group work, it’s more likely to qualify for a diagnosis.

Additionally, children often lack the vocabulary or self-awareness to articulate social fear. So, their anxiety may manifest behaviorally, through:

• Crying
• Throwing tantrums
• Freezing or shutting down
• Clinging to parents or caregivers
• Refusing to speak (selective mutism sometimes overlaps)

These behavioral cues are considered acceptable signs of social anxiety in children, unlike adults, who must express a recognition of their fear as unreasonable or excessive.

In both children and adults, symptoms are expected to persist for around six months or longer.

2. Generalized Anxiety Disorder (GAD)

In adults, DSM-5 requires at least three of the following symptoms for a GAD diagnosis:

• Restlessness
• Fatigue
• Difficulty concentrating
• Irritability
• Muscle tension
• Sleep disturbance

However, for children, the diagnostic threshold is lowered to only one of those symptoms.

In both cases, the symptoms must show up on most days for at least six months. The worry must involve several aspects of daily life, such as school, work, or relationships, and the person must find it difficult to manage or control these worries.

3. Separation Anxiety Disorder (SAD)

In the updated diagnostic criteria, the requirement for symptoms to begin before age 18 was removed. The “Early Onset” specifier, for cases starting before age 6, was also dropped. These changes were made to acknowledge that SAD can occur in adults, not just in children and adolescents.

To meet the criteria, the individual must show at least three of the following signs:

• Repeated, intense distress when facing or anticipating separation from home or major attachment figures.
• Ongoing worry about losing those figures or something bad happening to them, like illness or accidents.
• Fear of events (e.g., getting lost, kidnapped, or injured) that could lead to separation.
• Refusing to leave home, whether for school, work, or other activities, because of separation fears.
• Reluctance to be alone or without attachment figures, even in familiar places.
• Refusal to sleep away from home or without being close to a loved one.
• Nightmares centered around themes of separation.
• Physical complaints (like stomach aches, headaches, nausea, or vomiting) that occur before or during separation.

The main difference is that in children and teens, they should last at least four weeks. In adults, they typically need to persist for six months or more.

Anxiety Disorders Without Age-Specific Diagnostic Differences

Some anxiety disorders have the same diagnostic criteria for children, teens, and adults. This is usually because the disorder is rare in children or, in some cases, less common in adults.

As a result, the diagnostic framework doesn't include age-based distinctions. However, if clinical evidence and patterns of presentation begin to shift, these criteria can evolve over time, just as they did with SAD.

These include:

1. Panic Disorder

As noted earlier, panic disorder usually begins in adulthood. It is rare in young children, with some studies reporting that fewer than 0.5% of those under 12 experience it.

The diagnosis of panic disorder includes at least one panic attack, followed by one or both of the following (experienced for at least a month):

• Ongoing worry about having more attacks or their effects
• Major changes in behavior to avoid having another attack

Meanwhile, a panic attack is a sudden period of intense fear or discomfort that peaks within minutes. It must include at least four of the following symptoms:

• Fast or pounding heartbeat
• Sweating
• Trembling or shaking
• Shortness of breath or feeling smothered
• Feeling like choking
• Chest pain or discomfort
• Nausea or stomach upset
• Dizziness or lightheadedness
• Feelings of unreality (derealization) or detachment from oneself (depersonalization)
• Fear of losing control or “going crazy”
• Fear of dying
• Numbness or tingling
• Heat sensations

2. Agoraphobia

Agoraphobia is rare in children but may begin during the teen years, especially if the person has experienced panic attacks.

The diagnosis involves fear or anxiety about two or more of the following situations:

• Using public transportation
• Being in open spaces
• Being in enclosed places (like shops or theaters)
• Standing in line or being in a crowd
• Being alone outside the home

This fear or avoidance must last for six months or longer.

3. Selective Mutism

Selective mutism is a rare anxiety disorder that usually starts before age 5. The criteria for diagnosis include:

• A consistent inability to speak in certain social settings (like school), even though the child speaks in other situations.
• The silence causes problems in school, work, or social life.
• The issue lasts for at least one month (not just during the first month of school).
• The child understands and is comfortable with the language used in the setting.
• The silence is not caused by another communication disorder.

In most cases, children naturally grow out of selective mutism.

Summary

Anxiety disorders can affect people at any age and show up in different ways depending on the stage of life. Some start in early childhood, like separation anxiety or selective mutism, while others, such as panic disorder or generalized anxiety, tend to appear later. Each disorder has its own symptoms and diagnostic rules, which can vary between children and adults.

Understanding when and how these disorders typically develop can help in spotting them early and getting the right treatment. Recent updates to diagnostic criteria, like recognizing separation anxiety in adults, make it easier to get an accurate diagnosis at any age. Early recognition and support are essential to managing symptoms and improving long-term outcomes.

Frequently Asked Questions

How do I know if my child has anxiety?

You might notice changes in their behavior or mood. Common signs include frequent headaches or stomach aches without a clear medical cause, trouble sleeping, irritability, avoidance of social situations, clinginess, or sudden school refusal. Younger children might cry, freeze, or throw tantrums when triggered. If these behaviors persist for weeks and interfere with your child’s daily life, you should speak with a pediatrician or child psychologist for evaluation.

How are anxiety disorders different from normal stress or worry?

Everyday stress is usually short-lived and tied to specific situations. Meanwhile, anxiety disorders involve persistent, excessive fear or worry that interferes with daily functioning, even when there’s no clear threat.

Which treatments are used for anxiety disorders?

Treatment can include therapy (like cognitive-behavioral therapy), medications (such as SSRIs or benzodiazepines), lifestyle changes, or a combination of these. The best approach depends on the type of anxiety disorder and the individual’s needs.