Welcome to our Summer Blog Series examining the impact of anxiety disorders on church participation and spiritual development in kids. Today, we’ll look at some of the causes of anxiety disorders in children and youth.

Multiple risk and protective factors contribute to the experience of anxiety in any given child.

Genetics clearly play an important role in the development of anxiety. Children of parents with anxiety disorders are more likely to develop anxiety disorders. These effects occur independently of parenting style or family environment.

Temperament, also described as a child’s natural predisposition plays an important role in the development of anxiety. Children who are more shy and inhibited are at greater risk of experiencing anxiety. Such effects may be further mediated by activation or inhibition of other circuits in the brain.  Persons with social anxiety experience activation of the amygdala, one of the structures in the brain that makes up the limbic system, a brain circuit involved in the regulation of emotion. As a result, they are often prone to overreact to relatively innocuous social cues.  Anxious children also experience a failure of the brain’s prefrontal cortex to accurately assess the level of risk in a given situation. The end result is a child who interprets risk differently than their peers and experiences fear in situations that most of their peers tolerate.

The neurochemistry of anxiety is extraordinary complex. At least six different neurotransmitter systems in the brain demonstrably contribute to anxiety symptoms. Neurotransmitters are chemicals responsible for transmitting electrical impulses from one cell to another in the nervous system. An increase or decrease in the activity of one neurotransmitter system impacts the activity of all of the other systems.  Medications used to treat anxiety typically increase the activity of one primary neurotransmitter system.  Neurotransmitter systems involved in learning modulate the activity of systems associated with anxiety and vice versa.  To further complicate matters, another set of proteins collectively referred to as neuropeptides affect both memory and anxiety while functioning as hormones in other parts of the body.

Parents can model inappropriate responses to anxiety-provoking situations for their children and unintentionally reinforce maladaptive coping strategies and patterns of avoidant behavior. Children who on the basis of temperament are vulnerable to anxiety are more prone to the effects of overprotective, excessively critical and controlling parenting styles.

Children with insecure attachment relationships with caregivers (especially at risk are adopted children and children who have experienced significant trauma, neglect or abuse during critical stages of development) are at greater risk of developing anxiety disorders in childhood.

Anxiety symptoms may also be caused by a variety of medical conditions. Parents should consider having their child seen by their pediatrician or family physician to rule out such potential causes of anxiety, even in situations when mental health intervention is being pursued.  Such conditions include, but are not limited to hyperthyroidism, asthma, seizure disorders, migraine headaches and lead intoxication.

In my practice, one of the most common precipitants to anxiety symptoms is stimulant medication prescribed for the treatment of ADHD.

ADHD symptoms may play a protective role in mitigating against anxiety in kids with both conditions. One common therapy strategy used in working with kids with anxiety is to train them to distract themselves or to substitute other more pleasant thoughts when struggling with fears or obsessions. Kids with ADHD are naturally distracted by their inner thoughts and external circumstances. As a result, they are less likely to perseverate on a specific thought or fear. When they are started on medication for ADHD and become less distracted in response to the medication, they often become intensely more aware of bothersome or intrusive thoughts and experience far more difficulty ignoring or letting go of those thoughts.

Whenever I’m asked to see a child who has become more moody, irritable or emotional while being treated with ADHD medication, I ALWAYS ask detailed questions about anxiety symptoms.

Other prescription medications associated with anxiety-like symptoms include medications prescribed for asthma, guanfacine and atomoxetine. Anxiety is a potential side effect associated with many prescription and over-the-counter medications, including cold medications, antihistamines and diet pills. Energy drinks with high caffeine content are an increasingly popular precipitant to anxiety symptoms among teenagers.