Children who avoid scary situations likelier to have anxiety

The researchers developed two eight-question surveys: the Children's Avoidance Measure Parent Report and the Children's Avoidance Measure Self Report. The questionnaires ask details about children's avoidance tendencies, for instance, in addressing parents, "When your child is scared or worried about something, does he or she ask to do it later?" It also asks children to describe their passive avoidance habits. For example: "When I feel scared or worried about something, I try not to go near it."

One of the most surprising findings was that measuring avoidance could also predict children's development of anxiety. Children who participated in the study showed stable anxiety scores after a year had passed, but those who described avoidance behaviors at the onset tended to be more anxious a year later.

"This new approach may enable us to identify kids who are at risk for an anxiety disorder," says lead author Stephen Whiteside, Ph.D., a pediatric psychologist with the Mayo Clinic Children's Center. "And further, because cognitive behavior therapy focuses on decreasing avoidance behaviors, our approach may also provide a means to evaluate whether current treatment strategies work they we think they do."

In 25 anxious children surveyed following cognitive behavior therapy that slowly exposed children to the situations that caused fear, the avoidance scores from surveys of their parents declined by half. This likely indicates that part of the reason they're getting better is that they're no longer avoiding things, Dr. Whiteside says.

"Even after controlling for their baseline anxiety, those who avoided had more anxiety than kids who didn't avoid," Dr. Whiteside says. "That was consistent with the model of how anxiety disorders develop. Kids who avoid fearful situations don't have the opportunity to face their fears and don't learn that their fears are manageable."

Most children experience fears of one kind or another, but for some children those fears become heightened as part of an anxiety disorder. When children begin to avoid scary situations, anxiety disorders can become particularly disabling, preventing participation in everyday activities. Even though several methods exist to gauge children's fearful thinking and symptoms like feeling nervous, clinicians have had few tools until now to measure avoidance behaviors.

Dr. Whiteside is the developer of the Mayo Clinic Anxiety Coach, an iPhone app that helps individuals learn about anxiety, gauge and manage their symptoms, and make lists of activities to help them face their fears. The study was funded by Mayo Clinic Department of Psychiatry and Psychology.