Throughout childhood and adolescence, kids have plenty to worry about - from the monster in the closet to what classmates are wearing to school. Fear, worry and anxiety are all part of growing up; that's why it's seldom easy to detect those who fret too much.

One study of 800 children, ages 7 to 11 years old, found that about 9 percent had an anxiety disorder that put a serious crimp in their lives. Large surveys have found a prevalence of 12 to 20 percent. At least a third of children with an anxiety disorder also have other psychiatric problems such as depression, a behavior disorder or substance abuse, and at least some of their problems likely are to follow them into adult life.

Fear and worry are normal, of course. Preschoolers are afraid of objects and situtions - both real and imaginary. Grade school students may worry about physical dangers or a trip to the dentist while adolescents are concerned with their image and how well they do on examinations and extracurricular activities.

Anxiety becomes a problem when it is inappropriate for a child's age - a sixth-grader fearing the dark, for example - and when it interferes with daily functioning. Children with anxiety disorders usually don't do well at school or in social activities because they are preoccupied or withdrawn.

Separation anxiety occurs in younger children while adolescents are more likely to have generalized anxiety disorder, panic disorder or obsessive compulsive disorder. Phobias, which can occur at any age, are less serious but sometimes troubling. Nearly all disorders respond readily to treatment, but early recognition is important to avoid persistent negative consequences.

Phobias

A simple phobia, such as a fear of snakes, is no problem if you're unlikely to come in contact with a snake. Even a fear of flying need not be a handicap if you're willing and able to use alternative forms of transportation.

Fear of public speaking, the most common phobia for adolescents, on the other hand, can create problems in the classroom or lead a child to pass up opportunities to participate in school plays, mock trial or debate.

Nearly everyone gets butterflies speaking in front of a crowd, of course, but the nervousness goes away with a little successful practice. For a student who is having trouble completing class assignments because of a public speaking phobia, behavioral therapy usually is all that's needed.

Fear of public speaking often is part of a more disabling problem - social phobia or social anxiety disorder. More than simply shy or unsociable, youths with social phobia are intensely anxious about a number of social situations - public eating, test taking, public writing, attending parties, using public rest rooms, speaking to authority figures or simply informal conversations.

While shyness in a child is nearly always noticeable, a child with social phobia may in some cases actually overrepresent her friendships and social activities but become ill or develop vague excuses when faced with a social situation. If untreated, social anxiety may lead to depression, conduct disorders or substance abuse.

Social phobia can be treated with cognitive behavioral therapy, which focuses on examining and changing the thought processes that lead to anxiety and developing coping skills to overcome them. Some studies also have found SSRI antidepressant medications effective in treating social anxiety in both adults and children.

Separation anxiety

This is common among elementary age children, often in the form of "school phobia." On starting third grade, Andrew became very distressed and begged to stay home. He claimed he was worried that he wouldn't be able to find his way to the bathroom, but he admitted he had no rational reason to fear going to school.

With some careful work by teachers and parents, Andrew's anxiety was lowered without reinforcing the school but may require treatment. Some children leave school without permission or withdraw in the classroorn, unable to function.

Other examples of separation anxiety include children who are unable to go to bed alone or insist on steeping with their parents. Some want to keep constant track of their parents, asking to call them from school or being unable to spend the night with friends. Catering to the child's wishes is no good, but getting angry also is counter productive.