Anxiety is a chronic and exaggerated feeling of worry or tension, even if there is little or nothing to provoke it. It is an unpleasant and sometimes debilitating emotion that we experience when we are faced with some form of a problem, challenge, or possible disaster.
It is a normal reaction to stress and can actually be beneficial in some situations.
Everyone experiences anxiety on occasion, and children are no exception.
In children, anxiety usually comes in phases that are temporary and harmless.
But sometimes children experience fear, nervousness, and shyness on a regular basis, and they start to avoid places, people, and activities.
When a child’s anxiety becomes constant and interferes with daily functioning, it may indicate the presence of an anxiety disorder.
Anxiety Disorders in Children
Anxiety disorders affect one in eight children. Research shows that untreated children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences, and engage in substance abuse.
According to the Child Mind Institute’s Children’s Mental Health Report, 80% of kids with a diagnosable anxiety disorder are not getting treated.
Children who have anxiety are more likely to have teen depression. About half of depressed teens had a childhood anxiety disorder. And 85% of teens who have both anxiety disorders and depression had their anxiety disorder first.
Types of Childhood Anxiety Disorders
There are many different types of anxiety disorders, and each has different symptoms. But they all share one common trait: prolonged, intense anxiety that is out of proportion to the present situation and affects the child’s daily life and happiness.
Anxiety disorders can develop slowly over time, or can come on suddenly.
The following anxiety disorders can develop in children.
Generalized Anxiety Disorder (GAD)
If a child has generalized anxiety disorder (GAD), he or she will worry excessively about a variety of things such as their health and safety (or that of family members), grades, family issues, relationships with peers, and performance in sports. Children with GAD tend to be very hard on themselves and strive for perfection. They may also seek constant approval or reassurance from others.
Panic disorder is a condition characterized by repeated, unpredictable panic attacks that can cause feelings of impending death, heart attack-like symptoms, and a disconnection from reality. During a panic attack, a child may experience palpitations, sweating, shortness of breath, dizziness, and other physical symptoms, and an intense urge to flee the situation. Panic disorder is rare in childhood, but can appear in adolescence.
Separation Anxiety Disorder
Some children experience anxiety when they are separated from a parent or caregiver. It is normal in the very young (8 to 14 months old), and many children between 14 months and three years of age experience it when a parent leaves the room or is out of sight. Usually children can be distracted from these feelings.
It’s also common for a child to cry when first being left at daycare or preschool, and crying usually subsides after becoming engaged in the new environment. Many young children go through a phase when they are “clingy” and fearful of unfamiliar people and places.
But if a child is over age 6 and the fear is excessive, the problem could be separation anxiety disorder, which affects 4 percent of children and is most common in kids ages 7 to 9. Children with separation anxiety disorder experience an unrealistic and lasting worry that something bad will happen to them or their parent when they are apart. Often, children with the disorder will refuse to attend school in order to stay with their caregiver. Refusal to go to sleep without a parent, fear of being alone, nightmares about being separated, bed-wetting, and complaints about stomachaches or headaches on school days are also symptoms of separation anxiety disorder.
Separation anxiety often develops after a child experiences a significant traumatic or stressful event, such as an illness, loss of a family member, friend, or pet, moving, or changing schools. Over-protective parenting can also lead to separation anxiety. In fact, it may not necessarily be a disorder of the child, but a manifestation of parental separation anxiety as well – parent and child can feed the other’s anxiety. Children with separation anxiety often have family members with anxiety or other mental disorders, which suggests that a vulnerability to the disorder may be inherited.
Social Anxiety Disorder (Social Phobia)
Social anxiety disorder (or social phobia), is characterized by an intense fear of social and performance situations and activities such as being called on in class or starting a conversation with a peer. This can significantly impair a child’s school performance and attendance, as well as his or her ability to socialize with peers and develop and maintain relationships. Children with the disorder have an irrational fear of others’ judgment, which can cause them to either avoid anxiety-inducing situations or suffer through them with intense distress.
Children who are unable to or refuse to speak in situations where talking is expected or necessary, to the extent that their refusal interferes with school and making friends, may suffer from selective mutism (SM). Adults and peers often think the child is willful and refuses to speak, or to speak loud enough to be heard, but the child experiences it as an inability. It can cause severe distress for a child – even if they are hungry, need to use the bathroom, or are in pain, they can’t communicate.
Children suffering from selective mutism may stand motionless and expressionless, turn their heads, chew or twirl hair, avoid eye contact, or withdraw into a corner to avoid talking.
These children can be very talkative and display normal behaviors at home or in other places where they feel comfortable, so parents are often surprised to learn from a teacher that their child refuses to speak at school.
Specific phobias are easier to identify than most forms of anxiety in children because they are distinguished by fears of situations and objects that most people would find irrational. There are thousands of phobias, each with their own name, but the most common phobia anxiety disorder in children is social phobia. Children with specific phobias are not usually anxious in general; their symptoms appear when they are confronted with the thing they fear, such as dogs, blood, water, storms, clowns, insects, the dark, and medical procedures.
Children with phobias will go to great lengths, including lying and manipulation, to try to avoid the situations they fear.
Obsessive-Compulsive Disorder (OCD)
Obsessive-Compulsive Disorder (OCD) is characterized by unwanted and intrusive thoughts (obsessions) and feeling compelled to repeatedly perform rituals and routines (compulsions) to try and ease anxiety. Often, children with OCD realize these thoughts and behaviors are irrational. Unnecessary counting, arranging objects, and excessive hand washing are common signs of this anxiety disorder in children. It may be difficult for children with OCD to explain why they perform their rituals and say they do them “just because.” Most children with OCD are diagnosed around age 10, although the disorder can appear in children as young as two or three.
Post-Traumatic Stress Disorder (PTSD)
Children with post-traumatic stress disorder (PTSD) may have intense fear and anxiety, become emotionally numb or easily irritable, or avoid places, people, or activities after experiencing or witnessing a traumatic or life-threatening event.
People with PTSD often re-experience their trauma in the form of “flashbacks,” memories, nightmares, or scary thoughts, especially when they’re exposed to events or objects that remind them of the trauma.
Not every child who experiences or hears about a traumatic event will develop PTSD. It is normal to be fearful, sad, or nervous after such events, and many children will recover from these feelings in a short time.
Children most at risk for PTSD are those who directly witnessed a traumatic event, who suffered directly, had mental health problems before the event, and who lack a strong support network. Violence and conflict home also increases a child’s risk of developing PTSD after a traumatic event.
Diagnosing Anxiety Disorders in Children
If you suspect your child has anxiety that is beyond what is normal, seeking help is important because untreated anxiety disorders can have serious negative consequences on your child’s development and self-esteem, and can lead to more serious mental and physical health problems.
With treatment and support, children can learn to manage the symptoms of an anxiety disorder and live a normal childhood.
The first step in helping a child who may have an anxiety disorder is to speak openly with a healthcare provider. A family doctor or pediatrician will likely start with a complete medical history and physical exam. There aren’t any specific lab tests for separation anxiety, but your health care practitioner may use various tests – such as blood tests and other laboratory measures – to rule out physical illness or medication side effects as the cause of the symptoms.
If no physical illness is found, the doctor will likely refer you to a child and adolescent psychologist or psychiatrist for an assessment. Diagnosis will be based on reports of the child’s symptoms and his or her observation of the child’s attitude and behavior.
Treatment of Anxiety Disorders in Children
Psychotherapy is the main treatment approach for anxiety disorders in children. The focus of therapy is to help your child learn how to manage and overcome anxiety.
A type of therapy called cognitive-behavioral therapy (CBT) has been scientifically shown to be effective in treating anxiety disorders. CBT teaches skills and techniques that children can use to reduce and manage anxiety.
CBT helps reshape the child’s thinking so that behavior becomes more appropriate. The child will learn to identify and replace negative thinking patterns and behaviors with positive ones. He or she will also learn to separate realistic from unrealistic thoughts and will receive “homework” to practice what is learned in therapy. These are techniques that a child can use immediately and for years to come.
Family therapy also may help teach the family about the disorder and help family members better support the child during periods of anxiety. The therapist can work with the family to ensure progress is made at home and in school, and he or she can give advice on how the entire family can best manage the child’s symptoms.
In serious cases, antidepressants or anti-anxiety medications may be used to help manage severe cases of anxiety disorders in children. Experts say they should not be the only treatment; they should be used in conjunction with talk therapy.
Tips for Parents and Caregivers
The following tips can help you help children manage anxiety.
Pay attention to and acknowledge your child’s feelings. But, don’t empower irrational fears.
Stay calm. When your child becomes anxious, be a source of calmness for them.
Highlight the positive. Recognize and praise small accomplishments.
Don’t punish mistakes or lack of progress. Allow time for your child to learn to manage anxiety.
Be flexible. Try to maintain a normal routine, but understand that challenges may arise. Modify expectations during stressful periods.
Plan for transitions. For example, allow extra time in the morning if getting to school is difficult.
Talk to your child. Be an attentive listener and help them communicate how they are feeling.
Show genuine interest. Don’t assume you know how your child is feeling. Allow him or her to express it in their own words. Don’t rush the conversation.
Resist the urge to jump in and provide solutions. Instead, brainstorm ideas with your child. Problem-solve with them, not for them, when possible.
Help them keep things in perspective. What seems like a big deal today might not matter at all in a week.
Pay attention to how YOU react to stress. Be a good role model. The most powerful lessons we teach children are the ones we demonstrate.
Stop reassuring the child. When a child is experiencing anxiety, it will be very difficult for them to think clearly or logically. Instead of trying to talk them out of it, try the FEEL method from GoZen:
Freeze – pause and take some deep breaths with your child. Deep breathing can help reverse the nervous system response.
Empathize – anxiety is scary. Your child wants to know that you get it.
Evaluate – once your child is calm, it’s time to figure out possible solutions.
Let Go – Let go of your guilt; you are an amazing parent giving your child the tools to manage their worry.
Don’t avoid things just because they make a child anxious. This teaches avoidance rather than coping skills and can reinforce anxiety.
Don’t ask leading questions. Let your child explain what is bothering them.
Explain that everyone worries from time to time and it is normal. Anxiety can serve to protect us in times of possible danger.
Be compassionate with your child and yourself. Watching a child suffer from anxiety can be frustrating, painful, and confusing. Most likely, you didn’t cause your child’s anxiety, and most likely, you can help them overcome it.