Anxiety In Kids: What You Absolutely Need To Know

Millions of kids silently suffer with unrecognized, treatable anxiety. For years. Don’t let the child you love be one of them. Find out what you need to know about anxiety in kids today.

Anxiety disorders are are the most common mental health disorder in children. More common than ADHD or depression. Some reports indicate that up to 30% of kids experience some degree of troubling anxiety, and that 10% to 15% or more of children experience a full-blown anxiety disorder before the age of 18. But, despite the frequent occurrence, 80% of kids with an anxiety disorder do not receive treatment. That’s millions of kids and millions of families.

WHAT IS ANXIETY?

We often think of anxiety has something negative. And it’s commonly associated with descriptions like intense apprehension or fear; mental distress; nervousness; uneasiness and worry. All fairly negative things.

But some level of anxiety can have positive benefits as well. Anxiety can be motivating. It can provide extra fuel to reach a goal or avoid a consequence. And, some level of anxiety is a normal part of moving through life. Indeed, it’s baked in. Think of the basic “fight or flight” response that we know so well. At normal levels, basic anxiety can keep us safe, healthy and whole.

But anxiety can become excessive. Either in intensity, frequency, duration, or all of the above. Then, it crosses the line into debilitating. And, it significantly interferes with the ability to function and enjoy your day.

DISTINGUISHING NORMAL CHILDHOOD ANXIETY FROM ANXIETY DISORDER

All kids experience anxiety. Whether it’s being scared of the dark, or worrying about a bogeyman in the closet. Those types of worries tend to fade with age. Unless they don’t. And, for some kids those fears and worries take root and grow. The anxiety grows out of proportion to anything that’s actually being experienced. And, it interferes with a kid’s ability to function in her daily life. Interfering with school, play, social activities and family relationships.

We all recognize that the “fight or flight” response is a survival mechanism baked into the human condition. It’s our physiological and psychological response to danger. That moment when we have to assess and decide whether it’s better to beat back or to beat it. Our body floods with hormones. Preparing us to address the dangers at hand. But, in the case of an anxiety disorder, the perceived danger doesn’t actually warrant such a response, or may not even exist at all.

SYMPTOMS OF ANXIETY DISORDER

So why does anxiety in kids so often go untreated? It can be hard to recognize. Many kids suffer in silence. Not doing anything on the outside that calls attention to themselves, but twisted with worry and turmoil on the inside.

Even when a child develops an actual anxiety disorder that interferes with relationships and activities, it can still exist undetected. Impaired functioning can still look like functioning. Indeed, some kids with anxiety disorders may appear to be very high functioning in many areas of their lives.

Just like some learning differences can make it more difficult, but not impossible, for kids to learn, an anxiety disorder can make it more difficult, but not impossible, to function. Everything may just be much harder than it really needs to be. Much harder. So, for instance, homework could take two or three times longer than it should.

Or, a child may continue to go through the motions of certain social or recreational activities but take no actual enjoyment from them.

Common Symptoms of Anxiety in Kids

Rapid heart rate.
Breathlessness.
Frequent headaches, stomach aches, or similar complaints without any apparent cause.
Excessive crying.
Intense worries almost every day for weeks or months.
Worrying about things long before they happen.
Recurring thoughts and fears about physical safety of loved ones.
Reluctance or refusal to go to school.
Can’t concentrate.
Irritability.
Sleeplessness – either can’t fall asleep or can’t stay asleep. Can be followed by excess sleeping during the day.
Frequent nightmares and sleep disturbances.
Inability to relax.
Frequent restlessness.
Frequently clenches or tenses muscles.
Extreme perfectionism: Always needing everything to be “perfect”; or, always assessing blame and pointing fingers at others.
Seeks isolation.

Signs of Anxiety in Kids You Could Be Missing

Many times a child’s behavior may be disturbing in some way, but grownups don’t associate it with anxiety. This is particularly true when it comes to disruptive behaviors like tantrums or defiance. Kids experiencing intense anxiety often engage in avoidance behavior. And sometimes that avoidance behavior can be a defiant pushing away, rather than a fearful running away. And anxiety can also be expressed as disruptive behavior when a child lacks the language or language skills to express his concerns.

Also, sometimes anxious kids feel out of control and defiant or oppositional behavior can be their attempt to create control.

TYPES OF ANXIETY DISORDERS IN CHILDHOOD

Kids can experience different types of anxiety disorders. And, experts characterize anxiety in different ways based on the source of the anxiety or how the anxiety presents.

GENERALIZED ANXIETY DISORDER (GAD)

With Generalized Anxiety Disorder (GAD), kids essentially experience continuing anxiety about a range of everyday topics small and large. The worries are excessive and beyond their ability to control.

The worries arise on nearly a daily basis and involve a variety of different topic (in other words, not fixated on one issue). They range from concerns about academic performance, relationships, and family health, to natural disasters, terrorism and global warming.

Children with a generalized anxiety disorder may also experience physical symptoms, such as headaches, abdominal pain, and muscle aches and pains.

Anxiety arising from GAD can be distinguished from typical worry in its excessiveness, duration and lack of any obvious triggering event. Kids with generalized anxiety often worry particularly about school performance and can struggle with perfectionism. They can be very hard on themselves and frequently seek out external approval and reassurance.

SEPARATION ANXIETY DISORDER

Typically, infants, toddlers or young children have some degree of separation anxiety when they are away from their parents or known caregivers. But when such anxiety continues past an age appropriate level, it could be a separation anxiety disorder.

So, for instance a child who is seven or eight who has excessive anxiety about being separated from parents or his home. Or, who continues to cry or cling physically to parents when departing, he may have separation anxiety disorder.

SELECTIVE MUTISM

Sometimes a child’s anxiety will prevent him from speaking in situations where he feels uncomfortable. Such a child can speak freely at home or in familiar surroundings, but consistently fails to speak in some situations where talking would be expected. Such as at school, or a play date, or when participating in a group activity.

In addition to not speaking, a child with selective mutism may also fail to make eye contact or turn his head away. He may physically withdraw to avoid talking. By standing in a corner, or against a far wall. Or, he may stand motionless like a statute.

Grownups often overlook selective mutism because they think they’re just dealing with a really shy child. But, when the failure to speak interferes with school and social activities, it can actually be an anxiety disorder.

SPECIFIC PHOBIA

Phobias involve intense anxiety triggered by a specific object, event or situation. The phobic anxiety will be excessive, unreasonable in relation to whatever is triggering it, and it will be something that significantly interferes with the child’s regular life activities.

Some examples of common phobias for kids include animals, insects, needles, storms, and loud noises. Or, heights, tight or enclosed spaces, swimming and blood. Typically, the child won’t recognize that the fear is irrational or unreasonable.

Kids will usually attempt to avoid the item or situation that triggers the phobia. But, when faced with the trigger, her reaction may include freezing up, clinging to someone present, or crying and tantrums. Or, reactions could be more subtle like headaches and stomach cramps.

PANIC DISORDER

We probably all know what a panic attack is. And may have even had occasion to experience one (or more). Typical symptoms of an attack include physical symptoms such as racing heart, chest pains, breathing difficulty, nausea, dizziness and choking sensation.

They may also include emotional and psychological symptoms like an intense feeling of impending doom, or strong urges to escape from something. Or, fear of approaching death or feeling insane.

But an actual panic disorder involves more than an isolated panic attack.

It also involves persistent worrying, for a month or more, that more panic attacks will come and/or worrying about what will happen if another panic attack strikes.

SOCIAL ANXIETY DISORDER

Kids who suffer from social anxiety disorder have an intense fear of engaging in a social or public situation that could result in them being humiliated, harshly judged, or rejected. This debilitating level of fear may prevent someone from engaging in social activities at all, or in taking any actions that will call attention to themselves. Like raising a hand in class. They may also avoid engaging with peers or interacting with people in authority.

Kids with this condition are excessively self-conscious. They may have an excruciating level of concern about how others perceive their physical presence in the world. Concerns about whether something will make them blush, whether they are stumbling over words, or how their voice sounds. Or, they may frequently worry that someone is looking at them in a bad way.

As with selective mutism, social anxiety in children goes far beyond simple shyness. It involves an intense fear of social situations or categories of social or public situations that substantially interfere with regular functioning.

Children with social anxiety disorder are at strong risk of developing depression or substance abuse issues as they get older.

ANXIETY’S CLOSE COUSINS

For many years, the mental health community characterized both obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD) as different types of anxiety disorders. However, each of them now has its own separate category in the DSM-5. Nevertheless, both conditions still involve some component of intense anxiety.

OBSESSIVE COMPULSIVE DISORDER

Kids with OCD experience recurring negative thoughts, fears or emotions that make them anxious and uncomfortable. And they try to control or neutralize those unwanted thoughts and related anxiety using some type of ritualized behavior that’s repetitive in nature.

A classic example of this would be excessive and/or repeated hand washing. Other examples include repeatedly checking to see that the doors are locked. Or, they can include things like hair pulling, skin picking and hoarding. These rituals can become disruptive and interfere with daily functioning.

For more information about childhood OCD, check out the brochure How to Help Your Child: A Parents’ Guide to OCD.

POST TRAUMATIC STRESS DISORDER

Sometimes kids who experience or witness a traumatic event can develop Post Traumatic Stress Disorder (PTSD). PTSD in kids can often be associated with traumatic events such as major car accidents, physical violence, violent crimes, catastrophic accidents, sexual abuse, or disasters arising from natural phenomena or acts of terrorism.

PTSD symptoms develop after a disturbing event and continue for a substantial period of time afterwards (as in several months, not days). Common symptoms can include:

Nightmares or flashbacks.
Reenacting the traumatic events in play activities.
Avoiding reminders of the traumatic event.
Emotional detachment.
Irritability and jumpiness.
Impulsive or aggressive behavior.
Difficulty focusing in school.

TREATMENT FOR CHILDHOOD ANXIETY DISORDERS

Kids with anxiety disorders have several effective treatment options available. Including options that don’t require years of therapy or expensive medications. And, with appropriate treatment, most kids with anxiety receive significant relief from their symptoms within a matter of months. (Making it even more of a shame that up to 80% of kids with anxiety aren’t properly diagnosed. They could potentially avoid years of silent suffering with a few months of treatment.)

Behavioral Therapy For Childhood Anxieties

The currently available research shows that the best therapy option for treating anxiety in kids is cognitive behavioral therapy (CBT). CBT techniques can meaningfully reduce a child’s anxiety. And some studies have shown that successful CBT treatment for kids with anxiety disorders leads to a long-term recovery rate of more than 90%.

CBT focuses on the relationship between thoughts, behaviors and feelings. The premise being that improving negative thinking and non-productive behaviors results in improved emotions.

CBT treatment for anxiety typically involves some program of exposure therapy. In a structured setting, a child confront what triggers her anxiety in measured, incremental steps. As she successfully cope with those triggers, her anxiety lessens. And, through a therapeutic program, the magnitude of the trigger increases as does her corresponding ability to cope.

You can find lists of potential behavioral therapists through the website of the Association for Behavioral and Cognitive Therapies (ABCT). Or, the website for the Anxiety and Depression Association of America (ADAA).

When you are evaluating a potential therapist, you should make sure that the person has specific experience treating anxiety in children. And, they should be able to tell you how long they expect treatment to last. (Treatment for mild to moderate conditions usually takes eight to 12 sessions.)

Medications For Treating Anxiety In Kids

The available effective treatment options for anxiety in kids includes prescription medications. But, while medication alone can be effective, research has shown that medication combined with behavioral therapy can be more effective than medication alone. Combined behavioral therapy and medication treatment is effective in more than 80% of kids with social anxiety, generalized anxiety or panic disorder.

The preferred class of medications for childhood anxiety disorders are the antidepressants. Specifically, the serotonin reuptake inhibitors, or SSRIs. This class includes medications like Paxil, Lexapro, Zoloft and others.

Benzodiazepines can also be used on a short-term basis to reduce intense anxiety. However, they can become addictive and have not been studied for long-term use.

For more information on medications that treat anxiety in kids:

Warning: Reasons to Avoid Avoidance Strategies.

When a child experiences severe anxiety, a parent’s natural inclination may be to address the problem by eliminating or avoiding whatever is creating the fear and worry. But experts warn that this can be extremely counterproductive. Avoidance is not treatment, and it’s not an effective remedy. It simply reinforces the underlying anxiety and helps the roots to grow stronger.

Rather than seeking to eliminate anxiety from a child’s life, he should learn effective management techniques that he can continue to use as he grows up. Learn more about effective strategies for helping your anxious child.

ANXIETY IN KIDS AND LEARNING & ATTENTION ISSUES

Although anxiety disorders are quite common, they’re often described as an “invisible condition” because the symptoms are so often ignored. And, they’re also described as the “great masquerader,” because symptoms are mischaracterized as other issues. And this can frequently happen with learning and attention issues.

Kids with learning and attention issues may be even more likely than their peers to worry about school, social activities and change. And they may be more likely to develop anxiety.

But sometimes an anxiety disorder can be mistakenly perceived as being a learning or attention issue. And, when anxiety is mistaken for another disorder, it can result in ineffective treatment.

ANXIETY AND ADHD

The relationship between ADHD and anxiety can be complicated. 25-30% of kids diagnosed with ADHD also have an anxiety disorder.

But sometimes ADHD kids will experience anxiety that is not itself a disorder as a consequence of their ADHD symptoms. Like being stressed out because they missed assignments, or didn’t hear something important that the teacher said.

Conversely, sometimes an anxiety disorder will be mistaken for ADHD. An anxiety disorder can be hard to recognize in an ADHD child because so many of the symptoms can be experienced internally without an obvious external signs.

Anxiety symptoms seen at school can easily be misconstrued as ADHD or defiant behavior. So, for instance, a kid who always seems distracted and unfocused may look similar to a kid with the inattentive type of ADHD. But, rather than showing an ADHD symptom, the kid’s actually distracted by the internal worry and fear that come with an anxiety disorder.

Or, he could be asking the same questions repeatedly because his OCD requires constant reassurance. Not because he wasn’t listening in the first place.

Similarly, a child’s anxieties may result in behaviors or coping mechanisms that mimic ADHD symptoms. Impulsivity, fidgeting, or “hyper” activity.

For examples of situations where kids were mistakenly diagnosed with ADHD or an anxiety disorder: ADHD + Anxiety Symptom Checklist for Children.

For more tips on how ADHD and anxiety can be distinguished: ADHD and Anxiety: What You Need to Know.

ANXIETY AND LEARNING DIFFERENCES

Sometimes challenges from learning differences can make school and social situations stressful and anxiety producing events.

And kids with learning differences often experience anxiety. For example, a dyslexic child may have lots of anxiety about reading out loud. Performance anxiety. Fear of failure. Fear of being judged.

However, sometimes a child’s anxiety disorder can appear to be an actual learning problem when it’s not. When a child starts doubting her abilities in a subject, anxiety can prevent her from learning or showing what she knows. Sometimes this looks like a learning disorder when it’s really treatable anxiety.

And, while a child with severe anxiety who’s struggling in school could also have a learning difference, she might need to be treated for the anxiety before the learning issues can be effectively evaluated and addressed.

DANGERS OF UNTREATED CHILDHOOD ANXIETY

When anxiety in kids goes untreated, it can lead to more significant problems down the road. Research shows that untreated children with anxiety disorders have a higher risk of performing poorly in school and missing out on important social experiences. They also suffer decreased self-esteem, and may engage in substance abuse.

Also, untreated anxiety in kids can lead to more severe mental health problems later in life.

Closing Thoughts:

An untreated anxiety disorder can prevent your child from reaching his full potential. And, decrease the overall quality of life for both him and his family. But anxiety can be treated effectively if it is properly recognized and diagnosed. There’s no reason that a child needs to suffer in silence.