Your Comprehensive Guide to Kids and Anxiety
Early support and treatment really does make a difference.
Anxiety in children has been diagnosed an at increasingly higher rate in the past few years. Here’s some information from the CDC:
7.1 percent of children aged 3-17 years (approximately 4.4 million) have diagnosed anxiety
For children aged 3-17 years with anxiety, more than 1 in 3 also have behavior problems (37.9%) and about 1 in 3 also have depression (32.3%)
Among children living below 100% of the federal poverty level, more than 1 in 5 (22%) had a mental, behavioral, or developmental disorder.
Age and poverty level affected the likelihood of children receiving treatment for anxiety, depression, or behavior problems.
Children who receive support and treatment early—as soon as possible after symptoms start—will have a better chance of successfully managing their anxiety. That’s why it is so important that parents (as well as teachers and other adults who interact with children) know the signs, and what to do to help a child who may have anxiety.
More pressure means more anxiety
Dr Patti Ashley
The increase in anxiety among children likely can be attributed at least in part to the high-pressure environment kids live in today, along with the desire to make their parents proud—which may be a challenge for kids who set unrealistically high expectations for themselves. “Kids want to please their parents and don’t feel like they’re enough,” says Dr. Patti Ashley, psychotherapist, author, and creator of a psychotherapy approach called Authenticity Architecture. “This causes lots of anxiety.”
Not surprisingly, social media and the tendency to be plugged in 24/7 also plays a role. Everyone else’s life looks so perfect and exciting, and there’s the persistent pressure to compete. Kids are constantly comparing themselves to everyone else. “There’s so much more to live up to, with the pressure of social media. Higher expectations,” Ashley says. “Then there’s also chronic fear because of mass shootings, especially in schools. The nervous system thinks it is in chronic trauma.”
How anxiety is different in children than in adults
There are some basic characteristics in anxiety that are generally consistent across the board. But there are some elements that make anxiety especially challenging for the children who have it—and the people who care about them and are trying to understand how to help them.
“Anxiety is a sign of personal distress and suffering, whether it be an adult or a child. The difference is usually an adult has more awareness and an ability to articulate what they are experiencing due to a more expansive ‘feeling vocabulary,’” says Linda Snell MSW, LCSW at New Method Wellness.
“Children experience anxiety in three ways,” Snell says. “It is experienced in the thoughts a child has, such as a fear of objects and/or worrying about events or people. Secondly, it is experienced in the body, such as stomachaches, headaches, vomiting, diarrhea, and tiredness. Lastly, it manifests in a child’s behavior. A child may freeze, cling, shake, fidget, and cry. In both children and adult’s anxiety will result in avoidance. Anxiety can cause a marked interference in one’s life affecting the adult’s work performance and the child’s school performance, disrupts both the adult and child’s relationships, and decreases self-esteem to name a few effects. In a child it can exacerbate a child’s feeling of dependency where for an adult it can increase isolation.
Dr. Dana Dorfman, PhD, psychotherapist and co-host of the podcast “2 Moms on the Couch,” echoes the connection between inability to express their situation and an array of physical symptoms. “Because children do not have the vocabulary, life experience, and developmental capacities to identify and verbalize their feelings, they may be less likely to do so,” Dorfman says. “Thus, anxiety may manifest in behaviors that may be easily misinterpreted. Some examples include tantrums, difficulty sleeping, difficulty separating from parents, nightmares, regression from previously acquired skills like toilet training and sleeping through the night, rigidity (being inflexible or highly demanding), irritable mood, changes in eating behavior, and excessive clinginess. Children may also exhibit tension or anxiety by nail biting, lip biting, tics. Anxiety in children can also manifest physically: such as stomachaches, headaches, and sensory sensitivity (hypersensitivity to noise, light, and touch).”
This tendency to produce confusing symptoms can make it difficult for adults to accurately detect anxiety in children, at least at first. “Children are rarely able to identify and verbalize feelings, particularly anxiety,” says Dorfman. “As a result, they exhibit it in behaviors which may be "misleading,” misunderstood, or misinterpreted by adults around them. For example, frequent stomach aches could be attributable to factors like diet or illness, rather than anxiety.”
Types of anxiety
As with adults, anxiety in children can have several different forms. Dorfman says, “There are several categories of anxiety disorders- the emergence of which frequently corresponds with developmental stages and can last far longer than developmentally appropriate.” Dorfman listed some examples of common types of anxiety:
In younger children: Separation anxiety
In early adolescence: Social anxiety
During school years and beyond: Obsessive - Compulsive Disorder
Adolescence and beyond: Panic Disorder
Generalized Anxiety Disorder (any age)
Posttraumatic stress disorder
“All of the above-mentioned disorders may be catalyzed by an event or experience,” Dorfman says. “They are likely to persist, often require treatment and may or may not recur throughout lifespan. If one experiences one or more of the disorders, there is a greater likelihood of recurrence or additional anxiety disorder to emerge at a later stage.”
What causes anxiety in kids?
There is no single definitive cause that has been identified as the root of anxiety conditions. However, Snell says an individual is more than likely to develop an anxiety disorder if:
he/she has experienced trauma
he/she has a physical condition that is linked to anxiety
he/she has biological relatives diagnosed with anxiety disorders or other mental illnesses.
“There is agreement that anxiety disorders can be both genetic and caused by environmental factors,” Snell says. “Studies do indicate that an anxious parent does pass on a predisposition for an anxious child to be more emotionally sensitive than the average child. On a positive note. an anxious child is more likely to be kind and compassionate.”
Does it run in families?
It often seems like some families have clusters of people (of all ages) who have anxiety, and experts say that’s no coincidence. “Yes, there are significant genetic factors which contribute to anxiety,” Dorfman says. “If a family member—particularly a parent—has anxiety, a child may be more likely to inherit this trait. Additionally, parents who demonstrate significant anxious behavior are likely to engender anxiety in children. Children who experience trauma such as loss of a parent, natural disasters, or are exposed to chronically stressful circumstances are more prone to anxiety.”
Signs that a child may have anxiety
Dr Takesha Cooper
It’s important for adults to be alert for possible signs of anxiety, so they can help children get treatment and support as soon as possible. Specific symptoms or anxiety-related behaviors can vary by the individual, but there are some things that can often be red flags. “Symptoms of anxiety include avoiding the situation that triggers anxiety,” says Dr. Takesha Cooper, assistant clinical professor of psychiatry at the University of California Riverside School of Medicine and a child and adolescent psychiatrist at the Riverside County Department of Mental Health's Lake Elsinore Family Mental Health Services. “For example, if a child is anxious about being away from a caregiver as in Separation Anxiety Disorder, that child will avoid scenarios in which they have to be apart from their caregiver. They might follow the caregiver through the house, express extreme anxiety or have a tantrum if the caregiver needs to leave.”
Dorfman advises parents to watch out for any significant changes in daily functioning, particularly related to eating, sleeping and general mood. “Parents should be aware of regressions. For example, a child who has been fully toilet trained for over a year suddenly begins having frequent accidents or a child who did not have difficulty with parents' departure at school drop off, may suddenly resist separations.”
It’s common for anxiety in children to manifest itself in ways that mimic behavior issues or anger management problems. “Children with anxiety often worry about ‘what might happen’ so they might verbalize these worries out loud,” says Cooper. “Some children when anxious can even become agitated and aggressive. This is their fight-or-flight that kicks in and can easily be mistaken for a disruptive behavior disorder, such as oppositional defiant disorder, or a mood disorder, such as bipolar disorder. This is why it’s important to have the child undergo a thorough assessment to understand their triggers and to talk to the child to better understand what is going through their mind before and during these episodes, because it gives us a clue into why they behave the way they do.”
What should you do if your child has anxiety?
“First, take a deep breath and know that anxiety in children is fairly common,” says Snell. “One in ten children are diagnosed with anxiety disorders. Getting your child help will require time, patience, commitment, and collaboration. I strongly suggest you and your child see a qualified mental health professional who is trained to assess your child and partner with you in addressing your child’s anxiety. A professional can help you and your child learn effective tools to decrease your child’s distress, apply the tools, and troubleshoot any issues as well as keep both you and your child motivated while monitoring progress.”
Don’t make them stifle their feelings. “I tell them all feelings are okay but all behavior isn’t,” says Dr. Ashley. “It’s okay to feel whatever they feel. Our culture has created this ideal that in order to be successful we must overcome these feelings.”
Parents need support, too
While the primary concern is the child with anxiety, family members—especially parents—can also benefit from helpful resources. “Parents greatly benefit from education about anxiety and treatment approaches,” says Dorfman. “Parents may contact pediatrician who is likely to be well versed in emotional issues of childhood and can refer the family to a mental health professional. Ideally, the professional will work with parents in addition to the child to educate, provide strategies and resources so that parents may support child with compassion and understanding. Parents may also confer with teachers and may reach out to school social worker or psychologist for resources, support and referrals.”
Treatment options
The traditional approach to treating anxiety was a two-pronged strategy: a combination of medication and therapy. “The two most common forms of treatment are Cognitive Behavioral Therapy (CBT) and Psychodynamic Psychotherapy,” says Dorfman. “Medications which are commonly prescribed are SSRI (selective serotonin reuptake inhibitor) and/or anti-anxiety and sedative medications.”
That’s still the basic foundation recommended by many mental health professionals. However, these days, more medical and mental health practitioners are also incorporating other strategies into their recommended treatment plan, as we’ll describe later.
Therapy
Dorfman says, “The most commonly used treatment approaches for children with anxiety are play therapy, for children under 12 or so; talk therapy; psycho-education (learning about anxiety); cognitive behavioral therapy; and parent guidance. Psychopharmacology—meaning medications like SSRI and anti-anxiety medications—are also effective, particularly when paired with therapy.”
Medication
“Medications can be effective and beneficial,” says Dorfman. “The introduction of medication is largely contingent upon the degree of impairment and the degree to which the anxiety interferes with daily functioning. Often, patients are assessed and engage therapy before medication is introduced, though patients and situations vary significantly. “
“Medication can be an important treatment for anxiety disorders, even in children,” says Cooper. “We consider medication when the anxiety interferes significantly in a child’s ability to function. For example, if a child has severe generalized anxiety disorder and has been unable to attend school for weeks due to the anxiety, it would be helpful to consider adding medication to the treatment plan which should already include psychotherapy. Or a child with Panic Disorder who has intense fear of future panic attacks such that she is unable to leave her home would benefit from a trial of medication to see if it helps her. “
“While these scenarios are severe, children with moderate anxiety can still be good candidates for medication, particularly if they are already receiving therapy but still are symptomatic,” says Cooper. “Oftentimes we see the medication can help children better utilize therapy because they are less anxious and more willing to discuss their anxiety or try anxiety reduction techniques the provider suggests such as exposures which are proven to help reduce anxiety. For mild childhood anxiety, medications should generally not be chosen, given that good cognitive-based therapy by a trained clinician alone is often effective in reducing symptoms.”
Alternative or complementary treatment options
Alternative or complementary treatment options are no longer viewed with the type of skepticism as they were in the past. Even better, these days there is such a wide range of creative (and fun!) alternative treatments that there’s something to fit everyone.
“In the past decade or so, patients have increasingly used various forms of meditation and mindfulness practice,” says Dorfman. “Patients are encouraged to exercise regularly, journal and breathing techniques.”
“I like to find what kids are interested in,” says Ashley. “Getting out in nature, doing art. Take a hike. You have to be in the experience of feeling joy and laughter. That gives the body a message that I am safe and okay. Talk therapy is important and helpful, so I like to combine several forms of therapy. I like to find something they enjoy doing that’s more right-brained, because that’s where the imprint happens. Try to make it as personal and customized as I can.”
Examples of alternative/complementary treatments
Many people are surprised to discover the impressive—and interesting—range of treatment options available to help those with anxiety. Here are just a few examples of therapy types that can be used to treat anxiety.
Surf therapy: the ocean waves have a soothing effect, and the water provides a serene environment that promotes bonding with family members.
Equine therapy: horses can have a calming effect, and caring and guiding the horses gives anxious kids an outlet to focus their energy, providing a positive distraction.
Dolphin therapy: while used primarily for children with autism, some experts say this can also be a good form of therapy for those with anxiety or depression.
Wilderness therapy: spending time outdoors in an “adventure program” can help kids gain confidence and develop problem-solving skills.
Yoga therapy: yoga is all about focusing your body and mind in a positive way, and the emphasis on finding your center and controlling your breathing can help alleviate the symptoms of anxiety.