Anxiety

Anxiety vs. Anxiety Disorder

Anxiety is a normal part of childhood, and every child goes through phases. Some may eat only orange foods or count in twos. Others may have an imaginary friend or have recurring nightmares about monsters under the bed.

The difference between a phase and an anxiety disorder is that a phase is temporary and usually harmless. Children who suffer from an anxiety disorder experience fear, nervousness, shyness, and avoidance of places and activities that persist despite the helpful efforts of parents, caretakers, and teachers.

Anxiety disorders tend to become chronic and interfere with how your child functions at home or at school to the point that your child becomes distressed and uncomfortable and starts avoiding activities or people.

Unlike a temporary phase of fear, such as seeing a scary movie and then having trouble falling asleep, reassurance and comfort is not enough to help a child with an anxiety disorder get past his or her fear and anxiety.

Take an anxiety screening at www.adaa.org. Then talk to your doctor, who can help you figure out what’s normal behavior for your child’s age and development level. Your doctor can refer you to a mental health professional, if necessary, for a more complete evaluation.

What to Do When Children Are Anxious

When children are chronically anxious, even the most well-meaning parents can fall into a negative cycle and, not wanting a child to suffer, actually exacerbate the youngster’s anxiety. It happens when parents, anticipating a child’s fears, try to protect her from them. Here are pointers for helping children escape the cycle of anxiety.

1. The goal isn’t to eliminate anxiety, but to help a child manage it.

2. Don’t avoid things just because they make a child anxious.

3. Express positive—but realistic—expectations.

4. Respect her feelings, but don’t empower them.

5. Don’t ask leading questions.

6. Don’t reinforce the child’s fears.

7. Encourage the child to tolerate her anxiety.

8. Try to keep the anticipatory period short.

9. Think things through with the child.

10. Try to model healthy ways of handling anxiety.

To read the full article from the Child Mind Institute, click here.

Types of Anxiety Disorders

Generalized Anxiety Disorder

If your child has generalized anxiety disorder, or GAD, he or she will worry excessively about a variety of things, which may include but are not limited to these issues:

  • Family problems

  • Relationships with peers

  • Natural disasters

  • Health

  • Grades

  • Performance in sports

  • Punctuality

Typical physical symptoms:

  • Fatigue or an inability to sleep

  • Restlessness

  • Difficulty concentrating

  • Irritability

Children with GAD tend to be very hard on themselves and they strive for perfection. These children may also seek constant approval or reassurance from others, even when they appear not to have any worries.

Separation Anxiety Disorder

Many children experience separation anxiety between 18 months and three years old, when it is normal to feel some anxiety when a parent leaves the room or goes out of sight. Usually children can be distracted from these feelings. It’s also common for your child to cry when first being left at daycare or preschool, and crying usually subsides after becoming engaged in the new environment.

If your child is slightly older and unable to leave you or another family member, or takes longer to calm down after you leave than other children, then the problem could be separation anxiety disorder, which affects 4 percent of children. This disorder is most common in kids seven to nine years old.

When separation anxiety disorder occurs, a child experiences excessive anxiety away from home or when separated from parents or caregivers. Extreme homesickness and feelings of misery at not being with loved ones are common. Other symptoms include refusing to go to school, camp, or a sleepover, and demanding that someone stay with them at bedtime. Children with separation anxiety commonly worry about bad things happening to their parents or caregivers or may have a vague sense of something terrible occurring while they are apart.

Social Anxiety Disorder

Social anxiety disorder, or social phobia, is characterized by an intense fear of social and performance situations and activities. This can significantly impair your child’s school performance and attendance, as well as the ability to socialize with peers and develop and maintain relationships.

Other symptoms include the following:

  • Hesitance, passivity, and discomfort in the spotlight

  • Avoiding or refusing to initiate conversations, invite friends to get together, order food in restaurants, or call, text, or e-mail peers

  • Frequently avoiding eye contact with adults or peers

  • Speaking very softly or mumbling

  • Appearing isolated or on the fringes of the group

  • Sitting alone in the library or cafeteria, or hanging back from a group in team meetings

  • Overly concerned with negative evaluation, humiliation, or embarrassment

  • Difficulty with public speaking, reading aloud, or being called on in class

Panic Disorder

Panic disorder is diagnosed if your child suffers at least two unexpected panic or anxiety attacks—which means they come on suddenly and for no reason—followed by at least one month of concern over having another attack, losing control, or “going crazy.”

A panic attack includes at least four of the following symptoms:

  • Feeling of imminent danger or doom

  • The need to escape

  • Rapid heartbeat

  • Sweating

  • Trembling

  • Shortness of breath or a smothering feeling

  • Feeling of choking

  • Chest pain or discomfort

  • Nausea or abdominal discomfort

  • Dizziness or lightheadedness

  • Sense of things being unreal, depersonalization

  • Fear of losing control or “going crazy”

  • Fear of dying

  • Tingling sensations

  • Chills or hot flushes

Agoraphobia can develop when children begin to avoid situations and places in which they had a previous panic attack or fear they would be unable to escape if experiencing an attack. Refusing to go to school is the most common manifestation of agoraphobia in kids.

Selective Mutism

Children who 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. While children develop selective mutism for a variety of reasons, in most children with the condition, it is thought to be a severe form of social anxiety disorder. But because it can arise for other reasons, technically it is not considered an anxiety disorder.

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 another place where they feel comfortable. Parents are sometimes surprised to learn from a teacher that their child refuses to speak at school. The average age of diagnosis is between four and eight years old, or around the time a child enters school.

Specific Phobia

A specific phobia is the intense, irrational fear of a specific object, such as a dog, or a situation, such as flying.

Fears are common in childhood and often go away. A phobia is diagnosed if the fear persists for at least six months and interferes with a child’s daily routine, such as refusing to play outdoors for fear of encountering a dog. Common childhood phobias include animals, storms, heights, water, blood, the dark, and medical procedures.

Children will avoid situations or things that they fear or endure them with anxious feelings, which may show up as crying, tantrums, clinging, avoidance, headaches, and stomachaches. Unlike adults, children do not usually recognize that their fear is irrational.

Obsessive Compulsive Disorder

OCD is characterized by unwanted and intrusive thoughts (obsessions) and feeling compelled to repeatedly perform rituals and routines (compulsions) to try to ease anxiety.

Obsessions:

  • Constant, irrational worry about dirt, germs, or contamination

  • Excessive concern with order, arrangement, or symmetry

  • Fear of harm or danger to a loved one or self

  • Religious rules or rituals

  • Intrusive words or sounds

  • Fear of losing something valuable

Compulsions:

  • Washing and rewashing hands to avoid exposure to germs

  • Arranging or ordering objects in a very specific way

  • Checking and re-checking objects, information, or situations

  • Repeating a name, phrase, tune, activity, or prayer

  • Hoarding or saving useless items

  • Counting objects such as steps

  • Seeking reassurance or doing things until they seem just right

Most children with OCD are diagnosed around age 10, although the disorder can strike children as young as two or three. Boys are more likely to develop OCD before puberty, while girls tend to develop it during adolescence. Research has shown that for teens with the eating disorder anorexia nervosa, OCD is the most common co-existing disorder.

Post Traumatic Stress Disorder

Children with posttraumatic stress disorder, or 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. These events can include a serious accident, violent assault, physical abuse, or a natural disaster.

Children with PTSD often re-experience the trauma of the event through nightmares or flashbacks, or re-create them through play. They can have difficulty sleeping or concentrating. Other symptoms include nervousness about one’s surroundings, acting jumpy around loud noises, and withdrawing from friends and family. Symptoms may not appear until several months or even years after the event.

Not every child who experiences or witnesses a traumatic event will develop PTSD. It is normal to be fearful, sad, or apprehensive 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 (such as injury or the death of a parent), had mental health problems before the event, and who lack a strong support network. Violence at home also increases a child’s risk of developing PTSD after a traumatic event.

Is treatment necessary? Will my child’s anxiety disorder go away on its own?

Like other medical conditions, anxiety disorders tend to be chronic unless properly treated. Most kids find that they need professional guidance to successfully manage and overcome their anxiety. And while family support is important to the recovery process, it is not the cure. (Also beware of any product or program that guarantees a cure or is peddled online or in TV infomercials.) Many licensed mental health professionals have the training, education, and experience to properly diagnose and treat your child.

In addition, research shows that children with untreated anxiety disorders are at higher risk to perform poorly in school, to have less developed social skills, and to be more vulnerable to substance abuse. That’s why it’s important to get help as soon as possible. Your child deserves a future that is free from the limitations of anxiety.

The above information is directly from the Anxiety Disorders Association of America's (ADAA) handout on anxiety disorders in children. To access the full handout, click here

Keep in mind...

This information is not exhaustive and at the same time, can be overwhelming. Information can be helpful, but it also can be tempting to do your own diagnosis. If you have concerns about your child experiencing any kind of anxiety, talk to one of the school counselors. We can help guide you on whether or not it is developmentally-appropriate levels of anxiety, or if it's something that needs to be brought to the attention of your doctor.

Books & Resources

What to Do When You Worry Too Much: A Kid's Guide to Overcoming Anxiety

By Dawn Huebner

A workbook you can do with your child. For ages 6-12


Freeing Your Child From Anxiety

by Tamar Chansky Ph.D.

This book is full of great information. It goes through what's going on in the anxious child's brain, how to seek treatment, and specific strategies you can use with your child to decrease their anxiety.

Promoting grit and a growth mindset in children has also been found to reduce anxiety. For more information on how to do this, visit the "Grit and Growth Mindset" page under the Social Emotional Resources section.

For more information on finding a mental health counselor, you can visit the "Counseling" page under the Caregivers section.

For book read-alouds about anxiety, visit the "Books" page under the Students section.

Sadly, children who experience an anxiety disorder are more likely to self-harm or have suicidial thoughts. Please visit the "Suicide/Self-Harm" page for more information.