Updated: Oct 28, 2019
by Nicole Schram, MA, LPC
Anxiety can be a healthy emotion. It can help us focus on work that we need to accomplish, it can help us remember to bring our lunch to work or anxiety can motivate positive behaviors such as studying for that upcoming test. Other times anxiety develops that is beyond the scope of normal or healthy.
Developmentally, toddlers may worry about fear of imaginary creatures or the dark or have mild-moderate reactions to being separated from a care giver. In school-age children, “healthy worry” is generally focused around concerns about natural events, school performance or specific big events in the future. As children grow-up and become adolescents, concerns often continue about school performance, fitting in and overall health. All of those worries are completely age appropriate and often manageable with brief intervention like deep breathing, taking a brief break or talking to a trusted friend or family member. Children have different tools than adults to face day to day challenges when anxious, therefore it makes sense that the signs and symptoms that indicate a child is experiencing anxiety may be slightly different as well.
Clinical Anxiety occurs when these worries begin to take up a disproportionate amount of the child’s mental or physical energy. This is more common than you might think. Anxiety related symptoms are some of the most commonly reported symptoms in adults and Anxiety Disorders are some of the most common psychiatric disorders diagnosed for children according to a report by Merikangas et al (2010). Despite this fact, many people experience clinically significant anxiety that is undertreated, under recognized or misdiagnosed. An estimated 80% of children who meet criteria for an anxiety disorder are not receiving suitable treatment (Merikangas et al., 2011).
One of the difficulties is that many children may not recognize their fears and worries are unreasonable and, especially if they are younger, may struggle to communicate exactly what they are feeling. It’s important to review the physical symptoms your child is having (i.e. headaches, upset stomach, diarrhea, sleep disturbance). Many children growing up with chronic anxiety are very attuned to their body’s response, sometimes overly so. In many cases, the parent’s response to these symptoms may help the child to label the feeling as anxious/worry. Labeling these feelings alone can sometimes help reduce the uncomfortable sensations. You might notice your child becoming preoccupied with thinking about an upcoming test or starting to withdraw from talking to teammates at a game. Helping them to understand what they’re experiencing is the first step to developing healthy coping skills. It is also your first clue in distinguishing between typical worry and clinical anxiety.
Anxiety in Children: How Can You Help?
Other non-verbal signs a child is experiencing anxiety are: excessive need for reassurance, persistent restlessness or fidgeting, inattention and poor school performance, chronic forgetfulness, losing things, explosive outbursts, pre-occupation with routine or change in eating.
Anxiety is believed to be caused by the interaction of many factors including childhood adversity, stress, or trauma and genetic predisposition. Risk factors to developing anxiety disorders include children who are behaviorally inhibited, what we might think of as shy and non-adventurous, having poor relationship(s) with caregivers and having a parent that has high levels of anxiety.
Clinical criteria that your provider or therapist may be watching for that indicates the presence of Generalized Anxiety Disorder include:
Chronic, excessive worry in a number of areas with at least one associated with somatic symptoms
Worry is most often present and not limited to a specific situation or object
The thoughts are difficult to control and cause impairment in social, occupational or other areas of functioning like avoiding people or places that are linked to the thoughts
Upsetting thoughts/feelings occur for more days than not and for at least six months
Generalized anxiety disorder is only one type of many that children and adults may experience. To more clearly diagnose anxiety disorders or if you have concerns that your child is experiencing symptoms like mentioned above, please speak a doctor or a mental health provider.
The most successful, non-medication based, approach to treating anxiety in children is cognitive behavioral therapy (CBT) (Walkup et al., 2008). The CBT approach is used to help mediate and eliminate anxiety’s pesky symptoms. It involves increasing a person’s awareness of their thoughts, the connection of thoughts with body and emotion responses. Skill are developed in and out of the therapy room to directly manage the body’s response or challenge the mind’s process. For children, this may involve the use of feeling thermometer, games that explore how feelings are experienced or expressed, etc. Medication may be prescribed by physicians in cases of more severe anxiety symptoms. A combination of medication and therapy research has shown has an ~80% effectiveness in treating symptoms to below clinical levels within 3 months (Walkup et al., 2008). Research suggested reducing medication after remission of symptoms within 6- 12 months (Bandelow, Michaelis & Wedekind, 2017).
Anxiety in children can be as difficult for the child and family members as the work it takes to manage the symptoms of a physical medical condition. Talking with a medical provider and mental health professional can help you and your child develop the tools needed to better manage your child’s anxiety.
Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-9.
Bandelow, B., Michaelis, S., Wedekind, D. (2017) Treatment of anxiety disorders, Dialogues Clin Neurosci. 19(2): 93–107.
Merikangas, K., Hep, J., Burstein, M., Swanson, S., Avenevoli, S., Cui, L., Benejet, C.,…Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication—Adolescent Supplement (NCS-A). Journal of American Academy of Child and Adolescent Psychiatry. 49(10): 980-989. doi: 10.1016/j.jaac.2010.05.017
Merikangas, K. R., He, J., Burstein, M. E., Swendsen, J., Avenevoli, S., Case, B., … Olfson, M. (2011). Service Utilization for Lifetime Mental Disorders in U.S. Adolescents: Results of the National Comorbidity Survey Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 50(1), 32–45. doi:10.1016/j.jaac.2010.10.006
Walkup, J. T., Albano, A. M., Piacentini, J., Birmaher, B., Compton, S. N., Sherrill, J. T., … Kendall, P. C. (2008). Cognitive Behavioral Therapy, Sertraline, or a Combination in Childhood Anxiety. The New England Journal of Medicine, 359(26), 2753–2766. doi:10.1056/NEJMoa080463
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