Anxiety in Children & Adolescents

Anxiety in children or adolescents is a concern for parents and teachers alike. All of us feel anxious sometimes. It is just part of life. We all know what it is like to feel worried, anxious, nervous or fearful. This is as true for children, as it is for adults. However, most of us are able to manage our anxious feelings. We learn to cope with them and are able to carry on despite them.

Anxiety in children or adolescents becomes a problem when children find it difficult to manage their anxious feelings and become stressed, upset and unable to cope with everyday challenges. For these children feelings of anxiety are constant and far more pervasive than an occasional wave of apprehension or anxiety. Anxious feelings dominate and interfere with healthy child functioning and optimum development.

Anxiety in children and adolescents manifests in many different ways, and ranges from relatively minor concerns to more serious and debilitating problems. Children or adolescents who exhibit high levels of anxiety that interfere with normal functioning in everyday life may meet the criteria for an anxiety disorder. Anxiety disorders include panic attacks, phobias, extreme shyness, obsessive thoughts and compulsive behaviors. In some cases, children who suffer from an anxiety disorder may find it difficult to leave home to go to school or to visit family and friends or go on outings and errands with their parents.

In addition, they may find it difficult  to cope with academic tasks at school. They may also show neurocognitive concerns such as problems with concentration and sustained attention, or difficulties  with working memory, and related executive function tasks.   

Common Anxiety Disorders

Social Anxiety Disorder: Children who suffer from social anxiety feel self-conscious and fear being around other people. Some of these children may feel that everyone is watching and staring at them or being critical in some way. These children will avoid social situations and other people. In severe cases, children with a social anxiety disorder may prefer to be alone much of the time. They often suffer from  performance anxiety and may show concerns around feelings of rejection and humiliation. 

Other children or adolescents who suffer from social anxiety know their thoughts and fears are irrational. They know others are not really judging or evaluating them at every moment. But this knowledge does not make their fears and anxieties disappear, nor does it make it any easier for them to engage in social interactions.

Panic Disorder: Children who suffer from panic disorder have panic attacks without warning. A panic attack usually lasts several minutes and can be extremely upsetting and frightening. In some cases, panic attacks last longer than a few minutes or occur several times in a short period. A panic attack is frequently followed by feelings of depression and helplessness. For these children, their greatest fear is that a panic attack will happen again. Often the child doesn't know what caused the panic attack. It seems to come out of the blue. At other times, the child may report that he or she was feeling stressed and upset and expected the panic attack.

Generalized Anxiety Disorder. Anxiety in children or adolescents may also present as a generalized anxiety disorder. Children who suffer from a generalized anxiety disorder are filled with worry, anxiety and fear. They constantly think about and dwell on the "what ifs" of the situation. They feel trapped in a destructive cycle of anxiety and worry and are vulnerable to feeling depressed. These children and adolescents feel incapacitated by their inability to shut the mind off, and are overcome with feelings of worry. In addition, the child's mood may change regularly, perhaps daily or even hour to hour. The child's feelings of anxiety and mood swings become habitual and disrupt the child's ability to cope with everyday life.

Children with generalized anxiety disorder frequently exhibit physical symptoms, including headaches, irritability, frustration, trembling, problems with concentration and sleep disturbances. They may also exhibit symptoms of social withdrawal and panic disorder.

Other Types of Anxiety Disorders:

  • Phobias: Fear of a specific object or situation.
  • Obsessive-Compulsive Disorder (OCD): A system of ritualized behaviors or obsessions that are driven by anxious thoughts.
  • Post-Traumatic Stress Disorder (PTSD): Severe anxiety that is triggered by memories of a past traumatic experience (now included in the DSM-V under Trauma and Stress Related Disorders).
  • Agoraphobia: Disabling fear that prevents the child from leaving home or other safe places

How is Anxiety in Children and Adolescents Treated?

The treatment for anxiety in children varies and depends on how extreme the problem is and how long the problem has been going on. In addition, the causes of anxiety in children are unique to each child and depend on a unique set of circumstances. Successful treatment outcomes will also depend on unique factors and circumstances. Some children, for example, will feel better after a few weeks or months of treatment, while other children may need a year or more to show positive effects in treatment.

Anxiety in children may coexist with other disorders such as ADD or depression. Treatment in these cases will differ and may take longer. While a treatment plan must be specifically designed for each child, there are a number of standard approaches that can help address anxiety in children. Mental health professionals who specialize in treating anxiety often use a combination of the following treatments:

  • Cognitive Therapy: The child learns how to identify and change unproductive thought patterns. He or she is taught to observe his or her feelings and to separate realistic from unrealistic thoughts.
  • Behavior Therapy: Treatment techniques are designed to help the child change and manage unwanted behavior.
  • Systematic Desensitization: This approach is designed to help children with phobias, OCD, and agoraphobia. The child is gradually exposed to small increments of anxiety producing stimuli. This increases his or her ability to cope successfully with situations that have previously produced disabling anxiety.
  • Relaxation Training: When children are feeling anxious and upset relaxation techniques like deep breathing, muscle relaxation and other calming strategies such as meditation, guided visualization and biofeedback can help.
  • Ultimately, children with anxiety benefit from a range of treatments. The treatment for each child depends on the severity and duration of the problem. The child's willingness to actively participate in the treatment is also an important factor. Research suggests appropriate treatment and strategies can help children with anxiety.

Tips to Help Children Who Are Feeling Anxious

When you are worried about anxiety in children the following strategies can help:
  • Encourage the child or adolescent to share his or her anxious thoughts and feelings.
  • Ask the child to list the things that make him or her feel most anxious and the actions that have been most effective in relieving the anxiety.
  • Or ask the child to draw two or three situations that generally make him or her feel anxious. Then ask him or her to draw a picture for each situation to illustrate a strategy that he or she could take to reduce anxiety in each situation.
  • Encourage positive self-talk to reduce or eliminate anxiety in children. Encourage the child to develop reality based, positive cognitive messages that will increase self-confidence and appropriate coping skills for dealing with fears and anxieties.
  • Teach the child relaxation techniques to help decrease feelings of anxiety: for example, progressive relaxation or guided imagery techniques to induce calm and decrease the intensity and frequency of anxious feelings.
  • Teach the child or adolescent problem-solving and assertiveness skills to deal effectively with situations that cause anxiety.
  • Increase physical exercise as a means of reducing anxiety.
  • Help to build the child's self-confidence.
  • Respond to the child’s fears and anxieties in a calm and confident manner: for example, remind the child of a time when he or she handled a fearful situation effectively and express confidence in the child's ability to deal appropriately with an anxiety provoking situation.

Anxiety in children affects large numbers of children and ranges from relatively minor concerns to more severe and debilitating issues and behaviors. Children or adolescents who are experiencing high levels of anxiety or who suffer from an anxiety disorder often have difficulty coping at home and at school. Their social, academic and interpersonal skills can suffer, and they may experience difficulty doing well at school.

Early intervention can help reduce anxious feelings in children or adolescents, and prevent problems from escalating. Children who exhibit high levels of anxiety or who suffer from an anxiety disorder also need help to develop healthy coping strategies to ameliorate and reduce their feelings of anxiety.

Contact Dr. O'Connor about anxiety in children. She will respond to your concerns and suggest options for addressing them. 

Dr. O'Connor also offers Psychological Assessment Services that she tailors to fit the needs of an anxious child or adolescent.

To learn how an assessment can help the anxious child or adolescent, click here. 

Click here to learn more about child anxiety, including when its a problem, risk factors, and causes.

Contact Dr. O’Connor to learn more about our Psychological Assessment Services and how to help when anxiety in children is a problem.

A Psychological Assessment can  get to "the root of the problem" and point to effective solutions and intervention strategies to address it.

To learn more about child anxiety, including signs and symptoms and how to help, click here.

You can also purchase our case studies about children who suffer from an anxiety disorder.