An anxious child often means a worried parent. You want to help, and that’s completely natural! Everyday childhood concerns, such as new experiences, challenging tasks, making mistakes, and encounters with unfamiliar people, can be problems to solve.
So what do you do when your child suffers from an anxiety disorder?
The first step is understanding the root of the problem. Once you have that understanding, you can form well-informed strategies to help a child with anxiety and improve their well-being.
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According to the Journal of Pediatrics, 7.1% of children¹ (approximately 4.5 million) aged 3-17 years have been diagnosed with an anxiety disorder.
Several factors can cause the development of an anxiety disorder in children. These factors include:
Genetics. If anxiety disorders are prevalent in your family, there is an increased likelihood that your child will develop one as well.
Brain chemistry. Dysfunctions in the brain that cause specific chemical imbalances can lead to an anxiety disorder.
Life experiences. There are situations your child can encounter that stick in their mind and cause them to develop anxiety, often about that specific situation or an element of it.
Learned behaviors. Growing up in situations where people around them are anxious can "teach" children to be nervous, especially in those particular situations.
There are many symptoms² associated with anxiety. Unfortunately, children tend to be reluctant to talk about what they are experiencing out of fear or lack of understanding about how to express themselves. Learning to recognize the signs will make it easier for you to help.
These signs and symptoms include:
Anger or aggression without an apparent cause
Nervous behaviors such as fidgeting, lip biting, nail-biting, or refusal to make eye contact
Difficulty behaving or performing in school
Withdrawal from social situations
Changes in appetite
Anxiety disorders can manifest in different ways and for a variety of reasons. Knowing how each type of disorder is classified and how it develops is a big part of learning how to help a child deal with their anxiety disorder.
While children occasionally become nervous or anxious over everyday things, children with generalized anxiety disorder worry more often and with more intensity.
In addition, children with GAD are often nervous about everyday things³ that they may have no control over, such as future events, the safety of others, and death.
One of the hallmarks of GAD is an inability to feel okay even when presented with reassuring facts and logic. GAD can be highly disruptive to day-to-day tasks due to excessive distress and fear.
It's normal for very young children to be anxious about being away from their parents or trusted family members, especially when they reach school-age.
Developmentally appropriate⁴ separation anxiety typically develops between the ages of 6 and 12 months when children bond with a parent. The problem comes when the child doesn't outgrow the fear of leaving their parents. They may make excuses to not go to school, refuse to leave the house, and become distraught when their parents aren't around.
Being in contact with strangers can make children nervous. However, social anxiety disorder presents itself as a marked and persistent fear⁵ of social situations involving unfamiliar people, that the child cannot overcome.
This anxiety is often present when the child is around their peers. Typically, the anxiety stems from concerns over being humiliated or scrutinized.
There is a system in place for dealing with stressful situations that trigger a 'fight or flight' response in the mind. This can be a normal response and helpful in stressful situations. However, those with panic disorder have recurrent, unexpected panic attacks.
During these attacks they experience physical symptoms such as nausea, dizziness, shortness of breath, a choking sensation, pain or discomfort in the chest, dissociation from reality or oneself, and sweating, shaking, or tingling.
The presence of panic attacks is not a sole indicator of panic disorder, however. This disorder is marked by panic attacks that occur frequently and unexpectedly, chronic anxiety over the onset of panic attacks, and the continued development of at least four physical symptoms.
Panic disorder is also marked by panic attacks that aren't caused by a separate disorder, such as agoraphobia, or by chemical factors, such as drugs and medications.
This extreme form of anxiety disorder develops when children are so anxious that they refuse to speak. Of the many ways anxiety disorders can manifest in children, selective mutism tends to be one of the most overlooked.
Children with this disorder are described as 'shy' or 'nervous' and are often encouraged to speak despite their anxiety.
Anxiety disorders are usually treated with cognitive behavioral therapy (CBT)⁶, a series of short-term treatments focusing on teaching both children and parents specific skills for coping with anxiety and managing fear.
CBT teaches children that what they do and how they think can affect how they feel, by focusing on how their thoughts, emotions, and behaviors are interconnected. This allows therapists to intervene at various points.
Despite the presence of a therapist, CBT is driven by the understanding that the child knows themself better than anyone else. Children and their parents are encouraged to take an active role in treatment both in and out of session.
CBT teaches skills that require practice to become second nature, to make anxiety disorders easier to manage. Children are given a chance to try to cope with their anxiety and receive praise and encouragement as they progress.
In addition, there are different styles of CBT. In individual CBT, the focus is placed solely on the child or adolescent. It involves one therapist who teaches the child or adolescent the skills they need to overcome the challenge of anxiety disorders.
Group CBT includes not only the child or adolescent and the therapist in the therapy sessions but also involves others outside of the child or adolescent's social groups.
These other children and adolescents are typically also dealing with similar anxiety disorders. Because of this, the group format allows beneficial relationships to form and teaches the skills needed to manage anxiety.
A variation on this style involves including the parents of the child or adolescent and teaching them skills and techniques to help care for their anxious youth.
Trauma-focused CBT is especially effective in helping children and adolescents who are struggling with trauma. It is conducted in the same way as other CBT sessions, emphasizing the addressing of factors related to the child's traumatic experiences.
In addition, parents are encouraged to learn skills necessary to recognize their child's trauma and help them manage it.
In some cases, psychotropic medications are used to treat anxiety disorders in children and adolescents. While medication can certainly be beneficial, an approach that combines medication and therapy is the most effective way to help children and adolescents manage their anxiety. Be sure to work with a professional to find the proper medication⁷ for your child's needs.
Fortunately, there are many things you can do to support your anxious child.
The first thing to understand is that you must be patient. Anxiety disorders are a manifestation of fear, and children naturally avoid things that they find scary. You must encourage your child and let them know that you're willing to help.
Focus on managing anxiety - not curing it
You must also realize that the goal is not to eliminate anxiety. Instead, focus on helping your child manage their emotions when they feel anxious. It's healthier to learn to tolerate anxiety and function through it than to avoid any stressors that may trigger anxiety altogether.
Avoidance behaviors become coping mechanisms very quickly, which only allows the fear to worsen. Learning to live with the anxiety and work around it will cause it to decrease eventually, but it takes time and practice.
It's essential to be positive but also realistic. You can't assure your child that they will always have fun or that nothing bad will happen. But you can assure them that they can handle the problems that occur.
In addition, you can express confidence that their anxiety will lessen over time if they work on the skills necessary for coping with it. This approach gives them the confidence that you won't ask anything of them beyond what they can handle, meaning they’re more likely to make an effort to manage their anxiety.
Avoid leading questions
When asking your child about their anxiety, be sure to avoid leading questions. Instead, keep your questions general and open-ended while still keeping them focused on their feelings. For example, instead of asking, "Are you anxious about your first day of fourth grade?", ask, "How do you feel about your first day of fourth grade?"
Set a positive example
Finally, it's vital to demonstrate healthy behaviors surrounding anxiety for your child. Kids are perceptive, and they're going to notice if you can't handle stress or anxiety, especially when it relates to them.
Let your kids hear or see you managing and tolerating it calmly, and teach them how you do so. Even if they can't control their stress the same way you do, it's good for them to know that there are options available for doing so.
The various types of childhood anxiety disorders can be disruptive and upsetting for both you and your child. However, there are strategies for helping a child with anxiety.
Cognitive behavioral therapy is a vital tool in teaching children the necessary skills for managing their emotions and behaviors when dealing with anxiety.
Be patient, be supportive, and model appropriate behaviors for your child that they can use as inspiration in the future.
Anxiety Symptoms in Children | Very Well Mind
Cognitive Behavioral Therapy | Effective Child Therapy