Anxiety in Children and Teens

Having fears and worries is a normal part of childhood development. For example, young children (6–12 months of age) often experience stranger anxiety and distress around people with whom they are unfamiliar. Older children will have transient fears of animals, the dark, or losing a loved one. Since many of these behaviors are a normal part of development, how then do you as parents recognize concerning signs for symptoms of severe anxiety? A general guideline is that normal anxiety is short lived and, most importantly, does not interfere with your child’s daily function or ability to perform tasks he or she desires. If your child has excessive and intense worries that affect his or her ability to carry on daily function, then he or she may suffer from an anxiety disorder.

Fear vs. anxiety

Fear is an emotional response to a real or imagined immediate threat. Children may be afraid of things like strangers, separation from parents, or specific situations (e.g., the dark and thunderstorms).

Anxiety, on the other hand, is the anticipation of a future threat. Older children and teens may be anxious in social situations or worry about grades or athletic performance, among other things.

How do I know if my child has an anxiety disorder?

It is normal to worry from time to time. Many children and teens carry on despite their worries. Your child may have an anxiety disorder if his or her worries are seriously distressing or cause problems in everyday social interactions or at school. Anxiety disorders are characterized by worries that are persistent, excessive, unreasonable, and irrational.

Tips for helping a child with his or her anxiety

Because anxiety is unreasonable, it is difficult to talk someone out of it or to explain it away. Spending too much time rationalizing or processing worries can actually lead to the problem worsening over time. The good news is that there are effective treatments to help your child manage anxiety. There are a number of proven strategies to help manage anxiety.

  • Set aside “worry time”
    • What is it? Set aside time once per day when you and your child can discuss his or her worries. Keep it short – no more than 10–15 minutes per day. If your child seeks reassurance from you about a worry throughout the day, gently tell him or her that you understand he or she is anxious and that you two will sit down and talk about it later in the day. Then encourage him or her to keep doing what he or she was doing without further discussion. When “worry time” rolls around later, let your child pick. Does he or she want to talk about what was bothering him or her earlier? Or would he or she prefer to do something else with you, like play with a favorite toy or talk about a favorite movie or TV show? Let your child decide and praise him or her for practicing bravery earlier in the day!
    • Why should I do it? Some children want to talk about their worries several times per day. This can start to interfere with daily learning opportunities, social engagement, and enjoying the activities of daily life. Many parents naturally try to comfort their anxious children by offering lots of reassurance, distraction, and physical affection when they repeatedly express worries. Although it feels good and probably does comfort your child in the short-term, in the long-term this approach is not likely to be effective. In order to treat anxiety, your child will need to learn to develop and use coping skills over the long-term.
  • Practice relaxation
    • What is it? Diaphragmatic breathing (aka “deep breathing”), progressive muscle relaxation, and guided imagery are appropriate for most older children (generally about 11 years old) and teenagers. There are many free websites and apps that can help children and teens learn relaxation skills, such as:
      • BellyBio: Free app only for Apple products. Uses the device’s accelerometer to monitor “deep breathing” and provides real-time audio and visual feedback.
      • Rainbow Reach: A great resource for younger children. Includes guided relaxation exercises using easy-to-understand language.
      • MindBody Lab: A great resource for adolescents. Includes guided exercises in deep breathing, progressive muscle relaxation, guided imagery, and mindfulness meditation.
    • Why should I do it? Children with anxiety may experience physical symptoms like stomach discomfort, increased heartrate, fast/panicked breathing, sweating, headaches, muscle tension, etc. This is our body’s natural response to stress. The good news is, with practice, your child can learn to reduce these unpleasant physical feelings.
  • Practice exposure
    • What is it? Mental health providers often call this step “systematic desensitization” or “exposure therapy.” It involves creating a “fear hierarchy” where your child ranks situations from the least scary to the scariest. The goal is to work through the hierarchy bit by bit. Once children face their fear, they should not leave until their anxiety goes away. Start with the least scary situations first so that your child will not be overwhelmed and can be successful. Once your child feels confident in that situation, he or she is ready to face a tougher fear! Also choose an activity over which you have some control so that your child can stick with it for as long as needed. Exposure practice can be hard to do, so let your child earn a reward for practicing bravery and seek assistance from a mental health professional with experience treating anxiety to help guide you through exposure-based therapy. 
    • Why should I do it? Without question, the most proven way to defeat your child’s anxiety is to teach him or her through experience by facing it head on! Avoiding the situations that produce anxiety in your child will feed into the anxiety and likely result in more anxiety over time. Facing the fear head-on through exposure is the best way that your child can defeat the anxiety.
  • Get on the same page as other caregivers
    Spouses, partners, and grandparents can all be allies in helping your child practice bravery and learn to cope. This can only happen if you are all practicing the same strategies. For example, it is not helpful to your child if one parent encourages him or her to wait until “Worry Time” to talk about anxiety, but another parent consistently offers reassurance throughout the day. Your child will quickly learn to go to the parent who offers reassurance and gives him or her lots of attention throughout the day. 
  • Know when to seek professional help
    If your child’s worries are seriously distressing or causing problems with friends or school, talk to your pediatrician. He or she can help you find local mental health providers who specialize in treating anxiety in children and teens. Here are some things to consider when looking for a mental health provider:
    • The provider should take a skills-building approach. Remember, you cannot reason with anxiety so treatment should not only involve talking about fears. Good treatment requires action!
    • Most of the work should be done outside your provider’s office. Your child should have homework to do between appointments, like practicing relaxation skills or working through his or her fear hierarchy. After the first appointment, the rest should focus on learning about anxiety, learning new skills, and talking about progress with homework.
    • Parents should be involved in every step. It can be hard for anyone to face his or her fears, so parents play a big role in helping their children to do homework between sessions and in offering rewards for progress.

Recommended reading:

  • AnxietyBC – This website offers education about anxiety and anxiety treatment for children and teens.
  • Coping Skills for Kids – This website offers kid-tested strategies for calming anxieties commonly used by child therapists.
  • What to do When You Worry Too Much: A Kid’s Guide to Overcoming Anxiety by Dawn Huebner (book)
  • What to do When You Don’t Want to Be Apart: A Kid’s Guide to Overcoming Separation Anxiety by Kristen Lavallee (book)
  • David and the Worry Beast: Helping Children Cope with Anxiety by Anne Marie Guanci (book)

 

Written and reviewed by Blake M. Lancaster, PhD, Katherine Tennant, PhDUpdated June 2018