If you’ve ever felt anxious before delivering a speech, taking a test or performing on stage, you’re not alone. Most people feel anxious on occasion and it can actually be a good thing. Evolutionarily speaking, anxiety has kept humans alive because it signals danger. It also motivates us to practice for that speech, study for that test or rehearse our performance. Unfortunately, for some people — including children — anxiety can become severe, persist over time and become debilitating.
Anxiety disorders are the most common mental health concern in the United States, according to the National Alliance on Mental Illness (NAMI). Approximately 7% of children ages 3 to17 experience issues with anxiety in the U.S. each year, and most people develop anxiety before age 21. Anxiety is more prevalent in girls than boys, and women are more than twice as likely as men to develop an anxiety disorder in their lifetime. More than 40 million adults (19.1%) have an anxiety disorder.
Parents can play a decisive and positive role in helping their children cope with anxiety. It starts with education.
[READ: 7 Physical Signs You Have Anxiety]
What Is Anxiety?
Anxiety is part of the human experience and a normal human emotion, according to Dr. Paul Leandri, a clinical psychologist who specializes in treating anxiety in adults and children.
A perfect example is anticipatory anxiety, which we tend to feel leading up to a nerve-racking event, such as public speaking. For most people, once we’ve done the thing that was causing the anxiety, we calm down and the anxiety goes away. That experience then helps us approach future anxiety-producing situations.
“The difference between feeling the emotion of anxiety and what we might call an anxiety disorder is usually based on the duration and the intensity of the anxiety,” Leandri says. “This is especially true if the anxiety lasts for an extended period of time, causes significant distress that’s disproportionate to the cause or worry that the anxiety might be based on.”
Signs your child’s anxiety may have developed into an anxiety disorder, according to Leandri: If the anxiety is interfering with your child’s functioning or their quality of life, if it’s affecting their behavior and their decision-making, and/or if it lasts six months or longer.
[Read: What Are the Best Ways to Stop Overthinking and Reduce Anxiety?]
Types of Anxiety
“Anxiety comes in lots of different flavors — it’s sort of like ice cream and you can have more than one flavor at a time in your bowl,” says Dr. Sarah Stearns, a clinical/pediatric psychologist who treats anxiety disorders in toddlers up to young adults. Here are some of the common types.
— Generalized Anxiety Disorder (GAD). One of the most common childhood anxiety disorders, it often develops between ages 9 and 11. A child with GAD excessively worries about the stuff of daily life. They may fret about things before they happen or fear for the health and safety of their family. The issues may change, but the worry is typically ever-present.
— Obsessive Compulsive Disorder (OCD). With OCD, children become obsessed with anxious thoughts. They often develop rituals that help them feel in control, including behaviors such as compulsive hand-washing.
— Phobias. Unlike normal fears, for example of spiders, kids with phobias are afraid of things that aren’t typically considered dangerous, or their level of fear is out of proportion to the actual danger.
— Separation Anxiety Disorder. Normal separation anxiety typically begins between the ages of 8 and 12 months and starts to decrease when children enter preschool. Separation anxiety disorder is when, beyond that age, a child has disproportionate anxiety about separating from a parent or caregiver, often crying for extended periods of time.
— Social Anxiety Disorder. Young people are often anxious about social interactions — saying the right things and being observed or performing in front of others, particularly their peers. Kids with social anxiety disorder are anxious about being around a lot of people and feel overwhelmed in large groups.
[Panic Attack vs. Anxiety Attack: How to Tell the Difference]
Childhood Anxiety Symptoms Checklist
Since children often get upset over small things and teenagers have a tendency to be nervous about fitting in, getting good grades, scoring a goal and a million other things, it can be difficult for parents to tell if their child’s anxious behavior is normal or something more troubling. There is no definitive test for anxiety but there are common symptoms.
Stearns says it’s helpful to divide the symptoms into three categories: physical, behavioral and emotional.
— Physical symptoms can include complaints of stomachaches, muscle tension and headaches. In young children especially, parents might notice these symptoms first, Stearns says.
— Emotional symptoms may manifest as irritability, getting angry easily, worrying or crying more than their peers and looking for a lot of reassurance.
— Behavioral symptoms may include avoidance and a lack of age-appropriate independent activities — an inability to sleep alone, attend school or participate in an after-school program. They might worry about future events, ask tons of questions, ruminate on a particular topic and fret about improbable outcomes.
Additional behavioral symptoms are characterized as the Three Fs of anxiety: fight, flight or freeze.
— Fight: Kids might seem angry or oppositional.
— Flight: Kids avoid the thing that they’re anxious about.
— Freeze: Kids shut down and won’t communicate or talk about how they’re feeling or what’s going on.
Stearns says that it’s possible to have more than one type of symptom, depending on the type or types of anxiety being experienced.
Causes of Anxiety in Children and Teens
There is usually more than one cause of childhood anxiety. Genes play a role, so if a family member has an anxiety disorder, the child is likely to have one as well. Biology may also play a part; some people are simply wired to be more anxious than others. Environment can be a factor — growing up in a family of anxious people may “teach” a child to be anxious. Life events can also generate anxiety.
“It’s helpful for us to know that any sort of change — a transition or stressor — could lead to kids exhibiting some symptoms of anxiety,” says Dr. Christine Crawford, a child psychiatrist and associate medical director at NAMI. She cites starting a new school, transitioning into a new grade, moving to a new community, a death in the family and divorce as examples.
She adds that kids themselves say that academic pressure contributes to anxiety, and as they advance in school, anxiety increases. “I can tell you that it tends to peak during junior year of high school,” Crawford says. Junior year also happens to be the time when most kids turn 16 or 17, so they’re expected to get their driver’s license and may be pressed to get a job while keeping up with a rigorous school schedule, so it’s generally a stressful time.
Then there’s the impact of vicarious trauma. Through the internet and social media, kids have immediate access to all kinds of tragic news and information. Stearns notes that children and teens often see vivid images of disasters, and are watching without an adult who could interpret them and provide context.
For example, kids hear about school shootings and worry that something could happen in their community or at their school. “Kids are carrying that with them each and every day, even though they might not be communicating that to their parents.”
Social media poses additional problems for kids and teens. “There’s this constant fear of missing out, so you’re aware of what other people are doing and when you’re not included in something,” Stearns says. “I think that’s difficult for everybody, but if you’re an anxious teen, it’s that much more difficult.”
Finally, living through the pandemic has prompted anxiety in this generation of children, according to Crawford. And even though COVID is no longer the threat it once was, kids are still carrying the concern that at any moment, there may be threats to their safety. “And that’s something that can’t be erased because that was something that really has impacted their development at a very critical time in their life,” Crawford says.
Childhood Anxiety Treatment
The primary treatments for childhood anxiety are a type of psychotherapy called cognitive behavioral therapy (CBT) and medication.
CBT helps people recognize and connect their thoughts, feelings and actions.
“We teach people to recognize physical sensations of anxiety and not be alarmed by them, but just to think of that as information, like a clue that they’re beginning to feel anxious about something,” Stearns explains. “Then we try to give them confidence that they can cope with that physical sensation. So, we teach relaxation strategies to counteract that fight, flight or freeze reaction.”
With CBT, kids learn to evaluate their thoughts and not accept an anxious thought as truth. Stearns says people with anxiety are more prone to automatic negative thoughts, so a therapist will help the child evaluate the thought and ask if it’s likely, accurate or helpful. If it’s not, they’ll challenge the thought and try to come up with a more positive or neutral thought that could lead to a more positive or at least neutral emotion. When the child is feeling better, they’re less likely to avoid or engage in an unhelpful coping strategy or action.
Medications for childhood anxiety include selective serotonin reuptake inhibitors (SSRIs), which work by boosting serotonin levels in the brain, improving mood and easing anxiety, and for more severe cases, anti-anxiety medications, which help calm the central nervous system.
People who may benefit from medication include young children, those who don’t have access to CBT, kids who are overwhelmed by other treatment strategies or whose anxiety is so severe that they are missing school or can’t leave the house. Medications are effective for many anxiety disorders and may be used on their own or in combination with CBT.
How Parents Can Help Their Kids With Anxiety
If your child or teen is experiencing anxiety, listen to their concerns and seek professional help. Speak to your pediatrician or a counselor at school for an evaluation and possible referral to a credentialed therapist. Also, look into group therapy, which can be helpful because kids see that they aren’t the only ones who have anxiety.
Kids see their parents and model their behavior, so if a parent or parents have anxiety, one of the most important ways they can help their kids is to get treatment themselves.
“We know that a lot of the parents in the lives of our kids are also struggling to manage their anxiety,” Crawford says. “So kids are really having difficulty learning from their adult role models how to manage. If their parents are struggling to cope, they too will struggle to identify some of the strategies and tools they can use to manage their anxieties.”
Though it may be tempting, don’t try to remove obstacles or situations that might cause distress for your child. Snow-plow parenting is understandable, but Stearns says it’s not very helpful. “Kids need to learn how to tolerate distress. They need to learn how to tolerate uncertainty and to sit with those uncomfortable feelings,” Stearns says.
Lastly, don’t ignore anxiety in your child and assume they’ll outgrow it, because they may adopt poor coping strategies and avoid activities that are part of their normal development. Untreated anxiety can disrupt a child’s life and leave them vulnerable to other mental health issues as adults.
The goal is not to eliminate anxiety, since in many instances it’s helpful. “It’s like the brakes on a car. You wouldn’t want a car with no brakes but you also don’t want to have the emergency brake on all the time,” Stearns says.
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Helping Kids With Anxiety: What to Do and Not Do originally appeared on usnews.com
