Anxiety Disorders

What Are Anxiety Disorders?

Anxiety disorders cause extreme fear and worry, and changes in a child's behavior, sleep, eating, or mood.

What Are the Kinds of Anxiety Disorders?

Different anxiety disorders can affect kids and teens. They include:

• generalized anxiety disorder
• separation anxiety disorder
• social anxiety disorder
• panic disorder
• selective mutism
• specific phobias

Generalized anxiety disorder (GAD). GAD causes kids to worry almost every day — and over lots of things. Kids with GAD worry over things that most kids worry about, like homework, tests, or making mistakes.

But with GAD, kids worry more, and more often, about these things. Kids with GAD also worry over things parents might not expect would cause worry. For example, they might worry about recess, lunchtime, birthday parties, playtime with friends, or riding the school bus. Kids with GAD may also worry about war, weather, or the future. Or about loved ones, safety, illness, or getting hurt.

Having GAD can make it hard for kids to focus in school. Because with GAD, there is almost always a worry on a kid's mind. GAD makes it hard for kids to relax and have fun, eat well, or fall asleep at night. They may miss many days of school because worry makes them feel sick, afraid, or tired.

Some kids with GAD keep worries to themselves. Others talk about their worries with a parent or teacher. They might ask over and over whether something they worry about will happen. But it's hard for them to feel OK, no matter what a parent says.  

Separation anxiety disorder. It's normal for babies and very young kids to feel anxious the first times they are apart from their parent. But soon they get used to being with a grandparent, babysitter, or teacher. And they start to feel at home at daycare or school.

But when kids don't outgrow the fear of being apart from a parent, it's called separation anxiety disorder. Even as they get older, kids with separation anxiety disorder feel very anxious about being away from their parent or away from home. They may miss many days of school. They may say they feel too sick or upset to go. They may cling to a parent, cry, or refuse to go to school, sleepovers, playdates, or other activities without their parent. At home, they may have trouble falling asleep or sleeping alone. They may avoid being in a room at home if their parent isn't close by.

Social phobia (social anxiety disorder). With social phobia, kids to feel too afraid of what others will think or say. They are always afraid they might do or say something embarrassing. They worry they might sound or look weird. They don't like to be the center of attention. They don't want others to notice them, so they might avoid raising their hand in class. If they get called on in class, they may freeze or panic and can't answer. With social phobia, a class presentation or a group activity with classmates can cause extreme fear.

Social phobia can cause kids and teens to avoid school or friends. They may feel sick or tired before or during school. They may complain of other body sensations that go with anxiety too. For example, they may feel their heart racing or feel short of breath. They may feel jumpy and feel they can't sit still. They may feel their face get hot or blush. They may feel shaky or lightheaded.

Panic disorder. These sudden anxiety attacks can cause overwhelming physicals symptoms, such as feeling shaky or jittery, trembling, a racing heart rate, and shortness of breath. Panic attacks can happen any time. They’re more common in teens than kids.

Selective mutism. This extreme form of social phobia causes kids to be so afraid they don't talk. Kids and teens who have it can talk. And they do talk at home or with their closest people. But they refuse to talk at all at school, with friends, or in other places where they have this fear.

Specific phobias. It's normal for young kids to feel scared of the dark, monsters, big animals, or loud noises like thunder or fireworks. Most of the time, when kids feel afraid, adults can help them feel safe and calm again. But a phobia is a more intense, more extreme, and longer lasting fear of a specific thing. With a phobia, a child dreads the thing they fear and tries to avoid it. If they are near what they fear, they feel terrified and are hard to comfort.

With a specific phobia, kids may have an extreme fear of things like animals, spiders, needles or shots, blood, throwing up, thunderstorms, people in costumes, or the dark. A phobia causes kids to avoid going places where they think they might see the thing they fear. For example, a kid with a phobia of dogs may not go to a friend's house, to a park, or to a party because dogs might be there.

What Are the Signs & Symptoms of Anxiety?

A parent or teacher may see signs that a child or teen is anxious. For example, a kid might cling, miss school, or cry. They might act scared or upset, or refuse to talk or do things. Kids and teens with anxiety also feel symptoms that others can't see. It can make them feel afraid, worried, or nervous.

It can affect their body too. They might feel shaky, jittery, or short of breath. They may feel "butterflies" in their stomach, a hot face, clammy hands, dry mouth, or a racing heart.

These symptoms of anxiety are the result of the "fight or flight" response. This is the body's normal response to danger. It triggers the release of natural chemicals in the body. These chemicals prepare us to deal with a real danger. They affect heart rate, breathing, muscles, nerves, and digestion. This response is meant to protect us from danger. But with anxiety disorders, the "fight or flight" response is overactive. It happens even when there is no real danger.

What Causes Anxiety Disorders?

Several things play a role in causing the overactive "fight or flight" that happens with anxiety disorders. They include:

Genetics. A child who has a family member with an anxiety disorder is more likely to have one too. Kids may inherit genes that make them prone to anxiety.

Brain chemistry. Genes help direct the way brain chemicals (called neurotransmitters) work. If specific brain chemicals are in short supply, or not working well, it can cause anxiety.

Life situations. Things that happen in a child's life can be stressful and difficult to cope with. Loss, serious illness, death of a loved one, violence, or abuse can lead some kids to become anxious.

Learned behaviors. Growing up in a family where others are fearful or anxious also can "teach" a child to be afraid too.

How Are Anxiety Disorders Diagnosed?

Anxiety disorders can be diagnosed by a trained therapist. They talk with you and your child, ask questions, and listen carefully. They'll ask how and when the child's anxiety and fears happen most. That helps them diagnose the specific anxiety disorder the child has.

A child or teen with symptoms of anxiety should also have a regular health checkup. This helps make sure no other health problem is causing the symptoms.

How Are Anxiety Disorders Treated?

Most often, anxiety disorders are treated with cognitive behavioral therapy (CBT). This is a type of talk therapy that helps families, kids, and teens learn to manage worry, fear, and anxiety.

CBT teaches kids that what they think and do affects how they feel. In CBT, kids learn that when they avoid what they fear, the fear stays strong. They learn that when they face a fear, the fear gets weak and goes away.

In CBT:

• Parents learn how to best respond when a child is anxious. They learn how to help kids face fears.
• Kids learn coping skills so they can face fear and worry less.

The therapist helps kids practice, and gives support and praise as they try. Over time, kids learn to face fears and feel better. They learn to get used to situations they're afraid of. They feel proud of what they've learned. And without so many worries, they can focus on other things — like school, activities, and fun. Sometimes, medicines are also used to help treat anxiety.

How Can I Help My Child?

If your child has an anxiety disorder, here are some ways you can help: 

• Find a trained therapist and take your child to all the therapy appointments.
• Talk often with the therapist, and ask how you can best help your child.
• Help your child face fears. Ask the therapist how you can help your child practice at home. Praise your child for efforts to cope with fears and worry.
• Help kids talk about feelings. Listen, and let them know you understand, love, and accept them. A caring relationship with you helps your child build inner strengths.
• Encourage your child to take small steps forward. Don't let your child give up or avoid what they're afraid of. Help them take small positive steps forward.
• Be patient. It takes a while for therapy to work and for kids to feel better.