Anxiety Disorders in Children

Overview

What is Anxiety?

Anxiety is an emotion people feel when they’re worried about something they think might happen. It affects the mind and body, sometimes causing that “butterflies-in-the-stomach” feeling. People use lots of different words to talk about anxiety, like “worry,” “stress,” “fear,” “nervous,” “scared,” “uneasy,” and “dread.”

Almost everyone feels anxiety from time to time. In fact, having a little anxiety can even help motivate you or keep you safe, but too much can cause problems.

What Are Anxiety Disorders?

When anxiety doesn’t go away or worsens and gets in the way of doing or enjoying things, it’s called an anxiety disorder. There are different kinds of anxiety disorders, and they can cause changes in behavior, sleep, eating, or mood. Getting the right treatment and support can help kids and teens feel better and thrive.

Top Things to Know

• An anxiety disorder is anxiety that doesn’t go away and prevents people from doing or enjoying activities.
• There are many different kinds of anxiety disorders.
• Kids and teens with anxiety disorders may avoid school or have bellyaches, headaches, or trouble sleeping.
• One of the most common treatments for anxiety disorders is cognitive behavioral therapy (CBT).

Signs & Symptoms

What Are the Signs & Symptoms of Anxiety Disorders?

Kids and teens with anxiety disorders may have symptoms that can affect them in different ways, such as:

Feelings and Thoughts:

• having worries or fears that take up too much of their time and energy, even when they’re safe 
• feeling nervous or needing others to keep telling them things are OK
• imagining the worst possible outcome
• worrying “what if” in many situations

Behaviors:

• skipping things that make them anxious, like school, sleepovers, new activities, and new places
• avoiding going somewhere alone
• clinging to parents or caregivers, or acting scared or upset
• crying often or having temper tantrums
• refusing to talk or do things they once enjoyed
• turning to things like alcohol or drugs, or other unhealthy behaviors to avoid feeling anxious

Physical Signs:

• being shaky, jittery, dizzy, or short of breath
• having a nervous feeling in their stomach (like "butterflies"), stomachaches, or headaches
• sweating or having a hot face, clammy hands, or a dry mouth
• trouble sleeping or eating
• having tense muscles, a racing heart, or chest pain

Kinds of Anxiety Disorders in Kids & Teens

Different anxiety disorders can affect kids and teens. Here are some common ones:

Generalized Anxiety Disorder

Kids with generalized anxiety disorder (GAD) worry almost every day about many things, like homework, tests, their health, or making mistakes. They get nervous about stuff like recess, parties, loved ones, weather, war, and getting hurt. The worries may not be realistic. They may feel restless, tense, or easily annoyed. GAD can make it tough to focus in school, have fun, and eat and sleep well. Some kids might ask over and over whether something they’re concerned about will happen. It's hard for them to feel OK, no matter what a parent or another trusted adult says.

Separation Anxiety Disorder

It's normal for babies and very young kids to feel anxious the first times they’re apart from their parents — it’s called separation anxiety. When kids don't outgrow the fear of being apart from a parent, it's known as separation anxiety disorder. They worry about something bad happening to themselves or their caregivers when they’re apart. They may miss a lot of school, cling to a parent, cry, have nightmares, or refuse to go to playdates. Kids may also have trouble sleeping alone or avoid rooms without their parent close by.

Social Anxiety Disorder

With social anxiety disorder (or social phobia), kids fear what others will think or say about them and worry about embarrassing themselves. They may avoid attention, like not raising their hand in class, and may freeze or panic if called on. They may worry about being watched when eating and skip lunch at school. Social anxiety can even make kids avoid school or friends. They might feel sick, tired, or have symptoms like a racing heart, shortness of breath, blushing, or feeling shaky. Some kids with social anxiety do fine in some settings but have fear in others, like being afraid of speaking or presenting only in public.

Selective Mutism

This is a form of social anxiety that causes kids to be so afraid that they don't talk in some settings. Kids and teens who have it can talk, and they do talk at home or with their closest people. But they may refuse to talk at all at school, with certain people, or in other places where they’re uncomfortable.

Panic Disorder

With panic disorder, a person has panic attacks (suddenly feeling fear and like they can’t move, even if there’s no clear reason). They can cause intense physical symptoms, like feeling shaky or jittery, trembling, having a racing heart rate, and being short of breath. Panic attacks can happen any time so people may worry about having more of them or avoid situations that could cause them. Panic disorders are more common in teens than in younger kids. Panic attacks can also be a part of another condition, like other types of anxiety disorders, depression, and posttraumatic stress disorder (PTSD).

Specific Phobias

With a specific phobia, kids may have an extreme fear of things like animals, needles, blood, throwing up, choking, thunderstorms, people in costumes, or the dark. Younger kids may show this fear through temper tantrums or clinging to caregivers. If kids are near what they fear, they feel terrified and are hard to comfort, so they try to avoid what scares them. For example, a kid with a phobia of dogs might not go to a friend's house, a park, or a party because dogs might be there.

Causes

What Causes Anxiety Disorders in Kids & Teens?

The body's normal response to danger is called the "fight or flight" response. It triggers the release of stress hormones (kinds of chemicals) in the body, which prepare people to deal with real danger. The hormones affect heart rate, breathing, muscles, nerves, and digestion. The "fight or flight" response is meant to protect people from something harmful. But with anxiety disorders, the response is overactive and happens even when there’s no actual danger.

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 — by inheriting certain genes.
• Brain chemistry. Genes help direct the way brain chemicals (called neurotransmitters) work. If there aren’t enough of certain brain chemicals or they’re not working well, it can cause anxiety.
• Life events. Things that happen in a kid’s life can be stressful and hard to cope with. Loss, serious illness, death of a loved one, violence, or abuse can lead some kids to become anxious.
• Ways relatives react. Family members who have high levels of anxiety may be afraid or nervous when faced with certain challenges. Children may then react the same way in similar situations.

How Are Anxiety Disorders Diagnosed?

A trained therapist can diagnose anxiety disorders. The person will talk with you and your child, ask questions, and listen carefully. Therapists will ask how and when the anxiety and fears started and when they happen most. That helps therapists figure out the specific anxiety disorder your child has; If kids are old enough, they’ll also likely be asked to fill out surveys to find out the level of their anxiety and how much it affects daily life.

A child or teen with signs of anxiety should also have a regular health checkup. This helps doctors see if other health problems may be causing the symptoms or making them worse.

Treatment & Home Care

How Are Anxiety Disorders Treated?

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

CBT teaches kids that what they think and how they behave affects how they feel. They learn that when they avoid what they fear, the fear stays strong. But when they face a fear, the fear gets weaker -. Kids learn and practice coping skills so they can manage their worries better. These skills often include deep breathing, ways to relax muscles, and exercises to replace worry or negative thoughts. Parents learn how to best respond when a child is anxious and how to help kids deal with fears.

Over time, therapists show kids how to cope with situations they're afraid of, and give support and praise as they try. Without so many worries, kids can focus on other things — like school, activities, and fun. Sometimes, medicines are also used to help treat anxiety, usually with therapy.

How Can You Help Your 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. Ask for specific things you can do to best help your child.
• Help your child face fears. The therapist can show you how to help your child practice at home. Praise your child’s 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 strength.
• Encourage your child to take small steps forward. Try not to let kids give up or avoid what they’re afraid of. Remind them that using the tools they practice in therapy will help.
• Be patient. It takes time for therapy to work and for kids to feel better.

Other Common Questions

How can I help when my child worries?

All kids worry at times, and some may do so more than others. Learn how to help kids manage worry and tackle everyday problems.

How can I help my child heal after trauma?

Kids can recover after trauma with help from a specially trained trauma therapist and extra support and comfort from parents. Try these tips to help kids heal.

What are some ways to boost my child’s self-esteem?

Self-esteem (feeling good about yourself) comes easier to some kids than others. Healthy self-esteem helps them deal better with everyday worries. Here's how to help kids feel better about themselves.