Recognizing The Signs And Symptoms Of Anxiety In Children
Like adults, children will experience some anxiety at different points in their growth and development. However, the symptoms of anxiety in children can be different than adults and may be overlooked or perceived as a behavioral issue. In fact, anxiety disorders are one of the most common mental health conditions experienced by children worldwide. Statistics from the Centers for Disease Control (CDC) suggest that as much as 9.4% of children in the US (approximately 5.8 million) manage anxiety. Read on to learn how to recognize the signs and symptoms of anxiety in children and how therapy can be used to help them develop practical coping skills to manage symptoms and stress.
What Is Anxiety?
A simple definition of anxiety is a feeling of extreme unease and worry, especially in anticipation of future events. While often uncomfortable, anxiety is a natural human emotion that most people experience in reaction to stress.
Anxiety often does not develop alone. The CDC states that approximately one in three children with anxiety also experience another mental health issue. The currently available information shows that 37.9% of children with anxiety also have behavior problems, and 20.3% also have depression. A child may be diagnosed with different type of anxiety disorders as well, especially because of overlapping symptoms. As in adults, anxiety disorders in children are typically treated with mental health therapy and occasionally medication. With early diagnosis and treatment interventions, children can learn to understand the reasons behind anxiety and learn how to manage overwhelming feelings when they arise.
“Although fears and worries are typical in children, persistent or extreme forms of fear and sadness could be due to anxiety or depression. Because the symptoms primarily involve thoughts and feelings, they are sometimes called internalizing disorders.” — Centers for Disease Control and Prevention
What Causes Anxiety?
According to the Anxiety Disorders Association of America (ADAA), anxiety in children is believed to be caused by a combination of biological and environmental factors. Stressful events like moving, the loss of someone close in the family, or difficulty at school can precipitate the onset of an anxiety disorder. However, the ADAA said stress itself does not cause anxiety disorders. While the tendency toward anxiety can be genetic, it is not necessarily passed on from parent to child.
Recognizing The Symptoms Of Anxiety In Children
The symptoms of anxiety in children can be similar to adults, such as muscle tension and difficulty sleeping. However, they may also present with different symptoms or may internalize them completely. Because a child’s cognitive function is still developing, they may not be able to process these intense feelings nor communicate them outwardly to their parents.
While anxiety symptoms can present differently in each child, the following list includes some common symptoms children with anxiety may demonstrate.
Common Anxiety Signs And Symptoms
Difficulty sleeping
Frequent complaints of stomachaches, headaches, or other physical problems
Actively avoiding certain situations
Clingy behavior toward parents or caregivers
Trouble with concentration in school
Tantrums
Self-consciousness
Muscle tension or aches
What Is An Anxiety Attack, And How Can You Help?
Some children with anxiety may experience anxiety attacks, which are different from panic attacks. Both involve the intense experience of symptoms related to anxiety and can severely interfere with daily life. Your child may be experiencing a new change or simply has anxiety about a daily routine, such as going to school. Instead of showing small signs of anxiety, they may have had an attack of anxiety symptoms in response to these stressors.
Symptoms of an anxiety attack or a panic attack are similar and can include a racing heartbeat, trouble breathing, shaking, trembling, or tunnel vision. However, there are differences between the two:
Anxiety Attack—Often occurs in response to specific stressors and may build gradually. Anxiety attacks are more predictable than panic attacks. Typically, when a parent sees their child have an anxiety attack, it follows a period when their child has been anxious or stressed for quite some time.
Panic Attack— Often occurs unexpectedly and without warning or apparent cause, typically involving intense and overwhelming fear. Panic attacks are often accompanied by physical symptoms such as shortness of breath, racing heart rate, and lightheadedness. For parents, seeing their child experience a panic attack can be unsettling because it happens suddenly.
Types Of Childhood Anxiety
Children can experience anxiety in numerous ways. Below, each childhood anxiety disorder is briefly explained with an overview to help you understand how it can affect your child.
Separation Anxiety Disorder (SAD)
Sometimes children experience intense worry or extreme fear when separated from their parents or caregivers. While many children typically cry when being left with a babysitter or daycare, if the behavior continues for hours after the departure, your child may have separation anxiety. According to Stanford Medicine, experts believe a combination of environmental and biological factors causes SAD.
Signs And Symptoms
Common anxiety symptoms listed above
Persistent fear or stress when separated from family
Refusal to sleep alone
Repeated nightmares with separation themes and worry over caregivers becoming sick or dying
Fearful or reluctant to spend time alone
Clingy behavior, even at home
Social Anxiety Disorder
Child development experts at the Child Mind Institute said social anxiety disorder in children is more than feeling shy. Children managing social anxiety may experience an intense fear or worry that they will be embarrassed, rejected, or ridiculed by others in social settings. Accordingly, they will avoid events or tasks they need or want to do.
Signs And Symptoms
Common anxiety symptoms listed above
Intense avoidance of situations that require social performance
Fear or anxiety related to school, public situations, new people, or even conversations with unfamiliar people
Shaking, sweating, or shortness of breath
Showings signs of being upset long before the event they’re anxious about
Worry about saying or doing something to cause others to judge them
Test Anxiety
Test anxiety is a subset of performance anxiety involving intense worry and self-doubt related to tests for school or work. While some worry over a critical examination is typical, childhood development experts at the Mayo Clinic suggest that test anxiety can interfere with performance and make the test-taker miserable, even if they studied and prepared.
Signs And Symptoms
Common anxiety symptoms listed above
Feeling “butterflies” in their stomach
Cold, clammy hands
Headaches, nausea, hot and cold flashes, or feeling faint
Anger, helplessness, or irritation
Intense self-doubt related to the ability to perform well on the test, regardless of how well prepared
Generalized Anxiety Disorder (GAD)
According to Boston Children’s Hospital , generalized anxiety disorder is characterized by excessive and uncontrollable worry about various events and situations. These feelings are typically more intense and persistent than their standard counterparts. While anxiety and fear are expected emotions, children with GAD tend to experience them in excess compared to their non-anxious peers.
Signs And Symptoms
Common anxiety symptoms listed above
Worry over future events, such as what happens if their caregivers die
Fixation on past events
Expecting the worst, even without apparent cause for concern
Extreme concern over performance in school, social situations, or other circumstances
Restlessness, excess energy, or being on-edge
Other Anxiety Disorders In Children
Panic Disorders—Characterized by frequent, unexpected panic attacks that may cause a child to believe they are dying or having a heart attack
Selective Mutism—Anxiety that interferes with the ability to speak in certain high-stress situations
Specific Phobias—Extreme fear related to a specific thing or situation, such as flying insects, needles, or the dark
Obsessive-Compulsive Disorder (OCD)—Unwanted and difficult-to-control thoughts and compulsive behaviors
Treating Anxiety In Children
If your child is experiencing the symptoms of an anxiety disorder, know that treatment is available. While anxiety disorders are one of the most common mental health conditions children can have, they are also some of the most treatable. Cognitive behavioral therapy (CBT) is one of the most frequent treatments used to help children with anxiety. For children, CBT typically involves the therapist helping them to identify the thoughts that cause anxious feelings and modifying these thoughts into positive self-talk. One component of CBT is exposure, or the testing and ‘facing’ of fears in a safe environment. In addition, some mental health professionals suggest antianxiety medication and mindfulness techniques to help cope with anxiety symptoms.
“Almost all types of anxiety are best treated with cognitive behavioral therapy (CBT). CBT is based on the idea that how we think and act both affect how we feel. By learning to change negative thoughts and unhealthy actions, kids can change their bad feelings.” — Child Mind Institute
How You Can Help Your Child With Anxiety
While seeking a licensed therapist to help your child is one of the most effective ways to help manage the symptoms of anxiety disorders, there are several tactics parents can use at home to help.
Personalize the anxiety—Have your child give it a name. Draw pictures and give their anxiety a silly appearance. Try approaching it as something external. “Is that big, mean cloud, Shady, telling you the other kids don’t like you?”
Demystify future anxiety—If your child is worried about an event coming up, try visiting the location beforehand so they can be familiar with the area and form a plan for how they want to act. Visualize where things may be at the event and help them talk about how to deal with their worries.
Practice exposure—If your child has a phobia, try building their tolerance in small steps. For example, if your child struggles with public situations, try going on weekly outings with the goal of more social interaction each time. If you go out to eat, work up to ordering the meal on their own.
Talk about it—Build open emotional communication that allows your child to express their concerns to you. Talk about their worries and help them work through the problem. Try to find healthy coping strategies that help them get through tense situations.
How Therapy Can Help
A major component of treating anxiety in children is educating and including the parents in every aspect of the treatment plan. Even without a mental health condition, there can be many benefits to working with a licensed therapist through an online therapy platform like BetterHelp. These include learning practical coping skills to manage parental stress and gaining a deeper understanding of how anxiety affects your child. There are also virtual treatment options for children ages 13-19 through providers like TeenCounseling. Online therapy is frequently less expensive and involves shorter wait times than treatment in the traditional setting, with flexible appointment formats that make it easier to fit therapy into your busy schedule.
According to a 2014 study, online CBT can be as effective as traditional face-to-face treatments for children with anxiety. The study further states that this correlates with the effectiveness of internet-based therapeutic interventions for adults. Many patients also said the added distance of online therapy made it easier to open up emotionally to their therapist.
Takeaway
Frequently Asked Questions (FAQs)
How do you help a child with anxiety?
While symptoms of anxiety in children are ordinary, parents and legal guardians can help relieve their fears and worries to improve their overall behavioral health. Firstly, parents and guardians need to speak to their children about their concerns to indicate that you understand how they may be feeling. You may also wish to explain what an anxiety disorder is and how it can affect our mental and physical health. You may also want to:
Teach your young children to recognize anxiety symptoms
Practice basic techniques of mindfulness and relaxation such as deep breathing and counting to three
Ensure your child's daily routine is as consistent as possible as it will bring them comfort
Encourage your child to speak to you when they are feeling anxious
What causes child anxiety?
Anxiety in teens and children is common. Research suggests it is prevalent for children to experience anxiety and develop an anxiety disorder at different stages of their lives for several reasons. For example, children aged 3 to 6 may develop a separation anxiety disorder, which may cause them to cry and be clingy with their parents. However, for the most part, this is part of a child's normal development that will subside when they turn around two or three years of age. It is also widespread for children who are just starting school to experience anxiety symptoms or specific fears and worries about stimuli in their environment, including the dark, animals, water, heights, and the sight of blood. Some young children will also experience social phobia in school before a test or in other social settings where they feel shy.
What are the first symptoms of anxiety?
Anxiety is pervasive in children and can affect your children's cognitive behavioral well-being if not treated accordingly. Therefore, to provide insight into the symptoms of anxiety in children, we have compiled a list of behaviors you should pay attention to:
Constant fears and worries
Development of separation anxiety disorder
Selective mutism
Always crying
Complaining of stomach aches or not feeling well
Difficulties in concentration
Difficulty sleeping
Wetting the bed
Lack of confidence in specific situations
Avoidance behaviors
Social phobia
Obsessive-compulsive behaviors, for example, checking to see if the door is locked multiple times continuously or health anxiety such as fearing they have a disease or illness.
Comorbidity of anxiety and depression
When should I be concerned about my child’s anxiety?
While symptoms of anxiety in children can vary from child to child, the contrast between usual fears and worries and an anxiety disorder is the overall severity of the symptoms experienced. Take note of these guidelines to help you distinguish between the two instances:
The Overall Severity Of Anxiety Is Highly Irrational. For example, if your child worries about hurting their family, they do not tie their shoes a specific number of times. Symptoms like these could be an indication that your child is experiencing a compulsive disorder such as OCD.
The Anxiety Does Not Subside. While it is common for children to experience situational anxiety symptoms after a significant event such as being in a car accident, a child experiencing traumatic stress will continue to experience night terrors months after the event has taken place that triggers their fight or flight system.
Their Anxiety Causes Them To Exhibit Avoidance Behaviors. For example, a child experiencing severe social phobia may avoid going to sleepovers and birthday parties even though their friends are present because they get overwhelmed by the loud noises.
The Fears And Worries Your Child Experiences Are Disproportionate. For example, your child may cry and get upset when they have a test the next day.
You Notice Symptoms Of Both Anxiety And Depression. Many children often experience symptoms of depression because of their anxiety.
Is anxiety in children normal?
Yes, symptoms of anxiety in children are a normal part of growing up. However, as previously mentioned, the difference between normal childhood worries and anxiety disorders in your children is the severity in which the symptoms manifest in your child's everyday life. While it is entirely normal to experience fears and worries concerning stressful events, an anxiety disorder can hinder a child's daily life beyond childhood worries. Your child may also be at risk of developing both anxiety and depression if not treated accordingly.
What does an anxiety attack look like in a child?
Children who have a panic disorder are likely to experience frequent panic attacks that can cause overwhelming emotional and physical stress in children and adolescents. According to the American Academy of Child and Adolescent Psychiatry, a panic disorder is a presence of "unexpected and repeated periods of intense fear or discomfort, along with other symptoms such as a racing heartbeat or feeling short of breath." Accordingly, symptoms of an anxiety attack in children include:
Dizziness
Lightheadedness
Shortness of breath
Increase heart rate
Intense fears
Shaking
How do I know if my child has stress or anxiety?
The best way to know if your child is experiencing stress or an anxiety disorder is to become familiar with the signs and symptoms of each so that you may teach your child how to deal with their feelings using positive coping mechanisms. Unresolved stress in your child's life may cause them to experience cognitive-behavioral symptoms such as anxiety. These two psychological health problems are generally co-morbid, meaning they occur together.
How can kids get rid of stress?
The first step to getting rid of your stress is to acknowledge why you are feeling stressed. By recognizing these uncomfortable feelings, you will get to the root of what is causing stress in your life. It is also essential for kids to practice activities to relax and soothe themselves, such as playing with toys or watching TV. Keeping a positive mindset is also crucial to reducing stress in a child's life. Encouraging positive self-expression to combat anxiety symptoms will allow children to reframe their thinking and move past their negative and damaging thoughts.
Can a parent’s stress hurt a child?
Children's mental and cognitive behavioral well-being is often directly affected by the actions of their parents. Therefore, it is very common for children to experience the adverse effects of their parents' stress as they can become susceptible to their parents' moods. While it can sometimes be challenging to hide your anxiety from your children, on-going exposure to parental stress can potentially be damaging to the well-being of your child's emotional, psychological, and physical health. Additionally, frequent exposure to stress as a child creates opportunities for children to develop unhealthy habits from a young age, such as overeating to self soothe their feelings of insecurity, anxiety and depression, and lack of nurturing feelings from their parents guardian figures.
What are the five warning signs of stress?
Five warning signs of stress in a child or adolescent youth are:
Loss of interest in school and extracurricular activities
Social phobia
Inability to concentrate
Competing with siblings or classmates for a teacher or parental attention
Exhibiting aggressive and impulsive behaviors
Refusal to leave their home
However, according to the Substance Abuse and Mental Health Services Administration, older youth may experience signs such as:
Disruptive and aggressive behavior in the home or at school
Social isolation from family and friends, including social phobia
Use of drugs and alcohol
Newfound tendency to resist authority
What are the three causes of stress?
When humans perceive a potential threat to our safety or challenge in the environment around them, stress is our body's natural biological trigger that is known as the fight-or-flight response, which releases a surge of hormones throughout our body to prepare us against the perceived threat or challenge. And while it is normal for everyone to feel stressed from time to time, people may develop a stress disorder when they experience prolonged, severe, and frequent stress in their everyday lives. Three common causes of stress disorder include:
High-intensity jobs where individuals must work long hours
Surviving traumatic events such as a natural disaster or abuse
Prolonged financial problems
If you are facing or witnessing abuse of any kind, the National Domestic Violence Hotline is available. Call 1-800-799-SAFE (7233) or Text "START" to 88788. You can also use the online chat.
However, we should note that while these causes may be stressful to some individuals, they may not affect others in the same capacity to cause a fight or flight response.
What are the five signs of emotional hardship?
As mentioned, while it is normal to experience stressors in our everyday lives, it is widespread for people to experience emotional hardship after experiencing a traumatic, stress-related event. While most symptoms subside on their own, children and adolescents will often experience traumatic stress disorder related symptoms that can affect them for weeks, months, or years. However, five signs of emotional hardship for both adults and children can include:
Having little to no energy
Experiences fear and worries frequently
Excessive sleeping or eating or lack thereof
Feelings of hopelessness
The difficulty of adjusting back home, school, or work-life
Anxiety and depression
How do I know if I am mentally unstable?
While certain psychological disorders may appear out of nowhere, most individuals who have begun developing symptoms begin to recognize small changes or feelings that something is not right concerning how they are thinking, feeling, or behaving before an illness appears in its full-blown effect. Therefore, learning the warning signs of a potential mental crisis is imperative to taking positive action before you become unwell. According to the American Psychiatric Association, signs and symptoms that may indicate the presence of a psychological disorder include:
Drastic changes in your mood
Changes to your sleep schedule
Changes in your appetite
Loss of interest in activities that were once enjoyable to you
Withdrawing from social environments or social phobia
Feelings of isolation and loneliness
Difficulty concentrating and remembering
Feelings of paranoia
Feelings of anxiety and depression
An important note to add is that while an individual experiences one or two symptoms noted, these alone are not enough to confirm that someone is experiencing a psychological health problem. Therefore, further testing and evaluation may be required before a formal diagnosis is determined. However, suppose someone is experiencing several of the above-noted symptoms that are causing them to be unable to live their day to day lives. In that case, it is an indication that they should contact a health professional for more details.
What does emotional stress feel like?
Emotional distress is a reasonably broad terminology that defines a state of mental distress that encompasses numerous symptoms and is often caused by mental health disorders, as a symptom of post-traumatic stress disorder, or specific situations at work, home, or school. However, characteristics of emotional distress generally manifest as symptoms of anxiety and depression. Like other behavioral health disorders, emotional distress symptoms may linger for a prolonged period or occur sequentially.
Symptoms of emotional distress may also vary in severity and type of symptoms from person to person, depending on their circumstances and their underlying psychological conditions. Those experiencing emotional pain may feel overwhelming emotions of hopelessness, anger, and fears and worries.
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