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. 

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. 

• 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 attacks often occur 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 attacks often occur 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. 

• 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. 

• 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. 

• 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. 

• 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

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.

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 cope 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.