Anxiety is feeling afraid, scared, worried, or nervous about things that might happen in the future or seem dangerous or unpredictable.
It is normal for children to experience anxiety in stressful situations. For example, many kids and teens feel scared or nervous on the first day of school; some youth describe feeling butterflies in their stomach. For most individuals, these anxious feelings go away once they get used to the new experience, but for others the feelings remain intense over time. When these feelings do not go away, they may be a sign of a childhood anxiety disorder.
Childhood anxiety disorders occur when feelings of stress or fear persist and are intense enough to interfere with everyday life. Childhood anxiety disorders can take many forms, but all involve excessive worry and stress. Children and teens with anxiety disorders are often distressed and easily frightened or upset, and they may have difficulty interacting with others.
Some children and teens with anxiety disorders may also feel excessively uncomfortable being in social situations (Social Anxiety) or when separating from a parent or loved one (Separation Anxiety). Other symptoms can include obsessive thoughts and/or compulsive behaviors (Obsessive-Compulsive Disorder, or OCD), unexpected panic-inducing distress (Panic Disorder), or more generalized worrying about everyday activities (Generalized Anxiety Disorder). These five anxiety disorders are the most common; less common anxiety disorders include Post-traumatic Stress Disorder, Selective Mutism, and Specific Phobias. Many children and adolescents have more than one type of anxiety disorder.
Fortunately, there are a number of effective treatment methods for childhood anxiety disorders, such as cognitive behavioral therapy (CBT), medication, and components of mindfulness. Teaching parents and other family members strategies for helping kids and teens deal with anxious feelings is an important part of treatment. It helps to create a home environment that is supportive and engaged in the youth’s progress.
All anxiety disorders involve fear, worry, and excessive distress. There are many types of anxiety. Some common signs and symptoms to look for in kids and teens include:
- Excessive discomfort in front of others or in public
- Avoidance of social or public situations
- Inability to speak in select social or public situations (such as at school, in a store, at a restaurant, etc.)
- Worry or fear before or during separation from parents or loved ones
- Frequent nightmares involving the loss of parents or loved ones
- Obsessive thoughts or compulsive behaviors
- Panic attacks, or fear of panic attacks
- Specific fears or phobias (such as of bees, dogs, etc.)
- Fear of natural disasters or other large-scale accidents
- Unrealistic or unfavorable opinion of one’s own performance or abilities
- Excessive need for reassurance and approval from others
These are just some signs that a youth may have an anxiety disorder. All of these symptoms can occur in kids and teens without anxiety disorders; however, for youth with anxiety disorders, these feelings are more intense and more persistent, and they can cause difficulty on a regular basis.
In all cases, it is up to a healthcare provider or mental health professional to make a diagnosis. As a provider, it is important to determine whether the symptoms a child is experiencing are temporary responses to a difficult or stressful life situation or associated with a specific anxiety disorder or medical condition.
Recommended treatment techniques may vary depending on the type and severity of the anxiety, as well as on individual and family factors. There are two primary treatment strategies for anxious youth: cognitive behavioral therapy (CBT) and medication. Mindfulness meditation is another tool often used to help individuals manage anxiety and stress.
- Cognitive Behavioral Therapy (CBT) – CBT is a structured, goal-focused, and time-limited intervention used to treat individuals with anxiety. CBT has been demonstrated to help reduce anxiety symptoms in both adults and children. It can be used alone or in combination with medication and/or mindfulness meditation. CBT involves working with a therapist for approximately 12 to 20 sessions to target specific fears. A major component of treatment is exposure therapy, or approaching feared situations in a graded, step-by-step fashion. This helps the child learn, over time, that they can tolerate feeling anxious. These exposures are conducted during the clinic session and are assigned weekly for at-home practice. Other components of CBT involve learning strategies to cope with anxious feelings and thoughts, challenging negative thoughts, and learning to relax one’s body when feeling physically stressed or anxious. Parental involvement in CBT may vary depending on age, development, and the type of anxiety.
- Medication – Medication is widely used to treat anxiety symptoms, often in combination with CBT. The medications shown in research studies to be most effective for both adult and child anxiety are Selective Serotonin Reuptake Inhibitors (SSRIs). Each child is different, and the type, dose, or necessity of medication will vary based on the physician’s assessment.
- Mindfulness Meditation – Mindfulness meditation can be an important component of any treatment for mental health difficulties like anxiety. This practice involves learning to focus on present-moment experiences, and observing thoughts, feelings, and bodily sensations without judgment. The ultimate goal is not to eliminate distressing emotions or thoughts altogether, but to change one’s reaction to difficult emotions and anxious thoughts.