What is Child Anxiety?
Does your child cry before going to school every morning? Does he or she avoid interacting with others or engaging in unfamiliar activities? If so, it’s possible he or she could have anxiety.
Anxiety affects millions of children and adults throughout the United States, and it looks very different in different people.
Sometimes it can be hard to detect, especially in young children who may not be able to understand or articulate what’s wrong. This might make it hard for parents to know if their child has a problem that needs help.
What most people don’t realize is that anxiety is actually a helpful and necessary part of being a human.
If you didn’t have any anxiety, you might not look both ways when you cross the street, or show up to work on time, or pay your bills!
Anxiety helps us survive. But sometimes, anxiety can get a little out of control and prevents us from doing the things that are meaningful and important in life.
For example, anxiety is not helpful for your child if it prevents them from talking to a peer, or participating in new activities they might really enjoy. We explain anxiety to children using the analogy of a smoke detector.
We ask children if the smoke detector has ever gone off in their house. Most kids say yes. Then, we ask if there was really a fire when it went off. Most kids say no. Anxiety is kind of like our body’s smoke detector – it’s there to alert us to danger, but oftentimes it alerts us to danger when there’s nothing really dangerous present.
The goal of treatment for anxiety is to reduce the sensitivity of that “danger” detector our kids have.
What are the types of child anxiety?
Separation anxiety
Children who experience separation anxiety have a high level of fear about being apart from a parent or loved one.
Many children with separation anxiety may experience a lot of distress when separating from their parent, such as when going to school in the morning, and may worry about something bad happening to them or their parent when they are not together.
These children may worry ahead of time about being away from their parent when they know that they are going to be separating. Some children with separation anxiety may experience physical symptoms, such as stomachaches or headaches, when they need to separate from their parents.
All children, especially young children, experience some discomfort separating from their parent at some point. Children with clinical levels of separation anxiety experience a high level of distress frequently, which interferes with their life.
Social anxiety
Children who experience social anxiety have significant fear in social situations.
These children are very distressed when they are expected to be around or interact with others. Some children may be afraid of interacting with other children, or adults, or both.
Children with social anxiety may have excessive fear in any of these situations: speaking up in school (such as asking the teacher for help, or reading out loud in front of the class), working or playing with a group of children, going to birthday parties, ordering their own food at a restaurant, having their picture taken, etc.
Most children with social anxiety attempt to avoid the social situations so that they don’t have to experience fear. Many children feel “shy” or uncomfortable in social situations, but children with clinical levels of social anxiety may be highly distressed and frequently attempt to avoid social situations to the point where it interferes with their lives or stops them from doing the things they would like to do.
Generalized anxiety
Children who have generalized anxiety may be called “worriers.”
These children worry significantly about various things, such as things coming up in the future, things going on in their family, or being “perfect” or “good enough” at certain activities. These children may also worry about their health, or the health of their family members, or about things going on in the world.
Every child worries about these things to an extent, but children with clinical levels of generalized anxiety worry excessively and their worries are hard to stop; further, their worrying may cause physical symptoms, like headaches or trouble sleeping, and the worrying interferes with their lives.
Specific phobia
Children who have a specific phobia experience significant distress around something very specific.
Some examples of specific phobias include: animals (such as dogs, snakes, bugs, insects), thunderstorms, heights, shots or needles, doctors/dentists, costumed characters, darkness, etc.
Most children may experience some fear around most of these situations/things, but children with a clinical specific phobia have a very high level of fear and attempt to avoid the specific thing that they are afraid of. Their fear interferes with their life to the point where it may cause problems for them at home or at school, or get in the way of doing things they would normally like to or need to do.
Selective mutism
Children with selective mutism have an inability to speak in social situations despite speaking freely in more familiar settings, like at home or with their parents.
Children with selective mutism may refuse to answer adults or peers who ask them questions. Some children may appear shy and reticent to speak sometimes, but children who have clinical levels of selective mutism consistently do not speak in social situations to the point where it interferes with their functioning at school or in other social settings.
Obsessive compulsive disorder
Obsessive compulsive disorder (OCD) is not technically categorized as an anxiety disorder, but treatment strategies for OCD overlap with treatment for other anxiety problems.
Further, OCD and other anxiety problems sometimes co-occur. Children with OCD experience distressing, intrusive, or bizarre thoughts, called obsessions, that they feel they are unable to control or stop.
Children with OCD also experience compulsions which are repetitive behaviors that typically occur in an effort to get rid of the obsessions/distressing thoughts.
Children with clinical levels of OCD experience obsessions and compulsions that are time-consuming and take up at least 1 hour per day.
Panic disorder
Children with panic disorder experience recurrent “panic attacks”, which is an abrupt surge of a combination of uncomfortable physical symptoms (such as fast beating heart, shortness of breath, nausea, dizziness) that usually only lasts for a few minutes.
Some children with anxiety may experience “panic attacks” on occasion, but children with clinical panic disorder experience persistent worry or concern about having a panic attack or significant change in behavior to avoid a panic attack (such as avoiding going certain places in case they have a panic attack, or carrying around a specific object that they may associate with being safe from having a panic attack).
Panic disorder is much less common in children younger than the adolescent ages but can still occur.
Agoraphobia
Children with agoraphobia experience significant fear in situations where they may be unable to escape or get help if they were to experience embarrassing or incapacitating symptoms (such as a panic attack).
Situations children may experience fear in or avoidance of include public transportation, open spaces, enclosed spaces, standing in line or in a crowd, outside of their home.
Children with clinical levels of agoraphobia almost always experience fear in these situations and their fear significantly interferes with their life. Agoraphobia is a less common anxiety disorder, particularly in young children.
Does my child have anxiety?
Like we mentioned before, everybody has anxiety.
So the easy answer is yes, your child has anxiety.
Is this anxiety something that needs help, or is it a healthy level ofanxiety? That’s what we would like to help you figure out.
In order to meet criteria for an anxiety disorder diagnosis, fear or distress has to be frequent and really interfere with the child’s or family’s life. When there’s a lot of distress, and the anxiety is really getting in the way of the child’s or family’s functioning, we consider the anxiety a “clinical” problem, which may need some professional help. Here are some examples to help understand what may be developmentally normal, and what might be clinical anxiety.
Jane is a 3 year old girl who cries most mornings when her mom drops her off for day care. Her mom has to stay for a few minutes at her daycare in the morning before she calms down, which makes her a few minutes late to work. Once Jane’s mom leaves, Jane calms down within 5-10 minutes and is able to engage in activities throughout the day.
Is this a clinical problem? Probably not. Jane is only 3 and having a hard time separating from a parent at that age is developmentally normal. Jane’s mom is a few minutes late to work most days, which indicates that Jane’s anxiety is interfering somewhat, but overall Jane is able to engage in daycare and stay calm throughout the day. Jane likely does not have a clinical anxiety disorder based off of this information.
Meg is an 11 year old girl who cries most mornings before going to school. Meg’s mom describes that she has a “tantrum” almost every morning, refusing to get dressed, and crying when it’s time to get in the car to go to school. Meg frequently complains of a stomach ache in the mornings. Meg is usually 10-15 minutes late to school most mornings and has a hard time concentrating throughout the day. It’s hard for Meg to make friends and sometimes she gets poor grades because she is unable to ask for help.
Is this a clinical problem? Sounds like it. Meg is 11 years old, so unlike 3 year old Jane from the previous example, crying before school most mornings is not developmentally normal. Her anxiety seems to be interfering significantly with her social life and academics.
Jordan is a 9 year old boy who is afraid of bees. When he sees a bee while playing outside with friends, he screams and runs away from it. Once he sees that the bee is gone, he calms down and keeps playing. Jordan doesn’t really think about bees unless he sees them around him and never avoids playing outside because of his fear. He just gets really scared when he sees them.
Is this a clinical problem? Probably not. Being a little afraid of bees is normal for any age level. Even though Jordan might overreact when he sees a bee, there doesn’t seem to be any interference in his life.
David is a 9 year old boy who is also afraid of bees. If he sees a bee while playing outside with his friends, he runs inside the house and does not come back outside. David also avoids going to certain parks in his neighborhood because he’s seen bees there before. Recently, David refused to go to his end-of-the-school-year outdoor picnic because he was afraid he would get stung by a bee.
Is this a clinical problem? Sounds like it might be. Both Jordan and David are afraid when they see a bee, but David has a much higher level of distress and is unable to do certain things he should be enjoying as a 9 year old boy, like going to the park and attending certain important activities, because of his fear. This may indicate that David has a clinical problem.
Of course these are just examples . In reality, anxiety can be much more complicated.
What are the causes of child anxiety?
A combination of factors contributes to the development of anxiety in children.
Anxiety is genetic so oftentimes children with anxiety have parents or relatives who also have anxiety. Anxiety can also be maintained by factors in our kids’ environments. For example, accommodating your child’s anxiety may actually make the anxiety worse.
An example of “accommodating” would be if your child is afraid of the dark and you let her sleep with her bedroom light on every night. Or, if your child gets nervous around new people so you do all the talking for them.
Accommodating anxiety seems like common sense – you don’t want to see your child in distress! And of course, if you didn’t accommodate, what would happen? Likely your child would tantrum or find some other way to avoid engaging in what makes her afraid.
Quality treatment for anxiety helps you to gradually reduce your accommodating behaviors and to help kids gradually learn to face their fears.
How can I get help with my child’s anxiety?
If you suspect that your child has a clinical anxiety problem, you should look for a provider as soon as possible.
Regardless of where you search for a provider, it may take some research before you find the right one. Every clinician has their own style, but you will want to search for a clinician who is going to operate from an evidenced-based, cognitive behavioral (also referred to as CBT) or behavioral framework.
Most importantly, quality treatment for childhood anxiety should never just consist of a therapist meeting face to face with a child in their office for the duration of therapy. If your child is 8 or younger, a good amount of treatment should focus on a clinician giving you as the parent the skills to manage your child’s anxiety. Even treatment for older children should have some component of the treatment involve parents – you are the ones with your child every day after all, you should have some skills too!
Another important thing good treatment for anxiety will consist of is exposures, where your clinician gradually helps your child face their fears by exposing them to the things they are afraid of. This can be really hard to do one-on-one in an office. For example, if your child has social anxiety, your therapist should lead you and your child through practices outside of the clinic in situations that may be challenging for your child, such as the park, library, or ordering food at a restaurant.
Research shows that meeting with a therapist over the internet through videoconferencing can be beneficial in reducing your child’s anxiety because sessions can occur in the very settings where your child has difficulty, such as at home, or in public.
MindBloom is developing its own database of science-driven clinicians so that parents can easily search by location and find a local provider. If you are in a state that we do not currently support, there are some websites and resources that help connect parents to a local provider. We recommend using one of the following resources to search for a therapist.
