When anxiety is present in children, the symptoms and behaviors displayed can sometimes seem completely unrelated to what you would expect anxiety to look like. Depending on your child’s age, developmental (i.e., maturity) level, and even unique personality traits, your child may not directly let you know that they are worried, nervous, or afraid.
Child anxiety symptoms and behaviors can appear as:
defiance or behavioral problems,
avoidance of places or situations,
sleep and/or appetite disturbance,
withdrawal or refusal to speak,
regressing (i.e., acting younger than their age),
perseverating on a topic (e.g., asking persistent questions about a particular concern),
obsessions with cleanliness or orderliness, or
physical symptoms (e.g., headaches, stomachaches).
This wide array of symptoms and behaviors can be easily overlooked by parents or can be attributed to another issue. For example, if a child demonstrates defiance, parents may initially believe that it is due to a need for discipline or that the child is spoiled. Although defiance and behavioral problems can indicate a variety of other issues, it is important to consider the context of the behavior. Is the child defiant when it’s time to go to school, complete homework, or engage in any other specific task or activity? This can indicate that defiance is not related to a behavioral problem, but instead the child is responding to overwhelming anxiety by refusal or essentially shutting down. If you have a doubt about whether your child may be struggling with anxiety, it is best to have your child evaluated by a mental health professional, such as a therapist or counselor.
The following are treatment options that are available to treat anxiety in children.
Cognitive Behavioral Therapy (CBT)
CBT is an evidenced-based treatment approach for children with anxiety that is delivered by a mental health professional in a counseling or treatment setting. CBT techniques for children with anxiety include cognitive restructuring and exposure exercises, among others. Research has indicated that most children treated with CBT will experience alleviation of anxiety symptoms after treatment.
Children may not be able to verbalize the thoughts that contribute to their anxiety, as they may be fearful of the thoughts themselves, may feel embarrassed to speak up, or may feel that the fear may become even more real if they speak about it aloud. A mental health professional can help your child to not only verbalize their fearful or anxious thoughts in a supportive therapeutic environment, but also to make the connection between their thoughts, their anxious feelings, and the specific situations that trigger anxious feelings and thoughts. These are the first steps of cognitive restructuring and are followed by the therapist guiding your child in developing more positive and realistic alternatives for their thoughts (i.e., thought challenging). Oftentimes, children can develop thoughts and ideas that may be exaggerated or misinformed and this leads to the development of much anxiety, but since children may avoid speaking up about these beliefs, there is no opportunity to correct and educate the child. For example, children who develop anxiety related to health and illness can have erroneous beliefs related to this theme (e.g., if they learn that another child has cancer they believe that they too will get the illness). By engaging in dialogue with the child, clarifying beliefs, and providing the child with alternative ways to conceptualize information, the child will learn a very useful strategy to minimize worry and anxious thoughts and beliefs.
Exposure exercises involve the mental health professional engaging in several therapeutic steps that ultimately lead to your child confronting a specific fear or phobia that contributes to his/her anxiety. This strategy is effective because it not only gradually exposes the child to the fear, but also discourages avoidance of the feared object or situation. Anxiety is largely maintained because the child copes by avoiding the feared object/situation and although this will temporarily alleviate the anxiety, avoidance actually strengthens the fear with time. Exposure exercises must be delivered by a qualified therapist and involve many preliminary steps, such as teaching the child relaxation exercises and ensuring the child can safely confront the fear.
Mindfulness includes interventions that involve your child achieving a sense of awareness of their thoughts, feelings, and physical sensations through meditation or other activities that increase the child’s ability to remain in the here and now. Although this may seem like a complex task for a child to grasp and put into practice, children are very receptive to mindfulness strategies and experience immense benefits, especially when coping with anxiety2. Anxiety is characterized by the mind remaining in a state of preoccupation with either the past and/or the future. Mindfulness is effective for treating anxiety because the child increases their ability to stay present and this prevents the child’s thoughts from shifting to past thoughts that are troubling/fear-inducing or future concerns that cause worry. Since mindfulness is achieved through practice, a therapist guides the child through fun and interactive steps that teaches the child to become increasingly mindful.
It is important to identify anxiety symptoms in your child and address the issue immediately. Anxiety is typically not something that the child will grow out of or get over on their own. Although children can develop a fear or worry and then with time it may seem to go away, in reality it is likely that the child has learned to cope with the anxiety by establishing avoidance behaviors or other negative coping skills (e.g., a child who develops anxiety from being bullied may cope by turning to aggression). In addition, anxiety in children has a way of transferring from one topic or theme to another, but the underlying issue remains. Children have an amazing ability to learn and absorb information and with the right interventions and treatment, they can be guided to understanding the anxiety and developing healthy ways to cope. This approach will provide invaluable life skills for your child and will help them develop the courage and self-confidence to confront future stressors and adaptively manage their emotions.
Anxiety Treatment for Children
Anxiety issues can be mild or serious for a child. Aside from the discomfort and suffering from the emotional experience, they can also impact this child’s behavior, relationships, academic and athletic performance. The good news is that there are effective therapies for children with anxiety disorders.
If you believe you and your child could benefit from meeting with a Cognitive Behavior Therapist and being assessed, having the opportunity to ask questions, and if necessary receiving therapy for anxiety, please call our office. We will be happy to help.