Understanding Anxiety in Children
Anxiety disorders are the most common form of psychiatric problems in children, and 618% of children ages 6-17 meet the criteria for an anxiety disorder. Even when a child
doesn’t have severe enough anxiety to warrant a diagnosis, symptoms of anxiety can exist
and interfere with a child’s sense of well-being and ability to accomplish things. The six
most common anxiety disorders seen in childhood include: generalized anxiety disorder,
separation anxiety disorder, social phobia, specific phobia, obsessive-compulsive
disorder, and panic disorder. Many children meet the criteria for more than one anxiety
disorder.
Children with generalized anxiety have chronic worrying for at least 6 months duration,
usually accompanied by feelings of restlessness, difficulty concentrating, muscle tension
and fatigue; children with separation anxiety have difficulty separating from their
primary caregiver, usually a parent(s), and often worry about something bad happening to
them or their caregivers during a separation; social anxiety symptoms include worrying
about being perceived negatively by others and the child can appear very shy and quiet;
specific phobias focus on one thing (e.g., dogs) or one situation (e.g., flying) and the
feared situation is either avoided or endured with extreme distress; panic attacks are
very fearful episodes of a cluster of symptoms, many physical in nature (heart
racing/palpitations, choking sensations/tightness in chest, difficulty breathing, sweating,
fear of going crazy, fear of dying) which peak usually in 10-15 minutes then slowly
reduce; and obsessive-compulsive disorder involves obsessions (repetitive thoughts,
images, or ideas that the child can’t stop thinking about) or compulsions (behaviors,
rituals, often done in response to the obsessions) which take at least an hour a day. For
anxiety to be considered a “disorder”, it must cause impairment in the child’s life.
According to the cognitive-behavioral approach (the most empirically supported
approach to treating anxiety), anxiety has 3 parts:
• body (physiological)
• thoughts (cognitive)
• behavior
Physical symptoms of anxiety include but are not limited to: rapid heart beat, muscle
tension, shallow breathing, stomachaches, sweating, hot flushes, and headaches. When a
child is anxious, they are often thinking anxious thoughts which include worrying,
making thinking errors, and engaging in negative self-talk. Children with anxiety often
worry about bad things happening, about encountering a feared situation, and about being
faced with a situation they feel they cannot handle (e.g., failing a test, answering a
question incorrectly). Thinking errors, also called cognitive distortions, include
“catastrophizing” (thinking about the worst-case scenario, “What if we get in an
accident?), “all-or-nothing thinking” (thinking in extremes, “If I don’t get an A, then I’m
a failure”), and “shoulds” (ironclad rules you have about the way things should be; “I
shouldn’t make mistakes”). The most common behavior associated with anxiety is
avoidance behavior, which can be subtle at times. If you are afraid of dogs, you will try
your best to avoid being near them; if you are afraid of failing, you will avoid answering
questions in class. There may be other behaviors that come out when a child is anxious,
such as checking behavior (e.g., checking that the doors are locked), reassurance seeking
(e.g., asking mom or dad to tell them everything will be okay, nothing bad will happen),
and fidgeting or appearing restless. Treating anxiety must involve addressing all three
components.