It is a natural thing to have anxiety. It is normal for very young children to be afraid of the dark, or for school-age children to worry about making friends. But sometimes normal childhood anxiety morphs into something more serious. A young girl might be afraid to leave her mother’s side, even to get on the school bus, or an anxious boy may need frequent reassurance over things that happened a month ago.

Anxiety disorders are the most common psychiatric condition in youth. The lifetime prevalence rate for any anxiety disorder in adolescents is 31.9%.  Anxiety disorders occur early in childhood with a median age of onset of 6 years. These disorders lead to significant impairment in academic, social, and family functioning. In clinical practice, it is common to see children who are homeschooled because of severe untreated anxiety disorders. There have been some recent studies and meta-analyses that address mental health hospitalization, optimal treatment, and long-term outcome for children and adolescents with anxiety disorders.

Eventually, an anxiety disorder can start interfering with a child’s friendships, life at home, and work in school. Even so, the anxiety still might not be noticeable to parents and caregivers.

For one thing, being anxious doesn’t necessarily mean that you can’t function—it might just make some kinds of functioning more difficult. A homework assignment that should take twenty minutes might take an hour, for example. With anxiety, it’s important to remember how internal it is. It dominates a child’s thoughts, but it might not be obvious to the people around her.

It’s also worth noting that in my work as a child psychiatrist, I see a lot of anxious kids who are still basically happy and enjoying life. Maybe they are only struggling in certain situations, which may make their anxiety all the easier to overlook.

Outward signs of childhood anxiety

When anxiety is expressed outwardly, there can be a wide range of signs and symptoms, which often complicates identification.

  • Kids may have trouble sleeping or complain about stomachaches or other physical problems.
  • They may become avoidant and clingy around parents or caregivers.
  • They might also have trouble focusing in class or be very fidgety—I like to say, “Not all that moves is ADHD,” even though that’s often the first thing we suspect from a hyperactive or inattentive child.
  • They may have explosive outbursts that make people think they are oppositional when their fight-or-flight mechanism is triggered.

The words we use to describe our anxiety can distract us, too. People use a lot of different words to describe what they’re feeling—kids might say they are self-conscious, shy, apprehensive, worried, or afraid. These words do a good job of capturing what they are struggling with, but fixating too much on them can distract from the fact that anxiety is an underlying factor—not some personal failure in personality. 

Consequences of untreated anxiety

If you look at the prevalence rates of anxiety disorders, you’ll see that the numbers rise as children get older. That makes sense because anxiety disorders are cognitive, so they develop as our cognitive ability develops. Separation anxiety, for instance, develops early, whereas social anxiety disorder usually develops after puberty. A study of more than 10,000 kids, interviewed by trained professionals, shows that more than 30 percent had developed an anxiety disorder sometime before they were 18.

Anxiety frequently recurs, too, and childhood anxiety is often a precursor for adult anxiety, especially for kids who don’t receive treatment. The same study showed that 80 percent of kids with anxiety do not get treatment. Many adults seeking help for anxiety remember feeling anxious when they were younger, which means that they’ve been struggling for a long time and could have benefited from treatment as children.

 

Avoidance reinforces anxiety

Kids with untreated anxiety also begin to develop poor coping skills. A common example is avoidance—very anxious people will try to contain it by avoiding the thing that makes them anxious. It’s a short-term solution that, unfortunately, reinforces their anxiety instead of acclimating them to it.

Similarly, untreated anxiety can lead to lower self-esteem, academic dysfunction, and self-medication through substance abuse.

 

Anxiety leads to depression

People living with anxiety for extended periods are also more likely to develop depression. It isn’t uncommon to meet patients who come seeking treatment for depression or depressive symptoms, and it turns out that they have been dealing with lifelong anxiety as well. In cases like this, people need treatment for anxiety and depression.

Fortunately, we know a lot about how to treat anxiety. It responds very well to cognitive behavior therapy, and some medications work, too. Getting help makes a big difference, and treatment doesn’t need to be a lifelong thing—although its positive effects will be.

Types of Childhood Anxiety Disorders

There are many types of anxiety disorders, but here are the disorders most common anxiety disorders experienced by children.

Generalized Anxiety Disorder – If a child experiences excessive anxiety or worry that results in fatigue, irritability, muscle tension, difficulty concentrating, or sleep disturbances, then they may receive a diagnosis of generalized anxiety disorder. This worry may be about school performance, friendships, family relationships, or other activities or concerns.

Separation Anxiety Disorder – Some separation anxiety is developmentally appropriate, especially for children between 1-3 years old. But for older children, if they have excessive fear or anxiety about being separated from caregivers, then they may qualify for a diagnosis of separation anxiety disorder. Children with the disorder may frequently worry about parents dying or becoming separated from them. They may refuse to go out or go to school, have nightmares about separation, or experience physical symptoms like headaches or nausea due to this anxiety.

Selective Mutism – Children with selective mutism may refuse to speak in certain social situations, even though they are very talkative at home or wherever they feel comfortable. They may refuse to speak at school and withdraw from others or avoid eye contact. Children around the age of 5 are most commonly diagnosed with this disorder.

Specific Phobia – Some children may exhibit fear or anxiety about a specific object or situation. If this fear lasts a long time and is out of proportion to the actual danger posed, this fear may be classified as a phobia. Children will cry, freeze up, or cling to an adult when their fear is present. Children can have phobias that include (but are not limited to) animals, storms, needles, loud sounds, and enclosed spaces.

Panic Disorder – Children who experience recurring panic attacks and worry about having more may have panic disorder. A child having a panic attack may complain of symptoms that can include shortness of breath, chest pain, a sensation of choking, nausea, dizziness, chill or heat sensations, fear of “going crazy,” and fear of dying.

Social Anxiety Disorder – If a child has an intense fear of having to participate in a class or interact with their peers, then they may have a social anxiety disorder. Children may exhibit this fear through throwing tantrums, crying, clinging to adults, freezing up, or refusing to speak. They may also attempt to avoid social situations that provoke this fear.

Helping Kids with Anxiety

Children with anxiety disorders are typically treated with talk therapy, medication, or a combination of the two. Cognitive-behavioral therapy can help a child test out what thoughts they have are realistic or unrealistic. Play therapy may work best for young children to work through anxieties. For some kids, medication may be prescribed in the short-term or the long-term, depending on the nature and severity of symptoms. Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed medication to treat anxiety disorders among children.

Parents often can feel helpless when they see their children experiencing intense fear or worry. There may be a temptation to simply remove the child from all situations that prompt this anxiety or to over accommodate for their child’s fear. These actions only make a child more sensitive to these environments. Parents can validate the child’s feelings but also model calmness and confidence that their child is going to be okay and can master scary situations like school or meeting new people. Also, because children are most anxious, leading up to a challenging situation, it’s important for parents not to ask too many questions about anxiety. Professionals can remind parents that it is not their goal to eliminate all anxiety from their child’s life.   It is their job to help their child learn to manage anxiety effectively so that they can deal with life’s challenges long into adulthood.