Anxiety and Children

What is Anxiety?:
The definition of anxiety is: a feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome. Anxiety is there to keep us from danger. It is a built-in self-protection mechanism that every human has. There is nothing wrong with experiencing the feeling of anxiety; it is how we react to those feelings that can lead to harm or unhealthy behaviors.

What does anxiety look like in children? 

These are some examples but anxiety can present in many other ways. 

• Clinging/separation anxiety 

• Tantrums

• Crying

• Hypervigilance (heightened state of awareness)

• Avoidance of people/places or things (which can often look like refusing to go/do what is expected)

• Regression (bedwetting, thumb sucking, baby-talk)

• Tics (motor tics, vocal tics, fidgeting, restless legs syndrome and/or tremors/shaking)

• Increased sensory seeking behaviors (starting at spinning objects, biting their nails/skin, chewing on items, listening to loud music)

• Shutting down

• Rapid talk/increased inquisitiveness (asking questions repeatedly)

• Selective mutism

• Lack of concentration/inattentiveness

• Increased somatic complaints (stomachache, headache, nausea, vomiting, extreme fatigue, hives/rashes

• Agitation

• Restlessness

• Difficulties with transitions

• Sleep disruptions

What is a protective level of anxiety and what is a problematic level? 

Anxiety is considered to be a problem when it affects the child’s daily functioning. If they are having problems at home, school and/or in the community this is considered a problem. There will be many times throughout a child’s life that anxiety will increase due to life events and this is not to be a concern unless it becomes chronic. It’s important to let kids experience anxiety and learn how to work through it. They need to learn how to get comfortable with the uncomfortable. This allows kids to develop perseverance, resilience and increase their self confidence that they can get through and do hard things. 

Causes of anxiety

There are many causes to anxiety but typically the main causes are the following:

• Trauma (disasters, accidents, abuse etc but also medical procedures can cause anxiety)

• Community violence (the area in which you live or the school in which you go to)

• Witnessing violence

• Death of a loved one-person or pet

• Transitions (moving, changing schools, or other major life transitions)

• School related issues (bullying, academic pressure, or social difficulties at school)

• Social Media and Technology (Increased exposure to social media and online interactions can lead to problems with body image, social validation, and fear of missing out)

• Learned (children pick up cues from the adults in their lives and learn how to manage their feelings by modeling what they see)

• Genetic predisposition (including sensory sensitivities)(Children with a family history of anxiety disorders may be more likely to develop anxiety)

• Brain Chemistry (imbalances in certain neurotransmitters like serotonin and norepinephrine

When do you know that your child needs professional help?  

When the anxiety is affecting the daily functioning of the child and/or the family for a few weeks and is not the result of a situation that one would expect anxiety to increase. In addition, if the heightened anxiety continues after the situation has resolved, professional attention may be warranted. However, if you are unsure if your child should start therapy, then reach out to a provider and talk to them about your concerns. 

What are the treatment options for my child’s anxiety? 

When figuring out the right treatment options for your child, you want to do your research on the different options to determine what makes sense for your child. Look for evidenced based treatment options that show how they have been successful with children and anxiety. If you know the root cause of the anxiety (i.e.: trauma, bereavement, school issues, etc.) then look for the treatments that specifically are for that type of anxiety. 

Below are a few of the evidenced based treatment options for anxiety in children: 

• Cognitive Behavioral Therapy (CBT) - It focuses on how thoughts, feelings and behaviors are interconnected and how changing one can positively affect the others. 

• Trauma Focused - Cognitive Behavioral Therapy (TF-CBT) - Helps to process the trauma and manage related symptoms, while also supporting the parents. Includes psychoeducation, relaxation techniques, cognitive coping, trauma narrative and in vivo exposure to trauma reminders.

• Exposure Therapy - Helps children gradually face their fears in a safe and controlled environment.

• Medications - SSRIs like Prozac, Zoloft and Lexapro; SNRIs like Duloxetine

• Parent Child Interaction Therapy for Selective Mutism (PCIT-SM) - Uses a two step approach to help children increase their verbal participation and reduce parental over-accommadation.

• Play Therapy - Utilizes play as a medium for emotional expression and healing.