Anxiety Disorders in Children

Anxiety is common in childhood, but excessive worry or panic can signal an anxiety disorder. Learn the signs, symptoms, and treatments for anxiety in children.

Childhood can be an anxious time, as young kids are continually navigating new environments, experiences, and people. Anxiety is the brain’s response to fear and can be beneficial if it helps a child avoid dangerous or threatening situations. Anxiety symptoms in children are a common part of development, but these feelings usually come and go. However, if anxiety is excessive, not linked to danger, or disruptive to a child’s regular activities, it may be a sign of an anxiety disorder in young children.

Anxiety in children is common, and it can be difficult to establish whether anxiety symptoms are a normal part of development or a sign of a more serious mental health condition. There are several types of anxiety disorders in children that can prevent a child from participating normally in their daily activities. Knowing the signs and symptoms related to children and anxiety disorders is important for recognizing abnormal levels of anxiety and seeking appropriate treatment.

Symptoms of Anxiety in Children

The signs of anxiety in children can be difficult to spot since some aspects of anxiety are a normal part of childhood development. In many cases, the signs of anxiety disorders during childhood might be more behavioral than emotional. This is because children are still in the early stages of emotional and psychological development, and are usually not yet able to articulate their thoughts and feelings.

Some of the behaviors that might be symptoms of anxiety in children include:

• Trouble sleeping
• Panic attacks
• Deviant behavior
• Crying or tantrums
• Clinging or seeking security
• Extreme shyness with unfamiliar people or situations

Many parents will recognize that these symptoms can also be a normal part of childhood behavior. However, if symptoms are persistent, long-lasting and excessive relative to the situation, they may signal an anxiety disorder. It may also be a sign of an anxiety disorder if these signs occur around children their own age, rather than just with adults.

Causes of Childhood Anxiety

There can be many things that might influence what causes anxiety disorders in children. Anxiety is usually influenced by a combination of genetics, experiences and the personality of the child. It’s usually considered that anxiety is a result of a combination of factors, rather than a single cause.

There are many factors that are predictive of childhood anxiety. These include:

• Behavioral inhibition
• Bullying or victimization by peers
• Scoring low on social skills
• Having parents with anxiety
• Having a physical health problem
• Having a co-occurring mental health condition, like attention-deficit hyperactivity disorder or autism
• Exposure to violence
• Poverty

Although these factors may not be causes of anxiety in children on their own, they can increase the risk or likelihood that a child might develop an anxiety disorder.

Anxiety and Related Disorders in Children

Anxiety disorders are classified in a specific diagnostic chapter of the Diagnostic and Statistical Manual, Version 5 (DSM-5). In most cases, these disorders are classified in the same way among children and adults, and there is no specific section for diagnosing types of anxiety disorders in children. There is a range of anxiety disorders included in this section or disorders that can be closely related to anxiety. Some of these include:

• Generalized Anxiety Disorder: Generalized anxiety disorder in children has many of the same presentations as the disorder in adults, with some age-appropriate adjustments. Children must only meet a smaller number of criteria to receive a diagnosis. Children may be fearful and avoidant of people or situations that give them anxiety to the point of severely impairing their regular functioning.
• Panic Disorder: Panic disorders in children can occur alone or as part of other anxiety disorders. Anxiety attacks in children can happen when they are confronted with an object or situation that causes them great anxiety. Symptoms can include shaking, nausea and shortness of breath.
• Obsessive-Compulsive Disorder (OCD): OCD in children includes obsessive thoughts and compulsive acts. This is the same as OCD in adults, but children may not sense that their thoughts or actions are inappropriate. OCD symptoms in children can include repetitive thoughts and behaviors tied to anxiety or relief from anxiety.
• Separation Anxiety Disorder: Separation anxiety disorder in children is one of the most common anxiety disorders in this age group. This can be a normal part of development in early childhood, but separation anxiety in older children is less likely to be part of a normal developmental stage.
• Social Anxiety Disorder: Social anxiety disorder in children can include extreme shyness, withdrawal or feelings of shame around unfamiliar groups of peers.
• Post-Traumatic Stress Disorder (PTSD): PTSD in children can be a result of an extremely stressful or traumatizing experience. PTSD symptoms in children might include feeling afraid, throwing tantrums or crying in response to a triggering object or situation.
• Selective Mutism: Selective mutism is a relatively rare anxiety disorder and is a new addition to the most recent version of the DSM. Selective mutism in children includes failure to speak in specific settings despite being able to speak normally elsewhere.
• Specific Phobias: Specific phobias in children can relate to real or imagined triggers. Phobias can be considered disordered if they persist outside of a normal developmental stage. The symptoms of phobias in children include panic attacks and withdrawal.
• Body-Focused Repetitive Behaviors: Body-focused repetitive behaviors tend to be common in children, but at extreme levels can be very distressing. For example, trichotillomania in children involves self hair-pulling and can result in bald spots or damage to the skin. These behaviors are often performed in response to feelings of anxiety.

Statistics on Childhood Anxiety Disorders

Anxiety is the most common mental health disorder and is a relatively common experience in childhood. Anxiety disorder statistics in children suggest that the prevalence of anxiety disorders in children and adolescents worldwide is approximately 6.5%. It is difficult to know the exact prevalence in children alone, as most studies tend to group children and adolescents together.

Separation anxiety disorder, specific and social phobia disorders are the most common anxiety disorders among children. As with other age groups, anxiety disorders appear to be more common in girls than boys, but the difference is less noticeable in younger children.

Children who have anxiety disorders may be more likely to have the same symptoms or disorder later in life or might be at increased risk for developing other mental health conditions. The stability of an anxiety disorder depends on the type. For example, panic disorders might be more stable over time, whereas social phobia may be more likely to subside over time.

Some of the features of anxiety disorders among children — such as high levels of distress, worry, or having several risk factors — might also increase the likelihood of developing other mental health conditions. Anxiety often co-occurs with depression, and this combination may increase the risk of a substance use disorder as a child ages.

Diagnosing Anxiety Disorders in Children

Diagnosing anxiety disorders in children can be difficult. Children often unable to provide insight or information on their thoughts and feelings and some aspects of anxiety are considered a normal part of childhood development.

Considering these challenges, the diagnostic criteria for anxiety includes considerations of age-appropriate anxieties and small adjustments to the duration or number of symptoms required for diagnosis. For example, a diagnosis of generalized anxiety disorder in children requires the presence of just one of six symptoms, compared to three out of six symptoms in adults. Children are also not expected to make judgments about whether their thoughts or fears are rational or reasonable, as this is not a reasonable expectation at an early stage of development.

Despite these slight differences in diagnostic criteria, anxiety disorders — with the exception of separation anxiety disorder — are grouped together in the DSM-5, regardless of what stage of life the condition develops. Diagnosis can be completed by a qualified mental health professional, who has experience telling the difference between different types of anxiety disorders in children.

Treating Anxiety Disorders in Children

Treating children’s anxiety disorders can include discussion surrounding causes and symptoms of anxiety in the child. These discussions can help professionals get a clear picture of the distress experienced and help them make the appropriate diagnosis.

Treating anxiety disorders in children can include several different strategies. This often includes learning about anxiety and developing strategies to reduce anxious feelings. Treatment approaches also usually include a psychological component, as well as developing social skills.

Several types of therapy have been shown to be effective for children with anxiety. These include:

• Individual or group cognitive behavioral therapy
• Therapy including parents
• Social effectiveness training (specifically for children with social phobia)
• Mindfulness-based therapies
• In some cases, medication

These treatments can be used on their own or in combination. Medication for anxiety disorders in children should not be used as a front-line treatment but may be appropriate in severe or persistent cases. Seeking professional help can be an important step in establishing how to reduce anxiety in children.

What Parents Can Do to Help

By learning to recognize the signs of anxiety in children, parents are better equipped to know how to help kids with anxiety. Parents can often provide health care professionals with key information on behaviors or changes in behavior in their child need to identify and diagnose an anxiety disorder.

In addition, parents play an important role in treatment and recovery from an anxiety disorder. In some cases, parents may attend therapy with children. Parents can also provide a safe and supportive environment for children to express their feelings and they can assist their child with new strategies and behaviors that can reduce their anxiety. In combination with a psychologist or psychiatrist, parents play a key role in identifying and improving feelings of anxiety in their children.

Editor – Megan Hull

Megan Hull is a content specialist who edits, writes and ideates content to help people find recovery. Read more

Medically Reviewed By – Dr. Sarah Dash, PHD

Dr. Sarah Dash is a postdoctoral research fellow based in Toronto. Sarah completed her PhD in Nutritional Psychiatry at the Food and Mood Centre at Deakin University in 2017. Read more