Anxiety disorders are found in children much more often than many people realize; ten to twenty percent of all children will suffer the symptoms of a full-fledged anxiety disorder prior to the age of 18, making this the most common mental health issue in young people. It's often overlooked, however, as it's difficult for parents to ascertain the difference between the normal fears and worries inherent in growing up and a true mental health concern. Likewise, anxiety in children is often misdiagnosed as an Attention Deficit Disorder, as anxious children have a hard time focusing in environments that place stress on them, such as school.

Indeed, a certain amount of anxiety is normal in children; they are, after all, small and relatively helpless beings coming to terms with a world that appears overwhelmingly large and complex. A child understanding germs for the first time may wash his or her hands more frequently than normal, for example, and children who value their academic performance may check their homework over multiple times. Anxiety when waiting for admission results or prior to important tests is perfectly normal - see my recent interview to Toronto Star regarding anxiety in graduating post secondary students.

Such behaviours are often harmless and outgrown over time, but if they worsen to the point that they are interfering with the child's life (e.g. they interfere with the child being able to sleep, or to maintain a healthy social life), then they most likely represent a more serious underlying problem. Extreme, intrusive worry that robs a young person of his or her enjoyment in life is not simply a normal part of growing up; it's a sign that a child needs professional help. We recommend all parents whose children exhibit signs of anxiety to try free child anxiety test below to evaluate whether your child's anxiety levels are a cause for concern.

Child Anxiety Screening Test Evaluate Your Child's Anxiety Level This free online anxiety test has been developed to help parents determine the level of anxiety in their children. It consists of 45 questions that assess specific traits common in highly anxious children and adolescents. The answers are weighted according to the relative importance of a particular anxiety trait and evaluated based on statistically normalized sample data. The final score indicates the risk of anxiety disorder and serves as a good indication of whether a formal evaluation (such as social-emotional assessment) would be beneficial. The test was designed by Child Psychologist Dr. Tali Shenfield based on data from the Advanced Center for Intervention and Services Research (ACISR) for Early Onset Mood and Anxiety Disorders. ***Please note that when you take the test our servers record your IP address and the final score. By proceeding with the test, you agree to this condition. © Copyright 2015-2020. Advanced Psychology Services Inc. - psy-ed.com

Which Children Become Anxious?

Like many mental health issues, anxiety tends to run in families; children who have anxious parents are more likely to become anxious themselves. Temperament may also play a role; children who are sensitive, cautious and negative tend to exhibit higher levels of anxiety. A more in-depth description of the aforementioned traits can be found below:

Sensitivity: Sensitive children are very aware of their surroundings, often noticing details that other people miss. They often point out small changes in others, such as new glasses, or a new haircut, and seem to have an uncanny knack for overhearing conversations—even those which happen several floors above or below them. They are often emotional “sponges” who detect even subtle changes in other people's demeanors, and inquire about what is troubling the adults in their lives even when said adults think they are hiding their concerns or problems well.

Sensitive children also react differently to stimuli in their environment than normal children; they may be sensory seeking (wanting more intense sensory input) or sensory avoidant. Smells, sounds, and tactile sensations may all worsen these children's anxiety.

Cautious: Many children are rather fearless beings, unable to assess risk and loving to push the boundaries of what they can get away with—much to their parents' chagrin. Some, however, exhibit the opposite qualities: They hang back on the fringes of groups who are roughhousing, concerned that someone will get hurt. They read up about dangers—wild animals, poisonous plants—and then become scared of taking walks in the woods, and so on. These children are often reluctant to try new things, and need a lot of cajoling before they will enter into unfamiliar situations.

Negative Emotionality: This trait is better known as pessimism, and describes those children who are frequently convinced something bad is about to happen. They may drive their parents crazy by—at the suggestion of an excursion that should be fun, such as a visit to a water park—bringing up countless “what ifs” regarding what could go wrong (e.g. “What if I drown?”, “What if I slip?”) It may prove next to impossible to reassure these children enough that they simply relax and have a good time.

In small doses, all of the above traits have their merits—it is wise, after all, to be observant of one's environment and the people in it, to think twice about unfamiliar situations, and to review risks—but when these traits limit a child's ability to live his or her life, they are crippling rather than beneficial.

Not all anxiety is brought about by traits and genetic factors, however; specific events may also trigger a child into developing an anxiety disorder. These may be obviously traumatic—such as an assault or car accident—or they may be something where a great deal of change was involved, such as moving to a new city.

In order to help their children manage their anxiety, parents need to be aware of their own anxiety levels and learn how to effectively manage them. Fear and anxiety are extremely transferable emotions; being able to pick up on anxiety in those around us was, after all, once a valuable survival skill. Our brains contain what are known as “mirror neurons” which ensure that we reflect our emotions back to each other, in order to facilitate non-verbal communication and keep groups moving in unison.

Parents also need to be aware of the fact that anxiety often manifests differently in different children, so there is no one sign the denotes the presence of an anxiety disorder. There are also different kinds of anxiety disorders, which will be described in more detail below. The key thing to remember is that worry is no longer “normal” when it develops into chronic anxiety that gets in the way of a child's everyday functioning.

Most Common Anxiety Diagnoses

Generalized Anxiety Disorder

• Children with generalized anxiety demonstrate excessive worry about a wide variety of situations. Indeed, the anxiety often adapts to each new situation that comes up.

• These children may even worry about events that did not happen, or that have not happened yet. Indeed, they may seem to be actively seeking things to worry about, trying to explain to themselves why they feel so anxious much of the time. You might find yourself censoring what information you give these children so as not to set off another round of “what ifs”.

• If you have to reassure your child very frequently and find it often has little effect, then he or she may be struggling with generalized anxiety. Generalized anxiety is a pervasive, ongoing condition which seldom responds for very long to logical assurances that everything is in fact all right.

Separation Anxiety Disorder

• It's important to understand that separation anxiety is perfectly normal in toddlers and preschoolers, but if by about age seven, your child still has a very hard time being apart from you, a deeper problem is likely present and the child should be evaluated by a professional.

• Separation anxiety usually stems from a fear of something befalling the child's loved ones (or even their pets) while the child is absent, hence the need to “cling” to everyone and everything important. This type of anxiety may also arise from a difficult event, such as having a parent who was ill, a threat in the neighborhood, etc.

• Naturally, many children with this type of anxiety disorder refuse to go to school.

Social Anxiety Disorder

• Social anxiety often comes on as children move into adolescence, i.e. the preteen years. The amount of upheaval, both from puberty and from the transition between schools that most children experience at this age, cause anxiety that may have been manageable before to become overwhelming. It's important to not simply write off this anxiety as “normal” if it seems to be significantly affecting a child's quality of life.

• This is another disorder than can be difficult to differentiate from a child's natural tendencies; shyness around strangers is quite normal in very young children, and some children simply remain rather introverted, reluctant to leap into group activities and so on. Social anxiety may therefore be more easily detected if one looks not only at a child's reticence about meeting strangers or joining in with peers, but at how the child feels after a social experience: Does the child worry excessively about the kind of impression he or she made? Does the child get convinced he or she will never be invited out again? Etc. Likewise, where introverts do not desire much social interaction, socially anxious children often do wish to interact, but feel they are prevented from doing so by their anxiety.

• Selective Mutism, a rare form of social anxiety where a child will not speak to people outside his or her family, or will only speak to friends but not adults (or some other variation of this selective silence), is generally diagnosed once a child goes to school and people notice he or she isn’t speaking up.

Less Commonly Diagnosed

Obsessive-compulsive disorder (OCD)

• Obsessive-compulsive disorder has suffered from a great deal of misrepresentation in popular culture, and many people think of it as a sort of stringent perfectionism, but true OCD is magical thinking run amok. People with OCD quite literally believe that their repetitive actions prevent very real calamities. This reliance on magical thinking goes far beyond the “standard” magical thinking of childhood, which can be seen in the common superstitions of children (in sayings like “don’t step on a crack or you’ll break your mother’s back”). It becomes instead a source of compulsion, of rituals the child “must” do to “prevent”, for example, his or her parent dying in a car crash.

• These compulsions tend to become more complex over time, unlike the small rituals associated with normal childhood superstitions, which diminish and quiet with age.

• Another difference between OCD and normal childhood magical thinking is that normal children can easily leave their rituals behind—if you tell them to hurry along and cease skipping on tiles, they can do so. A child with OCD will be unable to cease their rituals, no matter how dire the consequences, and will become visibly upset if pulled away from his or her compulsive activity.

• Many children are not terribly tidy or orderly, so children with OCD often stand out for the way they are obsessed with organizing, cleaning, doing things in a certain order, etc.

• It's important to note that OCD does not always manifest in stereotypical ways, such as counting or hand washing. The rituals associated with OCD can be quite diverse; in addition to repetitive actions, children may exhibit hoarding behaviour. Parents must be mindful to not get sucked into affirming these rituals; it's easy to get sucked into repeating things in certain ways or adhering to specific schedules in order to soothe your child, but this may mask a deeper problem.

• OCD seems to set in around age ten in many children; for reasons that are as yet unknown, it's more commonly seen in boys before puberty, and in girls after puberty.

Panic Disorder/Somatic Symptoms

• Panic Disorder is more often diagnosed in older children, but younger children (who are not yet able to understand and vocalize the complexity of their symptoms) may express their panic by complaining of somatic symptoms like stomach aches and headaches. Older children tend to experience the more typical symptoms of a racing heart and a fear of passing out or dying. It's important not to dismiss children who frequently complain of such physical symptoms as “faking it” to get out of chores or going to school, as this may be the only way these children can think of to express their underlying sensations of fear.

As a parent, it's important to remember not to panic yourself if your child is displaying some of the above symptoms; simply remain observant and try to ascertain, as objectively as you can, whether or not these symptoms are interfering with your child's day to day life to a great extent.

Regardless of whether or not your child has a full-blown anxiety disorder, learning to manage anxiety early in life is always beneficial, so do not hesitate to teach your child methods of dealing with his or her anxiety.

Helping Children with Anxiety

CBT

Cognitive Behavioural Therapy (CBT) is the counseling modality of choice for both older children and adults who are suffering from anxiety disorders. Research on effective anxiety therapies tends to take a three-pronged approach, one which includes:

• Disambiguating the physical response to anxiety;

• Recognizing and challenging the problems in one's thinking that perpetuate anxiety;

• Using controlled exposure to learn to manage those situations which provoke anxiety.

This process is, of course, much more complex and individual than what is indicated by the above points, but they form the basis of cognitive behavioural therapy for those suffering from anxiety.

The help frame this therapy in an example that a child might understand, let's take the case of Goldilocks and the Three Bears. After her confusing encounter with the Three Bears, Goldilocks finds that she is having trouble sleeping, she often experiences nightmares which harken back to the event with the bears, she is crying much more easily than she did prior, and she cannot leave for school without becoming convinced that the bears will invade her house. She also has an intense emotional reaction to the sight of porridge. Due to these troubling emotional symptoms, Goldilocks' mother brings her to a therapist.

The therapist would begin by discussing Goldilocks’s physical experience of being anxious, expressing understanding of the fact that being chased by bears is indeed a very valid reason to be frightened. The therapist would then discuss the necessity of calming down Goldilocks' physical reaction to this anxiety, as it is not needed or beneficial to think “Bears!” every time she hears a knock on the door, for example. The physical epicentre of the anxiety would then be discussed; is it in Goldilocks' stomach, for example? Does her chest feel tight? Does she feel shaky or have a dry mouth? The therapist would then give Goldilocks methods to deal with these physical sensations and relax, and likely also suggest she keep a record of things that trigger her panic attacks.

After Goldilocks had such basic coping techniques in place, the therapist would help her analyze her personal errors in thinking (sometimes referred to as “negative cognitions”); these errors commonly include:

• All or Nothing Thinking: “If I make one mistake on this test, I am stupid.”

• Catastrophising: “If I do not pass this one test, I will wind up flunking my entire school year.”

• Overgeneralization: “I once slipped while skating; I will never skate again without hurting myself.”

• Personalizing: “The fact that it rained on my birthday means I will have bad luck forever.”

• Discounting the Positive: “It doesn't matter that my family calls me pretty, they are just my family. I'm actually ugly.”

• Mind Reading: “I know everyone in class hates me deep down.”

• Labeling: “I’m taking so long to learn math because I am stupid.”

• Should Statements: “I should know how to spell by now.”

• Emotional Reasoning: “The fact that my feelings are hurt proves I am right and you are wrong.”

These are not the only forms of negative cognition that exist, but they are the most common examples. Counseling often proves invaluable in overcoming negative cognitions as the outside perspective helps a young person break out of his or her thought patterns more effectively than even parental reassurance (as it is quite easy for children to discredit their parents as “just trying to make them feel better”). Likewise, children (particularly older children and teenagers) often feel rebellious and have a prideful dislike of agreeing with their parents.

That is not to say parents cannot be effective aids in helping children overcome anxiety—they most certainly can be, and they should not simply hand over this task to a therapist without also providing support in the home—but rather that professional mediation is often useful to both parent and child.

Play Therapy

When dealing with young children, play therapy is often the most effective therapeutic modality, even more so than CBT. Young children are often quite caught up in the idea of adult approval, which can make it hard for them to admit to their feelings. Play therapy offers a safe, judgment-free space in which to do so.

Because play therapy is quite unstructured, it may take a while to produce noticeable results; it's important for parents to avoid getting frustrated by this, and to simply give it time. Young children are emotionally fragile, have a hard time vocalizing their feelings, and must, as a general rule, simply be allowed to move at their own pace. Likewise, these children have usually been told to ignore their anxious feelings by well-meaning but clumsy adults for many years, or conversely may have been praised for their anxious ways (as it has led them to be unusually fastidious or studious), and so they may hold onto them in an oddly protective fashion.

For children who have formed an identity around being anxious (e.g. the “perfect student”), giving up this identity is understandably terrifying, and often takes years to achieve. The results, however, are invariably worth it.

Image Credits:

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All content on this site is curated by Dr. Tali Shenfield, Clinical Director of the Advanced Psychology Services - Located in Richmond Hill (North Toronto), ON, Canada