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Anxiety And Kids: When To Worry About An Anxious Child

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Written By Jerome Bubrick, PhD

This story is part of Speak Up for Kids, an annual public education program held during National Children's Mental Health Awareness Week (May 6-12, 2012)

Kids worry. Whether it’s fear of the dark, starting at a new school, or getting another pimple, children can take life very seriously. But some kids worry more than others. It’s always painful to watch a child suffer from anxiety, but it’s especially difficult if you’re not sure whether she’s worrying too much and might need help.

The difference between normal worry and anxiety disorders is the severity and duration of the anxiety. While feeling anxious is a natural and even healthy reaction to stressful situations, anxiety becomes a disorder when it interferes with a child’s ability to handle everyday situations, or prompts her to avoid things that most people her age enjoy.

Here are some guidelines for distinguishing different types of anxiety disorders from ordinary anxiety.

  • Severe anxiety is out of proportion. A second grader might be nervous about taking a spelling test. A boy with generalized anxiety disorder (GAD) might be so worried that he starts studying for the test a week early and loses sleep for days.
  • Severe anxiety is being overly self-conscious. A girl might be nervous before performing in her first recital. Someone with social anxiety disorder might have a panic attack prior to ordering in a restaurant.
  • Severe anxiety is often unwanted and uncontrollable. A typical kindergartener might cry at school because he misses his mother. An older boy with separation anxiety disorder might cry at school because he can’t stop thinking that his mother will die if he is away from her.
  • Severe anxiety is unrealistic. A girl might be afraid of burglars robbing the house. Someone with obsessive-compulsive disorder (OCD) might think burglars will come unless she touches everything in her room twice.
  • Severe anxiety doesn’t go away. While anxiety symptoms are common and even expected after a disturbing experience such as a car accident or a flood, over time most children bounce back. Six months later a boy with post-traumatic stress disorder (PTSD) will still be having nightmares.
  • Severe anxiety leads to avoidance. A girl might be nervous about going to a birthday party. A girl with a specific phobia of clowns might refuse to go to birthday parties at all because she’s afraid that a clown may be there.

The common theme with all of these disorders, which are estimated to affect perhaps 8-10% of American children in a given year, is that they make children’s lives much harder than they should be and limit the experiences they are able to have. If you think anxiety is interfering with your child’s ability to function, find a mental health professional who can do an evaluation. Some children may display symptoms of anxiety (and still benefit from behavioral therapy) without having a diagnosable disorder.

For kids who do need help, cognitive behavioral therapy (CBT), sometimes combined with medication, is very successful in helping kids learn to tolerate their anxiety until it diminishes. CBT is a skill-based approach that teaches kids how to control their thoughts so they can better manage unwanted feelings and behaviors. A good example of this is exposure with response prevention (ERP). ERP exposes kids to things they would ordinarily fear and avoid in a carefully controlled and therapeutic way. This exposure helps them confront and eventually beat their fears.

In terms of medication, the most evidence-based choice for treating an anxiety disorder is SSRIs, or antidepressants. These have been found to be extremely effective, especially alongside a psychological intervention like CBT.

How often and how long your child receives treatment depends on the severity of her disorder. For adolescents who have been living with anxiety for a longer period of time, recovery can be more complicated. In addition to overcoming their anxiety, psychological rehabilitation may be needed to help them change an anxious lifestyle. The good news is that anxiety disorders respond very well to treatment in kids of all ages.

Child Mind Institute's Speak Up for Kids is an annual public education program held during National Children's Mental Health Awareness Week (May 6-12, 2012) aimed at ending the stigma, lack of awareness, and misinformation that cause children to miss out on treatment that can change their lives.

Read more articles about children's mental health here.

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