Anxiety disorders are the most common type of mental health disorders affecting children and adolescents, with approximately 15%-20% meeting the criteria for it. For youths aged between 13 to 18 years, estimates are as high as 31.9%. Despite having such a high rate of occurrence, many children with anxiety are left untreated. The main reason for this is that the common behavioral manifestations of anxiety, such as inattention and outbursts, often mimic features of other disorders present in childhood such as mood and externalizing problems. Anxiety is also overlooked because fear in children is considered an appropriate reaction to a perceived threat, especially since fear is developmentally typical throughout childhood.

It's important that while transient fear is a normal part of development, pathological anxiety is persistent, extensive, and disproportionate to the threat, impossible to reason with, and significantly impacts the child's ability to function at school, with family, peers, and even in activities of daily life. If a child's anxiety is left undiagnosed and untreated, many children face an increased risk of persistent anxiety symptoms into adulthood. This will then make them more susceptible to other anxiety disorders, depression, substance abuse and dependence, and even detrimental physical impacts like permanently heightened stress hormone levels, cardiovascular issues, and respiratory issues. In this article, we'll take a look at what a child's anxiety would manifest as, their causes, impact, and how you as a parent can address these issues for a better family life as well as a healthier future for your child.

Common Signs of Anxiety in Kids

Anxiety manifests in many ways, and often it can feel difficult to recognize it from the actions and reactions many children have as a normal part of growing up. As parents, it's important for you and your partner to be able to distinguish the many different kinds of symptoms of anxiety in your children, and distinguish it from what's part of a normal developmental process. Primarily, anxious symptoms manifest as behavioral and physical symptoms. Let's take a deeper look at the two:

Behavioral Symptoms of Anxiety Disorder

Your child will often ask questions to gain an understanding of the world, and one of those lines of questioning is 'What if' scenarios. While this is usually a normal part of growing up, it's important to see if your child is excessively worrying about the future, or ruminating over past events. Let's take a deeper look at what kind of anxiety disorders a specific symptom can indicate, as well as the developmentally appropriate fears and worries in contrast. We will follow the format of- Disorder :: Developmentally appropriate fears and worries :: Symptoms suggestive of anxiety disorder. Let's begin:

• Separation anxiety disorder (Preschool) :: Self-limiting distress around new separations from parent :: Clinging or closely following a parent, unfounded worries about parent injury, illness, or death, and inconsolable distress, somatization during transitions.
• Selective mutism (Preschool) :: Taking time to warm up or become more outgoing in social situations :: Being unable to speak at all in specific situations
• Specific phobias (preschool to school age) :: Time-limited fear of new objects or situations :: Fears persist and appear out of proportion to actual risk, leading to avoidance and diminishing quality of life or function.
• Social anxiety disorder (Late school age, early adolescence) :: Discomfort or hesitation around social events or requests to 'perform' :: Excessive, persistent fear of scrutiny, and avoidance or compromised involvement in family or community activities.
• Panic disorder (Adolescence, young adulthood) :: Transient concerns about physiological symptoms :: Recurrent panic attacks, fear of panic attacks and avoidance of associated situations, and worries about associated health risks.
• Agoraphobia (Late adolescence, young adulthood) :: Transient reluctance to use public transportation, to be in crowded or enclosed places, crowds, or to be outside of the home alone :: Persistent avoidance of two or more locations based on fears of not being able to escape or summon help for at least six months.
• Generalized anxiety disorder (Late school age through young adulthood) :: Transient worries about grades, health, or world events that do not impair participation in school, family, or community :: Constant, excessive worry about risk that impairs participation in multiple events or activities, as well as irritability, trouble concentrating, and even trouble sleeping.

Physical Symptoms of Anxiety Disorder

It's no secret that stress can bring about physical symptoms, and anxiety in children is no different. If your child shows the following symptoms, they may be suffering from anxiety disorder:

• Stomach aches and headaches
• Restlessness
• Muscle tension
• Trouble sleeping
• Tiredness
• Decreased appetite

It's difficult to diagnose childhood anxiety through physical symptoms alone. It's important to have a mental health professional assess your child in conjunction with a pediatrician or family doctor's appointment. Once you've established that these symptoms do stem from anxiety, it's time to address the root cause of it.

Causes of Anxiety in Children

Anxiety in children rarely stems from a single issue. It is usually a combination of many environmental, physiological, and even genetic influences. In order to address your child's anxiety issues, it's important to first determine what it stems from. Let's explore a few of the main causes of anxiety in young children:

Family Environment

Parents have the most influence on their children, and this shouldn't come as a surprise. The home and neighborhood your child grows up in, the financial situation and social status of your family, the relationship between you and your partner, and even your parenting styles will have a significant effect on your child's mental health. An inconsistent parenting style, such as those characterized by overprotection, excessive criticism, and helicopter parenting, can contribute to a child's anxiety. Even modeling anxious behavior in front of your child can cause them to internalize the patterns, causing them to perceive the world as a far more dangerous place than it is.

Family conflicts like high-conflict divorces, marital discord, stressful financial periods, and the death of a loved one can create an unstable and anxiety-promoting environment for children. On the flip side, maintaining a nurturing, supportive, and most importantly, predictable family environment can promote a child's sense of security and emotional well-being. This makes it harder for them to develop anxiety both in their childhood and later on in life. An important aspect of your relationship with your child is whether or not they feel they can communicate openly with you. Being able to comfortably express their feelings without having to fear reprimand or consequences will allow your child to develop healthy coping mechanisms, as well as give them the understanding that they can always approach you for advice and help when they're facing stressful events.

Genetics

Strong evidence supports familial and genetic influences on pediatric anxiety disorders, though identifying the specific genes that places children and adolescents at risk of anxiety disorder has proven difficult. Children who have parents or grandparents with a history of anxiety disorders, depression, or other mental health conditions are likelier to develop anxiety, which indicates a hereditary component. Studies have indicated that these genetic predispositions influence neurotransmitter levels in the brain, which will then affect the child's ability to regulate emotions.

School and Peer-Related Stress

Starting school can be a stressful experience for a child. They're away from their parents in the company of other children and adults they've never met before, in an environment they aren't familiar with. On top of that, academic pressures such as standardized tests, performance evaluations, rankings, and presentations can cause stress and worry for the child. Many children develop anxiety in relation to performances, such as group presentations. Even the social dynamics in schools and interactions with peers can be stressful, especially if your child has experienced bullying. Being bullied can lead to further feelings of intense anxiety and insecurity. Children who have issues with social skills may fail to understand cues, leading to awkward situations which they may ruminate and worry over. If your family constantly moves from place to place, the transition between different schools can also be a source of stress and anxiety, which can lead to your child becoming reclusive.

How Anxiety Impacts Child Development

Long-term anxiety in children can have lasting effects on their development. If left unaddressed, it can reduce a child's ability to function in society and navigate various personal and professional aspects of their life. These implications are significant, which is why it's essential to provide early intervention and support. First, we'll take a look at the kinds of challenges that can manifest from anxiety in children:

Social Challenges

Social situations are often the first place children tend to feel anxious. If this isn't addressed early on, it can impede their ability to function in social events and even engage in simple social interactions. Something as simple as ordering food at a fast-food restaurant can make them feel overwhelming anxiety. Intense anxiety in children can lead to them struggling to form and maintain relationships with their peers, and even lead to them avoiding group activities, playtime, and school events.

Children with anxiety may withdraw from some social situations. This will impact their ability to learn crucial social skills, and the feelings of loneliness and social isolation can end up with the child having low self-esteem, depression, and other mental health issues down the line.

Academic Challenges

Anxiety in children often manifests in school life. The pressure to perform well in tests and school activities can feel overwhelming for them, and over time, they'll feel anxious when they have academic stressors coming up. Anxiety in children can affect the child's ability to participate in classroom activities, ask for help, and even complete assignments on time. They may even struggle with time management, organization, and planning. Over time, the combination of these issues can lead to a decline in academic performance, a loss of motivation, and fostered distaste for school. Their self-esteem will be further affected by their poor academic performance.

Emotional Regulation

Anxiety can negatively impact a child's ability to regulate their emotions properly. When experiencing severe ongoing anxiety, children may struggle to identify and label their feelings. Their inability to cope with distress leads to emotional outbursts, tantrums, or withdrawals, as well as feelings of frustration, irritability, and sadness. They'll lack the ability to cope with stress and adversity, which makes it difficult for them to deal with daily challenges. They may end up developing avoidance behaviors or unhealthy coping habits. Eventually, their impacted emotional regulation can negatively affect their ability to form safe and healthy relationships.

Strategies for Parents and Caregivers

As parents, helping your child manage and overcome their anxiety is key. You can't take a backseat and hope they'll work it out themselves, because odds are they'll begin avoidant behaviors and develop negative coping mechanisms, as a result of which they'll be socially impaired as grown-ups. You need to create a supportive environment that promotes resilience and well-being. When your child feels safe in expressing their feelings and developing healthy coping mechanisms, you'll find it easier to treat anxiety. It's important to remember that children are unique, and what works for one child won't necessarily work for the other. Show patience and understanding, and tailor your methods to your child's needs and personality.

Establishing Routines and Providing Reassurance

Having a predictable structure to day-to-day life is a great way to provide a sense of security and consistency to a child struggling with anxiety. It's great for helping children feel more comfortable and in control of their environment, which helps reduce the anxiety associated with uncertainty. You can achieve this structure with a consistent bedtime routine, meal times, and schoolwork.

It's also important to reassure your child. There will often be times when an anxious child will face intense fear of upcoming events or situations, such as exams, public speaking events, family gatherings, and so on. Listening to their fears and concerns without minimizing them is essential to help your child understand that you are a pillar they can lean on. Acknowledge their feelings and provide gentle, factual responses to help them gain an understanding of the world, and try to maintain realism with your words. You don't want to make promises you can't keep. Follow through with the promises you do make, so that your words carry weight, and your child trusts you more. Empower your child and help them understand that no matter how scared or anxious they may feel, they'll always have your support and whatever resources they may need to cope.

Encouraging Open Communication

Being able to be open and honest about how they're feeling can help an anxious child feel better. Most children confide in their parents if they feel that they're in a safe and non-judgmental space, so try to provide that for them. Actively listening to what they say, validating their experiences, and asking more questions instead of immediately offering solutions will help your child feel better, as well as understand themselves more. By helping children identify and label their emotions, you've achieved the first step to managing them. If your child has difficulty in verbalizing their emotions, you can try having them journal, draw, or look for other creative outlets that can help.

On top of everything else, it's important that your child understands that you are not frustrated with them. Parents can sometimes feel burnt out when taking care of young children, and even older children who feel intense anxiety. This isn't a fault in you. It's important to help your child, but also give yourself ways to release the stress instead of bottling it up inside you.

Professional Help for Childhood Anxiety

Sometimes, despite doing everything you can, you won't be able to help a child with anxiety entirely. Professional intervention can provide targeted, evidence-based strategies to manage and reduce anxiety in children, help them develop healthy coping skills and achieve long-term well-being.

When To Seek Therapy or Counseling

If your consistent efforts to address the anxiety symptoms your child faces make little headway, you may need to involve a professional. There are particular signs to watch out for which can warrant involving a mental health professional:

• Difficulties in school
• Inability to participate in everyday activities
• Strained relationships with friends and family
• Physical symptoms of anxiety like headaches and stomachaches without a clear medical cause
• Significant changes in sleeping and eating habits
• Anxiety symptoms worsen
• The child has experienced a traumatic event
• There is a family history of anxiety and other mental health issues

Types of Therapy Effective for Children

There are many different kinds of therapies that are effective for children who suffer from anxiety:

• Cognitive-Behavioral Therapy: CBT is the most commonly used therapy for anxiety disorders in children. It addresses negative patterns and distortions in the way the child looks at the world and themselves. It helps them examine how their negative thoughts contribute to their anxiety, and then helps them reflect on how they behave and react in situations that trigger anxiety.
• Acceptance and Commitment Therapy: ACT focuses on teaching children mindfulness techniques and helps them develop psychological flexibility, which allows them to navigate difficult emotions and situations more effectively. It helps them accept their anxious thoughts and feelings without judgment and commit to actions that align with their values.
• Exposure Therapy: Gradual and controlled exposure to feared situations or objects can help a child build confidence and reduce anxiety over time. This leads to feelings of anxiety diminishing.
• Family Therapy: Family dynamics often contribute to a child's anxiety. Through family therapy, communication patterns are improved, conflicts are resolved, and a supportive environment is fostered for the child. It also helps the child and parents better understand each other.

Conclusion

Dealing with childhood anxiety is difficult, whether it's in early childhood or in later periods of the child's life. While you're helping your child, it's important to not ignore other children you may have, and understand that you are not alone. Anxiety in children is common, and it is treatable. As long as you provide the right treatment plans, support, and interventions, your child will learn how to manage their anxiety in a healthy manner. Show patience for both your child and yourself, and celebrate little victories when they come. As you take care of your mental health, it will reflect in your child. With your unwavering support, love, and understanding, your child's mental health will make leaps and bounds. We hope this article has been informative, and leaves you feeling better equipped to deal with childhood anxiety.

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