A certain amount of anxiety is a normal part of a child’s healthy development. Brief separation anxiety, fears of the dark, of strangers, of loud noises or of storms are all common worries children may experience as they grow and mature.
Frustrations and repeated difficulties in social relationships and school performance can lead to increased anxiety about being embarrassed in front of peers, as well as fears about letting down parents or teachers. Though these feelings are all normal, if they don’t subside with time and instead escalate or begin to interfere with a child's daily activities, there may be more cause for concern.
Approximately 5% to 10% of children in the general population struggle with anxiety disorders. Among children with ADHD, the rate appears to be even greater. A first step in helping a child manage and overcome anxiety is recognizing it, and sometimes this can be difficult. Anxious kids can also be rather quiet, shy, cautious and withdrawn. They may be very compliant and eager to please adults. On the other hand, an anxious child may “act out” with tantrums, crying, avoidance and disobedience. These behaviors may be misinterpreted as oppositional and “difficult” when they are actually anxiety related.
As a parent, it is important to be aware of some of the ways severe anxiety can show up in children. With increased awareness, you’ll be able to intervene early and get help.
Separation AnxietyChildren with separation anxiety experience excessive fear of being separated from their home and parent(s), caretaker, or to whomever the child is attached. The child may develop persistent worrying to the point of becoming panicky, refusing to go to school, throwing major tantrums, and clinging to the parent. She may be terrified of being apart even for brief periods.
Simply the anticipation of separation can bring on extreme stress and raw feelings of vulnerability. It is often difficult for these children to sleep alone because of the separation that occurs during the night time hours. These kids may have repeated nightmares and complain of frequent physical symptoms such as headaches or stomach aches that result from the anxiety.
Generalized AnxietyKids with generalized anxiety experience excessive, unrealistic worry and fear about every day things. They often anticipate disaster. The tension and stress is chronic and debilitating, affecting multiple areas of the child’s life. Just getting through the day can be a struggle.
Though the child may recognize that his anxiety is exaggerated, he still has great difficulty controlling and managing it. There may also be restlessness; difficulty concentrating (even times when the child’s “mind goes blank”); irritability; edginess; muscle tension; fatigue; difficulty swallowing; a need for frequent urination; stomach aches; and sleep difficulties associated with the anxiety. The child may startle easily and just can’t seem to relax.
PhobiasChildren may also develop phobias or persistent, irrational and extreme fears about a specific thing or situation. This anxiety causes the child to avoid the object, activity, or situation at all costs. If it cannot be avoided, it is painfully endured.
Specific phobias result in terrifying internal distress -- feelings of imminent danger or doom; the need to escape; heart palpitations; sweating; trembling; shortness of breath or even a feeling of being smothered as though one can’t breathe; chest pain; dizziness; a fear of losing control and “going crazy” or of dying.
Kids with social phobia (also called social anxiety worry about being scrutinized and negatively judged. They fear embarrassment and teasing in social situations. At school, they may have great difficulty answering questions in class, reading aloud, initiating conversations, talking with unfamiliar people, and attending social activities. They feel powerless in controlling anxiety and tend to have few social relationships, resulting in even more isolation, loneliness, and feelings of being different.
Panic AttacksWhen a child has a panic attack, he or she experiences a period of intense fear which starts suddenly and may escalate to the point of terrifying thoughts of impending doom when there is no real danger. The attacks are unexpected (and can even occur during sleep) and recurrent. They are so intense that the child begins to not only panic during the attacks, but become preoccupied about the dreaded anticipation of the attacks.
In addition to the overwhelming fear that something bad is going to happen, the child may also experience shortness of breath; choking or smothering sensations; pounding heartbeat; chest pain; nausea; lightheadedness; trembling and shaking; and fear of losing one’s mind.
If you have concerns or questions about possible symptoms of anxiety in your child, be sure to talk with your pediatrician or mental health professional. Early intervention and treatment can make a world of difference for your child and can prevent further complications around the anxiety. Learn strategies to help your child manage feelings of anxiety.
American Academy of Child and Adolescent Psychiatry. Practice Parameter for the Assessment and Treatment of Children and Adolescents with Anxiety Disorders. J. Am. Acad. Child Adolesc. Psychiatry, 46:2, Feb. 2007.
Anxiety Disorders Association of America. Understanding Anxiety. adaa.org
Thomas E. Brown, PhD. Attention Deficit Disorder: The Unfocused Mind in Children and Adults. Yale University Press. 2005.