Anxiety Disorders in Childhood and Adolescence

Mar 1, 2024

In my practice, I define therapy as what you do to achieve the life that you want to have. For children and adolescents, this means that therapy is to help them become more effective in their lives. Anxiety is one emotion that sometimes really ‘gets in the way’ of us being able to feel effective. We see this with our children as well as in our own lives.

Children and adolescents present anxiety disorders differently than adults. Mash and Wolfe define anxiety as “a mood state characterized by strong emotion and bodily symptoms of tension in which the child apprehensively anticipates future danger or misfortune.” Your child or adolescent may show physical, cognitive, and behavioral differences which may become debilitating.

Physical symptoms of anxiety can include things like a sudden feeling of being flushed, increased sweat production, or even an upset stomach.

Some examples of anxiety that can have on the cognitive system of the mind are having thoughts of not being good enough or inadequate or having inappropriately self-critical thoughts. These false cognitions serve no positive purpose and are what we work to correct when working with children and adolescents. 

The third system that anxiety can manifest in is the behavioral system. This symptom manifestation presents as physical behaviors such as lip biting, nail or cuticle biting, tense body language, or other behaviors out of the ordinary for your child.

Different Types of Anxiety Disorders

Several conditions fall under the umbrella term “anxiety disorders”: separation anxiety disorder, specific phobias, social anxiety disorder, selective mutism, panic disorder, agoraphobia, generalized anxiety disorder, and obsessive-compulsive disorders (which will not be included in this discussion), each with its own unique set of challenges.

Separation Anxiety Disorder

Separation anxiety disorder occurs when a child or adolescent demonstrates excessive distress from being separated from their caregiver or “trusted person”. These children and adolescents tend to have anxiety regarding interacting within new situations with new people and can go to great lengths to avoid being separated from whoever they want to stay with. This can include crying, screaming, and refusing to move, and can also manifest somatically.

Specific Phobia

A specific phobia is just that, a specific phobia that presents as debilitating or pervasive and prevents a child from having typical interactions with their environment. These children and adolescents “show an extreme and disabling fear about objects or situations that in reality, pose little or no danger or threat.” The fear that these children and adolescents experience can manifest in diverse ways such as crying, shutting down/freezing, or extreme avoidance.

Social Anxiety Disorder 

Social Anxiety Disorder or Social Phobia is a fear of social situations that open the child up to scrutiny by others or embarrassment. (Mash & Wolfe, p. 369, 2019). These children and adolescents try, as best they can, to avoid such situations.

Selective Mutism

Children and adolescents who have diagnosable selective mutism do not speak when there is a social expectation to do so. This mostly occurs as a reaction to stress, anxiety, or discomfort, as the child could be typically social in other, less threatening environments. This can also occur as a response to trauma.

Panic Disorder

Panic Disorder requires that one undergo a series of panic attacks, defined as “a sudden and overwhelming period of intense fear or discomfort.” Panic attacks tend to be sudden but short-lived, and also are more difficult to identify in children and adolescents who cannot adequately explain or communicate their emotions.

Generalized Anxiety Disorder

Generalized Anxiety Disorder, GAD, is the occurrence of excessive worry about many things during many/most days. Children and adolescents with GAD tend to be overly sensitive and perceptive, noticing frightening or worrisome things around them that others may brush off.

What to do if you notice symptoms in your child

Listed below are some suggestions for you to use with your child at home. Professional help is also available in the form of counseling.

Coping Skills

1. Exercise: Is your child getting enough exercise? Physical exercise improves physical and mental health, including anxiety and depression. People who exercise are less likely to have an anxiety disorder, and exercise naturally increases some of the brain proteins that help us learn that we are safe. Exercise appears to help with anxiety regardless of the causes or triggers of the anxiety, so it can be effectively applied to a range of anxiety-related problems, such as panic disorder, social anxiety disorder, and generalized anxiety disorder.

2. Breathing Exercises: Help your child gain control over their breathing. Gaining control over your breathing involves both slowing your rate of breathing and changing your breathing style. Use the following steps with your child at a time when they are not anxious to teach this skill: 

  • Ensure that you are sitting on a comfortable chair or lying on a bed.
  • Take a breath in for 4 seconds (through the nose)
  • Hold your breath for 2 seconds.
  • Release the breathtaking and count 6 seconds (through the nose), then pause slightly before breathing in again.
  • Practice, practice, practice!

By using breathing retraining you can slow your breathing down and reduce your general level of anxiety. With enough practice, it can even help to better cope with anxiety when you are in an anxious situation.

3. Practice Problem Focused coping strategies with your child or adolescent. This involves identifying the primary sources of stress and helping to tackle the things that you can change. For example, make a plan with your child on what to do if they become distressed. It is easier to activate a pre-existing plan than to try to develop one on the fly. Having discussed this with you might help your child feel more in control of the situations that cause them distress. 

Therapy Treatment Options

Many children and teens benefit from therapy. Cognitive Behavioral Therapy (CBT) is one treatment option for children and adolescents. CBT helps clients manage persistent and problematic anxiety by identifying the components that keep the anxiety going. Managing anxiety involves re-evaluating the threat, approaching, and testing feared and avoided situations, and using mindfulness skills to calm our mind and body. These strategies are often tailored according to the anxiety someone is experiencing. 

I often work with children and adolescents using CBT. In my experience learning about what keeps anxiety going is paramount in treatment. I use a behavior chain analysis which identifies the following: The event that causes anxiety. The thoughts about that event. - The feelings. And the result. 

Being able to identify the behavior chain of anxiety I can work with the client to interrupt the behavior chain that has maintained the overwhelming feelings of anxiety and help the client to become more effective in their lives. 

Source: Mash, E. J., & Wolfe, D. A. (2018). Abnormal child psychology (7th Ed.). Boston, MA: Cengage Learning.

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