A 6-year-old girl goes to her parents’ room twice at night because she had a nightmare.
An 8-year-old boy spends an hour erasing and rewriting an assignment.
A teenager doesn’t volunteer to solve the math problem in front of the class.
Are these examples of child anxiety? Are they a problem? Will the child need treatment for childhood anxiety?
The answer to all of these questions is “maybe”. Or maybe not. In this post I’ll explore the types of childhood anxiety and how to recognize if it’s become a problem. I will discuss common signs of child anxiety through specific examples. To better understand when anxiety in children is a problem, or when it becomes a disorder, we need to first understand normal anxiety.
- What is anxiety?
- Common childhood anxieties and fears.
- When is child anxiety a problem?
- What is a child anxiety disorder?
- What are common types of childhood anxiety?
- How to help a child with anxiety or deal with an anxiety disorder.
What is anxiety?
Anxiety is an emotion. Everyone experiences it. Anxiety is our body’s way of saying, “hey something dangerous is happening! Do something!” Anxiety moves us into action. It keeps us safe from real danger. It’s necessary for survival. For example, if you were camping and saw a bear, without much thinking, you would take action to stay safe. Your body prepares to protect you. Your mind becomes focused on the danger. Your heart beats faster to pump blood to your arms and legs, so you can move away. Your digestive system slows, to put energy toward other action. Your body works hard to keep you safe.
There are some worries that are common across the lifespan, like doctor and dentist visits, pain and illness, natural disasters, and traumatic experiences. Other fears are more common throughout childhood due to developmental factors. Kids usually outgrown these fears as they mature and move on to the next developmental stage.
Common childhood anxieties and fears.
For babies and toddlers, it’s common to have fears about strangers, separating from caregivers, sudden or loud noises, and new or unpredictable things. Fears of pretend things like imaginary characters, monsters, and the dark are common for preschoolers and kindergarten children. Elementary and middle schoolers tend to fear more real-life situations such as current events, performance, making friends, self-image, and health of self and loved ones. It’s common for teenagers to have more generalized worries about relationships, rejection, the future, and morality.
Imagine a high schooler who’s preparing for an exam. A little bit of anxiety and nervousness about getting a good grade pushes him to prepare and study for it. He plans what to study each day for a few days in advance of the test. He asks himself and his teacher questions about the concepts that he doesn’t understand. He reviews the tougher concepts a few extra times. When he sits for the exam, he takes a deep breath, begins to answer the questions, and feels confident. He hands in the exam, confident in his performance. He doesn’t think much about his grade after the exam is done. This is an age-appropriate and typical level of anxiety for a high schooler that prioritizes academics. Some anxiety was reasonable to start studying and before taking the exam.
When is child anxiety a problem?
Now, consider if this same high schooler spent several hours each night reviewing concepts that he already mastered. He emailed his teacher for reassurance that he was understanding the topic correctly, even though the teacher had already given him feedback on homework assignments on that topic. He started to decline invitations to hangout with friends on the weekends before exams. When it came time to sit for the test, his mind initially went blank. He saw some of the questions and began to think, “wait, how do I do this again?” He started with the questions he was confident about, adding those up and calculating what his grade would be if he couldn’t answer the rest. “Phew, I’d still get a B.” After that he completed the rest of the test. He thought about the questions he was unsure of a few times until he received his grade. Here, anxiety increased. He seeks more reassurance from his teacher and himself. He turns down social invitations to focus on studying. Thoughts about his performance get stuck in his mind after the test. Anxiety about school performance is likely becoming a problem. Despite this increase, this level of heightened anxiety is new. He still studies and takes the test without too much distress. He sees friends at other times. His life is not consumed by the anxiety about academic performance.
Child anxiety becomes a problem when that “hey something dangerous is happening! Do something!” alarm goes off more frequently, but there’s not real danger. It becomes a problem when it starts to disrupt daily life. It sticks around for a bit longer for a pattern to develop. It makes things like going to school or work feel harder. It begins to take up more time and space. Problem anxiety is harder to manage. It gets in the way of what kids need and want to do. It interferes with the main responsibilities of childhood: to learn, to make friends, and to have fun.
What is a child anxiety disorder?
It’s important to remember, not all anxiety becomes a problem. And not all problem anxiety becomes a disorder.
Anxiety disorders are at the far end of the severity spectrum. They are excessive and extreme anxiety that leaves someone feeling like they cannot cope. Many areas of life are affected, like school/work, social life, or family life. Anxiety that’s part of a disorder is often out-of-proportion to the situation and causes a lot of distress. Anxiety disorders are also persistent and chronic. In most cases, the level of anxiety has to be going on for at least a month. It’s not something that eases with time or development.
Going back to the example with the high schooler, some clues that his performance anxiety developed into a disorder would be the hours he spends studying, what happens to his body when he takes an exam, what he’s missing out on because of studying, and how long his anxiety has been this way. For example, he might start emailing his teacher nightly for confirmation that he understands a concept. He might not be able to hangout with friends at all due to pressure to study. His mind might go blank when he sits to take an exam. He might replay the exam in his mind over and over, trying to figure out what he did wrong. He spends many more hours studying than his friends to make sure he has mastered the material. The perfectionism and performance anxiety he feels would likely be a part of generalized anxiety disorder.
What are common types of childhood anxiety?
There are three common anxiety disorders in childhood: separation anxiety, generalized anxiety, and social anxiety.
Separation anxiety is extreme worry when separated from loved ones. Kids with separation anxiety have unrealistic fears about the safety of themselves and their caregivers. They worry something bad will happen that will cause permanent separation like a car accident, kidnapping, or death. They require a lot of reassurance from parents. Thay have a hard time being alone, and might cry, cling, or tantrum in anticipation of being away. Going to school, having playdates or babysitters, or sleeping alone might be very difficult.
Social anxiety disorder is extreme worry in social situations. Kids with social anxiety have intense fears about social and performance situations. They worry about what others will think of them, being laughed at, or embarrassed. They may have trouble writing on the board or reading in front of class. They may have trouble asking their teacher questions or for help. Reaching out to friends or joining conversations might be tough. Playing sports, going to a dance, or being on stage would likely be difficult because of worry about judgment from others.
Generalized anxiety (GAD)
Generalized anxiety disorder (aka GAD) is uncontrollable worry about many situations. It may also be unrealistic fears about many things in the future. Perfectionism and a frequent need for approval or reassurance are common with generalized anxiety. Physical symptoms like stomachaches, tight muscles, trouble sleeping, and poor concentration can also be part of it. Generalized anxiety disorder gets in the way of daily activities.
How to help a child with anxiety or deal with an anxiety disorder.
Sometimes though, even when fears are/were developmentally appropriate, kids have trouble coping. Increased and prolonged anxiety can cause stress for the whole family. When this happens, we are no longer talking about anxieties that kids will outgrow. Learning tools to cope is a great way to change the trajectory and feel more prepared the next time anxiety pops up. If something has become too stressful or if what you’ve tried has not worked, then it has become a problem. At this point, specific anxiety coping strategies could help get things back on track. To start learning more strategies, download the 3 Coping Skills Every Kid Needs guide.