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Think elementary school-age children are too young to have clinical anxiety, unless they have an abusive or really dysfunctional family? I wish that was true, but unfortunately, it isn’t. Other stressful life situations (school, peer relationships, etc.), as well as genetics and learned behaviors, can cause anxiety disorders, too.
Approximately 4.4 million children in the U.S. have diagnosed anxiety, which is only a fraction of the total number. Adolescents make up the largest percentage of these children; however, some are as young as three. (My son was five years old when he first began exhibiting what I now know is a sign of social anxiety that his teacher and I missed. The same is true with a second indicator that emerged the following school year.)
Sadly, most kids have an anxiety disorder for years before it’s detected – if it’s ever diagnosed at all.
The struggle is real
Identifying and treating an anxiety disorder is critical because, of children 3-17 years old who have them, more than one-third have behavior problems too, and about one-third also have depression. Studies also show that kids with untreated anxiety disorders are at significantly higher risk for poor school performance and substance abuse.
There are several types of anxiety, but when people use that term, they’re usually referring to generalized anxiety disorder (GAD). Children with GAD often struggle with perfectionism, and seek constant approval from others.
To be clear, GAD is much different from the fear or worry a child experiences when something frightening happens or something catches him off guard. That’s to be expected, and once the threat is over, his nervous system returns to normal. With GAD, however – or any type of anxiety disorder – the child is in an ongoing state of fight, flight or freeze.
“Anxiety is debilitating,” says Seth Perler, executive-function and twice-exceptional coach. “It can hold a child back from life because he’s constantly on alert.”
Most common signs of anxiety
Aileen Kelleher, LCSW, owner of Bloom Child and Teen Therapy in Chicago, says anxiety also tends to be misunderstood (and overlooked) because of the ways in which kids convey it.
“Children often communicate anxiety through behaviors, rather than voicing that they’re afraid of a situation or future possibility.”
What people often see instead, she says, is frequent irritability, avoidance, difficulty concentrating and sleep disturbances. Here’s why:
Irritability. “When a child (or adult) is living in a constant state of fear, it’s overwhelming, exhausting and frustrating,” explains Kelleher. “When this happens, the child may exhibit defiance or anger because she doesn’t know how to manage the feelings of fear she’s experiencing.”
Avoidance. If a child tends to avoid certain situations or gets upset when faced with those scenarios, Kelleher says anxiety may be at play. For example, if she repeatedly gets upset when she’s supposed to go to practice for a sport, she may simply dislike the activity; however, she also could be experiencing anxiety related to something going on with how her teammates are acting, the coach’s leadership style, or issues with her own performance. “It’s important to approach these situations with curiosity and try to find out more about why the child wants to avoid certain things,” she says.
Inattention or poor focus. When children are in a state of hypervigilance, their brains are preoccupied with self-protection; not whatever else is happening in the moment. Like the avoidance example above, Kelleher stresses that adults should approach concentration-related issues with a sense of curiosity (rather than assumptions or judgments). “Observing and getting more information from the child and other adults involved can provide key insights into her internal state,” she explains.
Sleep challenges. When children have difficulty falling or staying asleep, they may have racing thoughts about a future situation, or they could have trouble relaxing as a result of their fear. Even as a child, it’s horrible for both our brains and bodies to be in such a continual state of stress; therefore, don’t take ongoing sleep disturbances lightly. Thankfully, Kelleher says therapy can help with this immensely. “Learning how to relax our bodies is one of the main steps in treating anxiety,” she explains.
Other indicators of anxiety
Listed below are many other signs of anxiety in children. Any of these situations can happen from time to time. With anxiety, however, the instances will be frequent and may begin to occur for seemingly no reason.
- headaches or stomachaches
- muscle tension
- bowel problems
- change in appetite
- new compulsive habits
- change in quality of schoolwork
- starting to lie or become secretive
A child may become shaky, jittery or out of breath when he’s in the “fight, flight or freeze” state – or, as self-regulation expert Dr. Stuart Shanker calls it, the brown-brain state. He also may feel butterflies in his stomach or have clammy hands, a dry mouth or a racing heart. (The trigger stage, just before “brown brain” is the red-brain state.)
What I noticed with my twice-exceptional son
Sometimes a child will enter the red- or brown-brain state before he’s even in the situation he fears. For example, not long ago, my son, who is twice exceptional (“gifted” + a disorder; in his case, anxiety), was being bullied by a neighbor in the same grade.
My son has the psychomotor overexcitability that’s so common in differently-wired kids like him, so I’m used to his high energy level. However, I noticed one morning that, over the past several days, he’d been even jumpier and more animated than usual. I’d seen this before and realized it was probably due to a spike in his anxiety level.
Then, a couple mornings later, he stopped trying to get to the bus stop on time. (Normally, he’d move faster, but now, he was moving slower and saying there was no point because he wouldn’t be able to make it – even when he could have.)
Through all of this, my son insisted everything was “fine” and he began to get frustrated with me for continuing to ask. My radar was up, though, and by what I continued to see, my gut told me something was very wrong.
Because my son is very literal, and doesn’t share much personal information except through humor, he also began to joke that I was bullying him when I said he needed to brush his teeth, wash his hands before dinner, do a chore, or anything, really.
In addition, he had an intense nightmare one night that left him extremely upset. In his world of being a very asynchronous child, it was the worst possible dream he could have had. I felt certain this was related to the school-morning behavior I’d been seeing and was frantic to figure out what was going on. My son’s teachers didn’t know either, because the bully (a new neighbor) was behaving himself at school.
It took a couple more weeks, but one Sunday, after the kid shoved my son three times at a neighbor’s house, my son decided he’d had enough and told me what had been going on: taunting, threats, hair pulling, shoving and even a punch to the face.
No wonder his anxiety level had been sky high…
When we suspect a child has anxiety
So, what can adults do if we notice some of these warning signs and suspect a child has ongoing anxiety, especially if he isn’t willing to talk about it?
First and foremost, Kelleher says let the child know he can come to you with any concern or fear, and that you won’t judge him. If you’ve said that before, but it’s been a while, give him a gentle reminder. (He should hear this several times during his life anyway, right?)
She adds that many children feel shame about their worries, so also be sure to calmly validate his feelings if he expresses them to you.
If there’s a safety issue of some sort, you need to address that, of course, with whomever is appropriate given the situation.
“If there’s no immediate safety risk, assess how to help him face his fears in a gentle, loving way; encouraging avoidance only leads to more anxiety,” she explains. “Therapists can be helpful with coming up with a plan to help a child overcome his fears.”
Understand that this process can take time, though. In most cases, it takes quite a while to develop an anxiety disorder, so don’t expect the solution to be as simple as flipping a switch.
Creating healthier thought patterns and behaviors
One tool that many child psychologists, therapists and other anxiety experts recommend is cognitive behavior therapy (CBT). CBT involves a trained professional teaching your child how to identify negative thought-patterns and behaviors, and how to replace them with positive ones. (Kind of like a tutor, but instead of helping kids with math, they coach them on how to approach problems – real and imagined – in a healthier, more effective way.)
Three to 12 sessions with a therapist trained in CBT are sufficient to treat mild anxiety. Moderate anxiety usually takes six to 24 sessions, and severe anxiety, especially if depression also is present, will require at least 24 sessions.
The results are long term. Once the child can reframe the way he perceives anxiety-provoking thoughts and situations, he’ll have confidence and the ability to deal with stress more successfully – in his current life and down the road.
In the meantime, extend your child (or student) some grace and try to be patient. You also may want to use this downloadable anxiety log on Understood.org to identify patterns and gain more insight.
To learn more about Kelleher and her Chicago-based practice, visit http://www.aileenkelleher.com.
About 16 months after writing this article, my younger child was identified as twice exceptional. She’d been struggling pretty significantly for over a year, and no matter how we tried to help, the situation only worsened. In addition to ADHD and a few areas of giftedness, she was diagnosed with generalized anxiety disorder (GAD) and mild depression. For more about how her neurodiversity is affecting her, read Emotional intensity: one 2e child’s experience.
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