How To Help A Child With Anxiety

What Causes Anxiety Disorders In Children

Some children are born more anxious and less able to cope with stress than others.

Children can develop anxious thoughts and avoidant behaviours by seeing how others manage anxiety.

Some children develop anxiety after stressful events, such as:

• moving house or school often
• parents fighting or arguing
• the death of a close relative or friend
• becoming seriously ill or getting injured in an accident
• school-related issues like exams or bullying
• being abused or neglected

Children who experience significant anxiety can also experience other mental health difficulties. Depression is the most common.

Content supplied by the NHS and adapted for Ireland by the HSE.

What Are The Treatment Options

Treatment options for children with depression are similar to those for adults, including psychotherapy and medication. Your childs doctor may suggest psychotherapy first and consider antidepressant medicine as an option if there is no significant improvement. The best studies to date show that a combination of psychotherapy and medication is most effective at treating depression.

But studies do show that the antidepressant fluoxetine is effective in treating depression in children and teens. The drug is officially recognized by the FDA for treatment of children ages 8 to 18 with depression.

Most medications used to treat depression in children have a black box warning about the possibility of increasing suicidal thoughts. It is important to start and monitor these medications under the care of a trained professional and talk with them about the potential risks and benefits for your child.

Treating children who have bipolar disorder

Children with bipolar disorder are usually treated with psychotherapy and a combination of medicines, usually an antidepressant and a mood stabilizer.

Antidepressants need to be used with caution, as they can trigger bouts of manic or hyperactive behavior in children with bipolar disorder. Managing a childs medication must be part of an overall care plan that includes therapy and routine primary care appointments.

Causes Of Childhood Anxiety Disorder

According to the National Institutes of Mental Health , both genetic and environmental factors contribute to the risk of developing an anxiety disorder. Research shows that biology, biochemistry, life situations, and learned behaviors all play a role. Many anxious kids have anxious family members, says Alvord. Children model behaviors on what they see, she adds.

And then theres the genetic component. Anxiety disorders do run in families but a family history doesnt mean a child is destined to develop a disorder. Parental behavior can exacerbate and worsen childrens problem but thats not the same as saying that parents are the cause of the child having the problem in the first place, Lebowitz says.

Much depends on the childs innate sensitivity, family dynamics, and life experiences. Some children have a natural predisposition or vulnerability to anxiety or have difficulty regulating their feelings of anxiety and fear. And thats not because their parents did this or didnt do that, stresses Lebowitz, That said, parents can and should play an important role in helping children learn to cope better with their anxiety.

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How To Help Your Anxious Child

If your child is having problems with anxiety, there’s plenty you can do to help.

Above all, it’s important to talk to your child about their anxiety or worries.

It’s a good idea to seek professional help if your child is always anxious and:

• it’s not getting better or is getting worse
• self-help isn’t working
• it’s affecting their school or family life, or their friendships

Bonus: Create A Bedtime Ritual

Your childs sleep habits are either a nightmare or no big deal theres rarely any in-between. If your child isnt sleeping well on a regular basis, it will significantly disrupt both their lives and yours.

Numerous studies show that good sleeping habits benefit children in many ways, from lower levels of obesity and anxiety to improved behavior and school performance.

But good sleep habits dont just happen by magic.

Its something that requires some intention on your part. Fortunately, its never too late to start developing a bedtime routine for your child with anxiety.

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What Should I Do If I Think My Child Is Depressed

If you think your child is depressed:

Talk with your child about sadness and depression. Kids might not know why they are so sad and why things seem so hard. Let them know you see that theyre going through a hard time and that youre there to help. Listen, comfort, offer your support, and show love.

Set up a visit with your childs doctor. Let your childs doctor know if sad or bad moods seem to go on for a few weeks. By itself, this doesnt always mean a child is depressed. Tell your childs doctor if you have also noticed changes in your childs sleep, eating, energy, or effort. Tell them if your child is dealing with a loss, a big stress, or hardship.

The doctor will do a physical exam. A full exam lets the doctor check for health issues that could cause your childs symptoms. They can also check for depression. Your childs doctor may refer you to a child therapist. The doctors office might have a child therapist on staff.

Set up a visit with a child therapist. A child therapist will spend time talking with you and your child. They will do an in-depth check for depression by asking questions and listening. The therapist can explain how therapy can help your child.

Take your child to therapy visits. The therapist may suggest a few visits, or more. Therapy can take time, but you will see progress along the way.

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Teach Your Child The Skills They Need To Manage Their Anxiety

It’s normal for children to feel afraid sometimes. It can even be a good thing. After all, your child wouldnt think twice about running into oncoming traffic or jumping off a cliff if they didnt have a little fear. Fear is meant to keep them safe.

But sometimes, children can be scared of objects or situations that don’t actually pose a threatfor example, a fear of public speaking or monsters lurking under their bed. This anxiety can prevent them from doing things they’d like to do .

The way you respond to your childs anxiety will make a big difference in how they learn to cope with anxious feelings. Below are eight strategies that can help an anxious child learn to deal with their uncomfortable feelings.

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Social Anxiety Can Be Common For Kids And Teens

Social anxiety disorder is extreme worry about being rejected or judged negatively by others. Many situations might cause someone with social anxiety to feel anxious .

A school-aged child might not notice that they are socially anxious until middle or high school when they start to become more anxious. In fact, 7% of youth are affected by a social anxiety disorder, with relatively higher rates found in adolescents. That means that in a class of 25 students, 1 to 2 youths may have symptoms of social anxiety that interfere with their daily life.

Sometimes children worry that other kids will look at them funny or be left out, but when these worries become frequent, long-lasting and more intense, these worries can begin to impair a childs daily functioning, says Dr. Kwan.

Avoidance Is Not The Answer

You cant promise your child an anxiety-free life. Anxiety is a natural part of life that sometimes helps us make good decisions, like avoiding danger or pushing us to work harder.

But when it gets too strong, anxiety inhibits us from living our lives.

So, if you remove everything that makes your child unhappy, youll only make your child feel better in the short term. Instead, you should help your child learn to function through the anxiety, and well talk more about that below.

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Dont Reinforce The Childs Fears

What you dont want to do is be saying, with your tone of voice or body language: Maybe this is something that you should be afraid of. Lets say a child has had a negative experience with a dog. Next time theyre around a dog, you might be anxious about how they will respond, and you might unintentionally send a message that they should, indeed, be worried.

How Not To Reassure

The nervous child turns minor worries into giant fears, out of proportion to the situation. Dismissing the fear with Theres nothing to be afraid of doesnt comfort them.

Trapped in a process they cant control, these kids cant see reality. They have a picture in their head that frightens and disturbs them. Facts and logic dont help them to deal with these feelings.

Just avoiding the cause of the worry doesnt help, either. Letting a child play alone in his room because he fears the big dog he met in the park last week wont help him overcome his fear.

The best kind of reassurance helps your anxious child learn to examine and dismiss their fear for themselves. To do that, its essential to look closely at the reason for your childs anxiety.

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Dont Ask Leading Questions Do Think It Through

While this may seem contradictory, asking leading questions can often continue the anxiety cycle. It is better to ask open-ended questions or talk worries through with your child as this allows them to still talk about their feelings without giving power and control to the fear.

For example, instead of asking, Are you anxious about failing your test? Try to instead ask them how they are feeling about the test or even how they are feeling in general. Here, they are in control of their feelings.

Another great way to take power away from anxiety is to think things through.

For example, if your child is afraid that a stranger might be sent to pick them up, you can ask your child that if this does happen, they can express their fears of abandonment.

You can then both work together to come up with a solution like having a special code to give anyone that picks the child up, taking away the risk and fear. Here, having a plan is a way for your child to reduce uncertainty effectively.

Express Positive But Realistic Expectations

You cant promise a child that their fears are unrealisticthat they wont fail a test, that theyll have fun ice skating, or that another child wont laugh at them during show & tell. But you can express confidence that theyre going to be okay, that they will be able to manage it. And you can let them know that as they face those fears, the anxiety level will drop over time. This gives them confidence that your expectations are realistic, and that youre not going to ask them to do something they cant handle.

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Common Symptoms Of Anxiety In Children

Thumping heart, rapid breathing, sweating, tense muscles, nausea, and dread are familiar symptoms of anxiety that accompany a fight, flight, or freeze reaction triggered by real or imagined threats, like a snarling dog or new social experience. Anxious children may be clingy, startle easily, cry or have tantrums, sleep poorly, and have headaches or stomachaches.

But anxiety is not all bad. It can motivate us, or help us avoid danger, says Dr. Mona Potter, medical director of McLean Anxiety Mastery Program and McLean Child and Adolescent Outpatient Services. The problem is when anxiety gets out of hand and makes decisions for us that are no longer helpful maybe even paralyzing. By that point, normal anxiety may have become an anxiety disorder.

How To Help A Child With An Anxiety Disorder

When worrying gets in the way of a childs functioning, parents need to get help rather than arranging the childs life to avoid the occasions of anxiety.

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By Perri Klass, M.D.

Anxiety disorders, the most common mental health problems in children and adolescents, often go untreated while children suffer, even though there are effective treatments available, according to a new report on anxiety in children and adolescents from the Child Mind Institute in New York. Anxiety may be missed because it doesnt necessarily declare itself with attention-getting disruptive behaviors in fact, symptoms may keep some children quiet and inhibited, though in other children, alternatively, anxiety may be misunderstood as oppositional behavior.

Kathleen Merikangas, the senior investigator and chief of the Genetic Epidemiology Research Branch at the National Institute of Mental Health, said, To me, anxiety is one of the most underrecognized or under-treated conditions of childhood and adolescence. These children can get missed, she said, because they may seem to be functioning well many dont have the kinds of developmental problems or attention issues that draw attention in school, though they may be suffering.

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Q What Are The Common Types Of Anxiety Disorders In Children

Anxiety comes in different types. When the specific type of anxiety is correctly diagnosed, the treatment plan can be more refined.

The most common types of anxiety in children include:

• Generalized anxiety, or excessive and consuming fear of worry without a known trigger.
• , or extreme distress when removed from attachment figures or home.
• Illness anxiety, or preoccupation with illness or excessive health monitoring.
• Social anxiety, or fear induced in situations with peers.
• Specific phobias, or irrational fear of specific events, situations or objects like flying, heights or vomiting.
• Agoraphobia, or fear of public spaces such as public transportation, parks or outside the home.
• Panic Disorder, or worries that cause intense physical symptoms or panic attacks.
• Selective Mutism, or failure to speak when socially expected to.

Each of these anxiety types is well-described in an evidence-based diagnostic manual used by mental health professionals, commonly known as the DSM-5. In general, each diagnosis is reached after weeks to months of persistent symptoms and/or when the worry or fear is significantly interfering with other life events. Look to your pediatrician or pediatric mental health specialist for diagnostic details.

Consult a Pediatrician

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Signs And Symptoms Of Social Anxiety Disorder

Just because you occasionally get nervous in social situations doesnt mean you have social anxiety disorder or social phobia. Many people feel shy or self-conscious on occasion, yet it doesnt get in the way of their everyday functioning. Social anxiety disorder, on the other hand, does interfere with your normal routine and causes tremendous distress.

For example, its perfectly normal to get the jitters before giving a speech. But if you have social anxiety, you might worry for weeks ahead of time, call in sick to get out of it, or start shaking so bad during the speech that you can hardly speak.

Emotional signs and symptoms of social anxiety disorder:

• Excessive self-consciousness and anxiety in everyday social situations
• Intense worry for days, weeks, or even months before an upcoming social situation
• Extreme fear of being watched or judged by others, especially people you dont know
• Fear that youll act in ways that will embarrass or humiliate yourself
• Fear that others will notice that youre nervous

Physical signs and symptoms:

• Avoiding social situations to a degree that limits your activities or disrupts your life
• Staying quiet or hiding in the background in order to escape notice and embarrassment
• A need to always bring a buddy along with you wherever you go
• Drinking before social situations in order to soothe your nerves

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What Are Some Signs That My Child May Have Separation Anxiety

Its usually easy to spot: Do you get lots of tears at daycare drop off? Thats one sign. Some others include:

• Becoming more clingy when you leave them
• Crying or clinging in new situations
• Refusing to go to sleep without you or another caregiver nearby
• Beginning to cry at night after being able to sleep through the night

Keep in mind that it is completely natural for your baby or toddler to feel anxious without you by their side. Make sure to treat them gently and with compassion.

Treatment For Childhood Anxiety Disorders

If you suspect your child has a disorder, the first step is to see a trained therapist who will take a full history, talk with and ask questions of the parents, family members, and the child about the fears and behavior. The therapist can diagnosis the childs specific anxiety disorder based on the information collected through these interviews.

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Tips For Managing Social Anxiety When Giving A Public Speech Or Performance

Lets say you are thinking about a presentation you have coming up. You become increasingly anxious. Try to identify the specific thoughts that make you nervous. In other words, what are you telling yourself could happen that makes you feel anxious?

You could be afraid that:

• You will forget what you plan to say while speaking.

• You will trip as you walk to the microphone.

• Other people will think you sound stupid.

• The audience will laugh at you.

• You will pass out while everyone is watching you.

• You will get sick in public.

All of these thoughts have unwanted outcomes. To change negative beliefs, you want to look for contrary evidence. This is evidence that suggests that your fears might not be entirely accurate.

Heres how you can look for new evidence. Begin by asking yourself:

• Have I gotten sick in public before?

• Would people be compassionate toward me if something did go wrong?

• What is the worst thing that could happen if I forget what I plan to say?

• Is it possible that other people also forget what they were supposed to say when theyre nervous?

• What makes me think I will sound stupid?

• Do my friends usually say I sound silly?

• Is it possible that I dont sound ridiculous?

• How would I treat someone else who is nervous about public speaking?

• What advice would I give to a friend who was in my position?

There is a good chance that you have something worthwhile to say. It is likely that you wont trip walking up to speak. But if you do, people will probably be sympathetic.