It’s important for adults to be alert for possible signs of anxiety, so they can help children get treatment and support as soon as possible. Specific symptoms or anxiety-related behaviors can vary by the individual, but there are some things that can often be red flags. “Symptoms of anxiety include avoiding the situation that triggers anxiety,” says Dr. Takesha Cooper, assistant clinical professor of psychiatry at the University of California Riverside School of Medicine and a child and adolescent psychiatrist at the Riverside County Department of Mental Health’s Lake Elsinore Family Mental Health Services. “For example, if a child is anxious about being away from a caregiver as in Separation Anxiety Disorder, that child will avoid scenarios in which they have to be apart from their caregiver. They might follow the caregiver through the house, express extreme anxiety or have a tantrum if the caregiver needs to leave.”
Dorfman advises parents to watch out for any significant changes in daily functioning, particularly related to eating, sleeping and general mood. “Parents should be aware of regressions. For example, a child who has been fully toilet trained for over a year suddenly begins having frequent accidents or a child who did not have difficulty with parents’ departure at school drop off, may suddenly resist separations.”
It’s common for anxiety in children to manifest itself in ways that mimic behavior issues or anger management problems. “Children with anxiety often worry about ‘what might happen’ so they might verbalize these worries out loud,” says Cooper. “Some children when anxious can even become agitated and aggressive. This is their fight-or-flight that kicks in and can easily be mistaken for a disruptive behavior disorder, such as oppositional defiant disorder, or a mood disorder, such as bipolar disorder. This is why it’s important to have the child undergo a thorough assessment to understand their triggers and to talk to the child to better understand what is going through their mind before and during these episodes, because it gives us a clue into why they behave the way they do.”
What should you do if your child has anxiety?
“First, take a deep breath and know that anxiety in children is fairly common,” says Snell. “One in ten children are diagnosed with anxiety disorders. Getting your child help will require time, patience, commitment, and collaboration. I strongly suggest you and your child see a qualified mental health professional who is trained to assess your child and partner with you in addressing your child’s anxiety. A professional can help you and your child learn effective tools to decrease your child’s distress, apply the tools, and troubleshoot any issues as well as keep both you and your child motivated while monitoring progress.”
Don’t make them stifle their feelings. “I tell them all feelings are okay but all behavior isn’t,” says Dr. Ashley. “It’s okay to feel whatever they feel. Our culture has created this ideal that in order to be successful we must overcome these feelings.”
Parents need support, too
While the primary concern is the child with anxiety, family members—especially parents—can also benefit from helpful resources. “Parents greatly benefit from education about anxiety and treatment approaches,” says Dorfman. “Parents may contact pediatrician who is likely to be well versed in emotional issues of childhood and can refer the family to a mental health professional. Ideally, the professional will work with parents in addition to the child to educate, provide strategies and resources so that parents may support child with compassion and understanding. Parents may also confer with teachers and may reach out to school social worker or psychologist for resources, support and referrals.”
Treatment options
The traditional approach to treating anxiety was a two-pronged strategy: a combination of medication and therapy. “The two most common forms of treatment are Cognitive Behavioral Therapy (CBT) and Psychodynamic Psychotherapy,” says Dorfman. “Medications which are commonly prescribed are SSRI (selective serotonin reuptake inhibitor) and/or anti-anxiety and sedative medications.”
That’s still the basic foundation recommended by many mental health professionals. However, these days, more medical and mental health practitioners are also incorporating other strategies into their recommended treatment plan, as we’ll describe later.
Therapy
Dorfman says, “The most commonly used treatment approaches for children with anxiety are play therapy, for children under 12 or so; talk therapy; psycho-education (learning about anxiety); cognitive behavioral therapy; and parent guidance. Psychopharmacology—meaning medications like SSRI and anti-anxiety medications—are also effective, particularly when paired with therapy.”
Medication
“Medications can be effective and beneficial,” says Dorfman. “The introduction of medication is largely contingent upon the degree of impairment and the degree to which the anxiety interferes with daily functioning. Often, patients are assessed and engage therapy before medication is introduced, though patients and situations vary significantly. “
“Medication can be an important treatment for anxiety disorders, even in children,” says Cooper. “We consider medication when the anxiety interferes significantly in a child’s ability to function. For example, if a child has severe generalized anxiety disorder and has been unable to attend school for weeks due to the anxiety, it would be helpful to consider adding medication to the treatment plan which should already include psychotherapy. Or a child with Panic Disorder who has intense fear of future panic attacks such that she is unable to leave her home would benefit from a trial of medication to see if it helps her. “
“While these scenarios are severe, children with moderate anxiety can still be good candidates for medication, particularly if they are already receiving therapy but still are symptomatic,” says Cooper. “Oftentimes we see the medication can help children better utilize therapy because they are less anxious and more willing to discuss their anxiety or try anxiety reduction techniques the provider suggests such as exposures which are proven to help reduce anxiety. For mild childhood anxiety, medications should generally not be chosen, given that good cognitive-based therapy by a trained clinician alone is often effective in reducing symptoms.”
Alternative or complementary treatment options
Alternative or complementary treatment options are no longer viewed with the type of skepticism as they were in the past. Even better, these days there is such a wide range of creative (and fun!) alternative treatments that there’s something to fit everyone.
“In the past decade or so, patients have increasingly used various forms of meditation and mindfulness practice,” says Dorfman. “Patients are encouraged to exercise regularly, journal and breathing techniques.”
“I like to find what kids are interested in,” says Ashley. “Getting out in nature, doing art. Take a hike. You have to be in the experience of feeling joy and laughter. That gives the body a message that I am safe and okay. Talk therapy is important and helpful, so I like to combine several forms of therapy. I like to find something they enjoy doing that’s more right-brained, because that’s where the imprint happens. Try to make it as personal and customized as I can.”
Examples of alternative/complementary treatments
Many people are surprised to discover the impressive—and interesting—range of treatment options available to help those with anxiety. Here are just a few examples of therapy types that can be used to treat anxiety.
Surf therapy: the ocean waves have a soothing effect, and the water provides a serene environment that promotes bonding with family members.
Equine therapy: horses can have a calming effect, and caring and guiding the horses gives anxious kids an outlet to focus their energy, providing a positive distraction.
