What is it?

Anxiety means feeling worried, nervous or fearful. We all experience anxiety at times and some anxiety can be helpful. For example, feeling some anxiety before a test, interview or public-speaking can help motivate you to prepare for it.

When someone is threatened or in actual danger, their body has as an alarm system to keep them from harm. It triggers your “flight-fight-freeze” response that helps prepare the body to defend itself. It might have you run from the situation ("flight"), yell or fight back ("fight"), play dead or stay very still ("freeze").

In the absence of immediate danger, our body's 'fight-flight-freeze' response can still get triggered. For example, for some people having to get up and speak in front of a group of people can trigger the body's alarm system in the same way as if there were a real danger.

Anxiety disorders are one of the most common mental health challenges among children.

It's normal for children to have fears as they go through development. For example, many young children are afraid of the dark, afraid of monsters, or have a hard time being away from their parents.

Children and youth often have many more fears than adults, this is normal as they try to make sense of their world. Most childhood fears are normal and go away eventually. It is important to think about age and what is common when considering whether anxiety is becoming a problem. 

What does anxiety look like in children and youth?

Below are some examples of what children and youth may experience when they feel anxious:

• Worried thoughts, often about something bad happening
  • What if Mom doesn't pick me up from school?
  • What if I throw up?
  • Will everyone laugh at me?
• Feelings in the body
  • Racing or pounding heart
  • Shallow or fast breathing, hard to breathe
  • Stomach "butterflies" or stomach aches
  • Headaches
  • Dizziness
  • Tense muscles
• Behaviours
  • Avoiding situations, people or objects, or refusing to go places or do things
  • Seeking a lot of reassurance from parents or others
  • Temper tantrums or meltdowns
  • Crying

When does anxiety become a problem? How do I know if it's an anxiety disorder?

Anxiety becomes a problem when it gets in the way of the child or youth's ability to participate in day to day life. For example, children who are so worried about being away from their parents that they are starting to miss school. Another sign that anxiety is becoming a problem is when a child is experiencing a high level of upset or distress over a period of time. 

Specifically, it is important to think about:

• the amount of anxiety the child is feeling
• the level of anxiety
• how long it's been going on
• how much the anxiety is getting in the way of how they function
• how distressing it is for the child and for the family

When the anxiety happens too often and gets in the way of doing things at home, at school or with friends, it's important to seek help.

Anxiety disorders are one of the most common mental health challenges among children and youth. Anxiety comes in different forms, and often children are anxious about more than one thing. Children with other challenges like learning difficulties or challenges paying attention, among other things, are somewhat more likely to experience anxiety than children without those difficulties.

Types of Anxiety Disorders

There are five types of anxiety disorders in children and youth.

Separation Anxiety Disorder

It's normal for young children to have fears about being left with someone new, but they are usually able to get used to the situation. A child with separation anxiety continues to have a hard time being away from caregivers. For example, for some children even being in a different room in the same home can provoke anxiety. This fear gets in the way of children doing things by themselves when they otherwise would be capable of doing so.

Children with separation anxiety disorder may:

• refuse or avoid going to school
• call many times to be picked up early
• cry and cling to a caregiver
• throw tantrums
• avoid going to bed at night or use delay tactics at bedtime
• avoid play-dates and sleepovers
• refuse to be babysat
• express worries that something bad might happen to the caregiver
• complain of physical symptoms like tummy aches before, during and after separation

Social Anxiety Disorder (or Social Phobia)

Children and youth with social anxiety disorder have a strong fear of embarrassing themselves and of other people thinking badly of them. For example, they may worry about wearing the "wrong clothing" or doing or saying the wrong thing. They can at times feel deeply uncomfortable as if a spotlight is on them or they are the centre of attention, even when that is not the case.

Children and youth with social anxiety disorder may feel deeply uncomfortable when, or avoid completely:

• talking to classmates or adults
• going to social events like birthday parties or school dances
• using the telephone or texting with friends
• giving presentations or talking in front of groups
• eating in public or using public bathrooms
• in more extreme cases, going to school at all

Specific Phobias

Children and youth with specific phobias are scared of certain situations or objects. Their fear is stronger than the actual danger posed by these situations or objects. They try hard to avoid contact with what they fear. They may ask repeated questions, or for excessive reassurance when they have to confront one of the following:

• insects or animals: dogs, spiders, snakes, beetles, bees
• environment: dark, storms, heights, water
• specific situations: transportation (riding in cars, flying in airplanes), enclosed spaces (elevators, tunnels), bridges
• medical or physical: needles, going to the dentist, hospitals, vomiting, choking

Generalized Anxiety Disorder (GAD)

Children and youth with GAD experience frequent worries that are difficult to control. They tend to ask a lot of “what if...” questions and look for a lot of reassurance from others (for example, are you sure I should pick that one? Are you sure my homework is perfect?). People often describe them as “worrywarts.” Rather than having a specific area they fear, children and youth with GAD tend to have worries that span multiple topics. In addition to worry, it is common for children and youth with GAD to have physical symptoms like tense muscles or stomach aches, difficulty falling asleep, and have trouble concentrating when they are worried. Procrastination can also be common as children and youth struggle to do things 'perfectly'. Specific areas of worry tend to be:

• school performance
• doing things perfectly
• what people think of them
• bad things happening (disaster, environmental concerns, disease, war, robbery, accident)
• health or illness (getting cancer, AIDS, the flu)
• safety and well-being of loved ones (family, friends, pets)
• everyday stressors (being on time, what to wear, where to go, family finances)

Panic Disorder

A panic attack is a relatively short, intense feeling of anxiety or dread accompanied by multiple physical symptoms (dizziness, racing hear, shortness of breath, shaking, nausea) and triggering catastrophic thoughts like "I'm going crazy" or "I'm going to die". Sometimes there is a clear trigger for a panic attack (for example, a test, getting a needle). However, children and youth with panic disorder can have panic attacks that seem to come out of nowhere. A key part of panic disorder is a fear of future unexpected panic attacks. Children and youth with panic disorder may feel extreme fear in certain places or situations that they associate with having panic attacks, like crowded places or enclosed spaces such as elevators. This fear, called "agoraphobia", may lead them to avoid those places or situations.

When children and young people experience significant anxiety, this will often impact how families interact with each other on a daily basis. "Family accommodation" refers to the ways in which family members (caregivers, siblings, extended family) may change or adapt their own behaviours as a response to the child or young person's anxiety symptoms.

Family accommodation can take many forms, including:

• providing reassurance
• being constantly available by phone or text
• immediately "rescuing" the child from anxiety-provoking situations
• making major changes to family routines, or minimizing daily responsibilities and expectations.

While most family members accommodate anxiety with very good intentions as a way to reduce the young person's immediate distress, family accommodation can make their anxiety worse over time.

The good news is there are ways to overcome and better manage anxiety so that it doesn't get in the way of life. There are two main treatments that research shows often helps children or youth with an anxiety disorder.

1. Cognitive behavioural therapy (CBT) is a structured type of therapy that focuses on teaching children and families how to:

• Identify and challenge anxious thoughts
• Practice facing scary situations by taking one step at a time
• Promote bravery in their children and change patterns of family accommodation

2. Medications are sometimes a useful component of treating children and youth with anxiety.

Tips to help children with anxiety

• Work towards having regular routines (morning, school, homework, bedtime).
• Try and be clear with your expectations. Implement consequences that are realistic for the child's age.
• Notice your child's feelings and support your child to identify them.
• Model the positive ways you identify your own feelings and solve problems.
• Try and focus on your own calm when your child is anxious.
• Give specific praise and rewards, even for small steps in facing fears
• Plan ahead for times that may be difficult (getting to school, returning to school after breaks) by starting early with small steps towards the goal
• Model and encourage healthy living habits, including:
  • Regular physical activity
  • A healthy and balanced diet
  • Getting a good night’s sleep
  • Stress management and relaxation
  • Healthy relationships
  • Community involvement
  • Social support

Talk to your doctor and get help from a mental health professional by:

• Getting a mental health assessment and support through your local Child and Youth Mental Health team (through a walk-in intake clinic in your community). 
• contacting your Employee Assistance Plan (EAP), if you have this option.
• contacting a private psychologist or counsellor.

Looking for more information on this topic? Connect with a family peer support worker at the Kelty Centre to discover additional resources, learn more about support and treatment options, or just to find a listening ear.