Anxiety disorders in children

An anxious kid’s days are dominated by tension and “what if?” thinking. Here’s how to help a child who’s struggling with an anxiety disorder.

anxiety disorders in children

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It’s a maddening Tuesday morning, with our grab-the-lunches-coats-and-backpacks, hustle-them-out-the-door routine in full swing, when I notice that one of my two daughters has disappeared. Ten minutes tick by as I search for Payton, who’s 10, before I find her hiding in the closet, crying. When she first started avoiding school, around age six, I thought it was a game. Headaches and stomach aches came first, but hiding in the closet was clearly an escalation in her anxious behaviour. I check my watch. There will be late slips again today for both my girls. How will I explain this at the office?

Many children can manage a healthy bit of anxiety in life, but for others, like Payton, it becomes a force that interferes with development. I see her anxiety as an invisible opponent — a mental illness that creates paralyzing physical symptoms. She’s more than a worrywart. When Payton complains of an upset tummy or feels headachy, she is literally sick with worry.

The onset of clinical anxiety is typically around six years old, usually at the same time children start school full-time; symptoms can escalate around age 10. Generalized anxiety disorder (or GAD) affects about three to five percent of youth and often occurs with one or more of the other types of anxiety (such as separation anxiety, obsessive-compulsive disorder, or social anxiety). More girls than boys struggle with anxiety disorders. Payton and I characterize her anxiety a “worry bully,” who sits in the corner and is always telling her to expect the worst. But the good news is that today we have a better understanding of children’s anxiety than we have ever had before, and there are ways to help our children wrestle it into submission.

Read more: 5 ways to beat back-to-school anxiety>

What is an anxiety disorder?
Essentially, it’s any worry that’s out of control. But adults, including specialists, teachers and doctors, often misread children’s anxiety as a learning disorder, depression or attention deficit hyperactivity disorder (ADHD). A study published in the Journal of the American Academy of Child and Adolescent Psychiatry in October 2010 identified anxiety as the most common adolescent mental disorder, with more than 30 percent of the 10,000 adolescents surveyed meeting diagnostic criteria. (Nineteen percent had experienced behaviour disorders; 14 percent had experienced mood disorders.) Children with anxiety can appear oppositional or irritable, because they are so distracted by worries. They can be explosive, moody or tearful.

Here’s what anxiety can look like. Jack, 10, is a sensitive child attending a French first-language school in Kitchener, Ont. Recently, private assessments confirmed he is gifted. Last year, his mom, a teacher, celebrated the final day of school before the summer break. But her son couldn’t. He furrowed his brow, started wringing his hands, and hunched his shoulders. When she asked why he wasn’t excited about summer, he answered, “In two months I still have to come back.”

Meghan is a mother of seven-year-old twins. Her son has autism, and she’s seeking an anxiety disorder diagnosis for her daughter, who finds change stressful, has trouble getting to sleep, and has an intense need to know what to expect next. After a change in a daily routine — like a rescheduled, midday doctor’s appointment — her daughter peppers her with questions. “So what time are you coming again? When is that? What if I’m in gym class? What if I’m at recess? How will you find me then? What if the car breaks down? What if we get out early? What if you forget?” Meghan says parenting her daughter requires extreme patience. “I have to sit down with her and address each and every one of her concerns. It could be two or three questions, or it could take 45 minutes. You never know.”

Read more: New study: childhood shyness linked to adult anxiety>

Nine-year-old Jasmine has stomach aches every day before school starts. She tells her mom that her head often hurts, too. She can’t bring herself to eat lunch in front of the other children, and although she’s a straight-A student, she never raises her hand to speak in class. If she is called on by the teacher, her heart beats too fast, she gets knots in her stomach, her face flushes, her hands sweat, and she thinks she will faint. Her mother fields calls from the school secretary every week, reporting that her daughter is sick and wants to go home. But Jasmine never has a temperature and nothing irregular shows up in checkups or on X-rays.

Lynn Miller, president of the Anxiety Disorders Association of Canada, and an associate professor of educational and counselling psychology at the University of British Columbia, says it’s possible to find children who have an anxiety disorder as young as age four. “These children are often very intuitive, very sensitive and clever,” she says. “Most are also people pleasers. ” Like both Jasmine and Payton, Miller says the youngest children also frequently experience anxiety as tummy aches.

“It’s a typical response to a perceived threat,” she explains. This is rooted in biology and survival skills: An anxious feeling triggers the stomach to respond physically, making a child feel as if they need to vomit or defecate. Their bodies respond as if in survival mode.

Of course, a healthy dose of anxiety is normal. If we never felt any anxiety, we might not achieve things such as running a marathon, acing a test or delivering a dynamite presentation. Increased adrenaline can propel your healthy anxiety into a gold medal performance. But adrenaline in the bloodstream also causes the body to release cortisol. (Both adrenaline and cortisol are crucial to the fight-or-flight response.) Cortisol affects neurotransmitters in the brain, which are used by brain cells to carry information, and the disruption may cause confused thinking or disorganized behaviours. In children, anxiety that interferes with a child’s everyday living in one of the three domains — at school, at home or with friends — is a disorder needing treatment. The day Payton hid in her closet to avoid going to school was, to us, a clear signal she needed more help.

How to treat it
The key to helping a child thrive is early intervention. After an anxiety disorder diagnosis, Miller says even very young children can participate in their own treatment. When Payton was first diagnosed at age six, we tried multiple approaches. Art therapy and play therapy each had a turn, but they seemed limited. When we inquired about cognitive behavioural therapy (or CBT), a therapy aimed at teaching a patient how to change behaviour patterns, the standard reply was that it couldn’t be used before age 10 or 11. Miller disagrees, and recommends CBT as the first line of treatment — it can be adapted to work for patients as young as four. The Canadian Psychiatric Association and the Canadian Medical Association also support CBT as the first course of action.

Relaxation techniques, meditation, deep breathing and calm music at various times throughout the day can also help ease tension. Having a clear road map or blueprint of the day can help anxious children feel less stressed. For visual learners, it may be in the form of a pictogram schedule; for others, it is simply a verbal rundown of what to expect. With Payton, we have also used deep breathing techniques and relaxation CDs produced by Lori Lite, a mom and owner of Stress Free Kids. Her company makes books, lesson plans and CDs with soothing music, which my daughter listens to at bedtime. It helps her shut out the noises in her room and the worries racing in her head. Lite’s deep breathing techniques have helped both of our kids, and we use them at any time in the day when they’re feeling or acting overstimulated. (The technique is simple: Put your hand on your tummy and feel it going in and out, while breathing through the nose.)

Read more: Kids’ health: What’s in a label?>

Positive statements are another one of Lite’s favourite go-to tools. “Positive self-talk can reduce anxiety in minutes. Negative self-talk can increase it just as fast,” she says. (Negative self-talk is the inner critic in a child’s head: “I’m stupid. I can’t do this. I stink at math.”) Positive mantras developed by, or with, the child and repeated throughout the day can help override worry. It can be as simple as: “I can do math. I am good at it.” I’ve found it helps to get to know what triggers my daughter’s anxious thoughts.

Changes in routine, school work that isn’t perfect, airports, emergency drills at school — these all stress her out. Payton is also not a child who can function overtired or hungry. Some other treatments for children’s anxiety disorders include controlled exposure (which is repeated, gradual and planned exposure to the thing or event that the child is anxious about), and improving sleep-management skills with meditation or yoga.

Medication may be necessary if nothing else is breaking the pattern of anxious behaviour. After several years of trying to help Payton tackle her “worry bullies,” the day she hid in the closet I knew we had to start talking about medication. Our family doctor referred us to a child psychiatrist, who ran a series of assessments to determine a diagnosis. (A psychologist can also assess for anxiety, but they can’t prescribe medication.) After Payton told the psychiatrist she felt worried at least 45 percent of her day, and described the panic attacks she had every day before school, we decided on a combination of continued CBT, talk therapy and medication. A brief course of an antidepressant such as Prozac or Luvox is safe for children, we learned.

Family matters
In families with an anxious child, parents may feel as if they have to walk on eggshells. (I sometimes liken the experience to living with a pint-sized powder keg.) But that approach doesn’t do an anxious child any good; anxiety can feed itself if you dwell on it or give it too much attention.

Anxiety often runs in families, so if you suspect your child may be suffering from it, it may be a good time to assess your own anxiety levels and coping techniques. Other family members may need management strategies. In my family, our children are both adopted, and neither my husband nor I have anxiety disorders. (Most experts and doctors we’ve seen surmise that Payton’s anxiety is something she inherited from her biological family.)

This year, Payton is 11, and in grade six. She’s a typical tween, and happy about school again. In the spring, our family doctor will start to stagger her off the medicine to see if she just needed a short-term bridge. For a few years, a part of my daughter seemed broken, and we tried to treat it a million different ways. None seemed to work for very long. But now, we’re seeing her make friends and her confidence is flourishing. I know generalized anxiety disorder will always be in Payton’s life, but it no longer holds her prisoner.

This story originally appeared in our November 2012 issue with the headline “Worried sick” (p.40).

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33 comments on “Anxiety disorders in children

  1. Pingback: ADHD: To medicate or not to medicate? - Today's Parent

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  3. I have a 8 year old daughter who has been having anixety a lot. We just started seeing a therapist. She won’t tell us why she’s getting these. I feel sometimes it’s for attention. She would always complain about a stomach ache, headache before school. Can someone please give me some advise? Thank you.



    • Maybe it’s the lifestyle your subjecting him to..shrugging it off as attention seeking while paying a therapist is should parent..obviously they need inspiration and help from you the say they seek attention but out of concern you step aside for a therapist ..what have you done to your fullest ability?


    • I had the same thoughts but our therapist assured us that these fears are real to our children, and while it is frustrating, we parents have to do our best to come up with coping strategies and take these concerns seriously. When the child knows you are listening to their concerns, then hopefully they will open up to what is bothering them so you can deal with that as best as you can.


  4. Normally I would never post but I am lost as to what I should do with my 6 year old son. He worries about everything. He worries about hurricanes and tornados (we live in the desert where these things don’t happen!). His new thing within the last month is he thinks he’s gonna be sick all the time and that his stomach hurts or has “pains” and “cramps”. Took him to the dr and they found nothing, nothing on an X-ray… Nothing to explain the random pains. The family had a bad stomach flu over a month ago and ever since he was sick he now thinks he’s always going to get sick! It’s to the point where it’s interfering with his every day life, not sure what to do or who to call? I’m lost.


    • Maybe the news you subject him to (with hurricanes tornadoes..etc) scares need to educate him on the matter and talk to him about his worries..maybe home schooling if public school is causing so much everything in your power instead of subjecting to x rays and hard at nurturing mentally and physically..stop running to “professionals” who will only finally sell you drugs..there are many healthy exercises out there for the mind you can try but it takes your assertive effort not everyone else’s. ..take care of your child to your fullest ability


      • Hey Jeremy, Do you have kids? Have you ever suffered a panic attack? Clearly you have not, It does not matter what they are hearing in the news or lifestyle, it will happen anyway, if there is nothing they hear, they will invent things.



    • My five year old daughter has these symptoms, but she was also diagnosed with sleep apnea a few months ago. I am a Dental Hygienist and work for a Dr that treats TMJ and sleep breathing disorders. In reading this article, there are a number of statements about poor quality sleep. With my knowledge of sleep apnea and the flood of symptoms that come with it, I am confident her stomach aches and anxiety about school are strongly associated with the sleep apnea. Push your pediatrician to have a sleep study. The American Academy of Pediatrics guidelines states that all children who snore should be screened for sleep disordered breathing. I will be treating my daughter with orthodontics to expand her palate and help develop a proper airway along with changing her diet to a deflamed diet by eliminating gluten and dairy.


      • I find it interesting that you felt that you needed to include the fact that your daughter is adopted and this anxiety must have come from her biological parents because you and your husband don’t have anxiety disorders. Hmm?????


  5. My husband has 1/2 custody of his two boys; ages 8 and 10. The 10 year old suffers from anxiety. He chews fingernails off , asks 100 questions if there is a change in any aspect of his life, forces himself to throw up to get out of going to school and so on.


    • Both you and your husband’s life choices has effected your childs


      • Jeremy…you certainly seem to act as if you have the answers and prescriptions for everyone’s child’s concern. Why and what puts you in the enviable position of having all of the answers?


        • Walter,
          I was thinking the same thing.


          • I’ve got five kids. Three are the I-can-pat-myself-on-the-back-because-I’m-so-great-at-this-parenting-thing, but two of those five are anxious (probably going to need further help) and are nothing like the other three. According to Jeremy, I must be screwing two of them up (even though we haven’t sought treatment yet) and I need to apply myself more. lol
            I’m going out on a limb and guessing that Jeremy’s parents were the “run to the doctor but change nothing about parenting” type of parents. Did they expect a pill to be the answer to “their” problems? Remember that your experiences in life are not what everyone else is also experiencing. Or we could be going through the same experience, but our perception is very different.
            Regardless, there wasn’t enough information in these posts to make the assumptions that you made.

          • Jermey is just trying to get a rise out of you all. Parenting is the hardest thing I’ve done in my life. Give yourselves a break and realize that kids are experiencing so many emotions in their little bodies that they are learning how to cope with. Stay empathetic. I know how trying it is. I have a 6 year old daughter who is worried every day and I’m struggling to ease her pain and worries. One minute at a time they will get through this and we will too.

        • Agreed.


  6. Great article, and the tips are super helpful, even for kids who may suffer from less severe anxiety.


  7. Every time I hear about mental illness in children, I ask what is the cause? Its obviously related to their brain and, as this article states, high cortisol levels. How many of these affected parents let their children cry-it-out or put them through sleep training as an infant? Curious, is there a correlation since crying increases cortisol levels in the infant’s brain and for this to take place during a critical stage of brain development?


  8. I never comment but with this topic I have lots of experience ! Anxiety is a results of something happening PHYSICALLY as well as mentally . Im confused why this article does not address this side….almost all these sweet children complain about tummy issues….what about food allergies…hormone imbalances such as thyroid ….to much processed foods…the digestive system is a direct link to how we feel emotionally .I discovered this after I would have anxiety attacks after consuming caffeine and sugar. Take your children to a trusted pediatrician have a full physical including bloodwork.It changed our lives and it can changes yours too..don’t give up!!!!


    • Gluten is also a hidden culprit of anxiety in children, but can often go undiagnosed or misdiagnosed in children. The body’s response to the gluten that it cannot tolerate can take many forms, one of which is anxiety and behavior changes.


  9. When you say that someone is a ‘typical tween’ you belittle them. If a child said ‘you’re a typical adult’ you’d think that they sounded ungrateful or naive to you. So you sound the same for using that term about a child.


  10. My 10 year old son had issues with anxiety when he was 8 yrs old and now again in 5th grade. He complains of his stomach hurting and sometimes a headache. As a family we are focused on positive talk, minimizing conflict and spending quality time together. I am focusing on making sure his diet is appropriate and that we do not change his every day life and give in to the anxiety. A positive attitude chart has helped for daily activities that he struggles with. After 50 checks he will get a reward. If anyone has any more ideas for experiences please share. This is a family altering experience for sure. This week I am going to try prayer/meditation time with him before bed.


  11. Children have the same emotions and problems as adults do. They haven’t built up defense mechanisms yet, so it comes out in crying, hiding, holding on to a parent not wanting to let go, stomach aches, headaches, I don’t feel well. Listen to them. Talk to them. Seek therapy in severe cases. I wouldn’t suggest medication, but that’s just me. We’re parents first and foremost, our job is to raise our children to be healthy adults, capable of caring for themselves. It isn’t easy, we aren’t supermen and superwomen. Schools usually have psychologists, if reading and talking about anxiety and panic attacks doesn’t work (give it some time but make sure your children know these are normal feelings, it’s what we do with them to overcome them) then consult with your schools psychologist. Don’t give up, your children need you. Don’t give in either, keeping them out of school is one of the worse things you can do, that tells a child that running from their problems is ok. Obviously you can’t leave them while they’re having a meltdown either. My daughter thinks the worse when we drop her off at school, but only on Mondays. She’s almost 9 and this recently started. I had terrible anxiety as a kid, I was neglected but who wasn’t back in the 60’s and 70’s? Maybe anxiety is inherited? Maybe anxiety is normal and in some of us it’s just bigger? Talk yo your children. Seek help professionally. Just my opinion. We’re all in this together good luck


  12. I agree. Its sad that Jeremy should put down parents who obviously care about their children and want to do the right thing by them. I love my daughter but that did not prevent anxiety for her. I’m trying my best and will love her and continue to provide all the support she needs to get her through. So many parents are trying so hard and its imperative we support each other. Jeremy, as for your thoughtless and arrogant posts ? I think you need to fund another website to post on.


  13. My seven year old has been displaying almost every behavior mentioned above. We feel helpless. She starts therapy next week and we are praying for some peace for her. It is good to see that there is some light at the end of the tunnel. Has your daughters doctor told you if this would always stay with her? I do worry about how this will play a roll in my daughters life as she develops.


  14. This was a good article in terms of highlighting some natural remedies to this rampant problem. However, I tend to agree with Jeremy because I believe certain medications should be avoided, especially in kids. Everyone should watch the the documentary from 2008- Generation Rx. I’m surprised it’s not mentioned, but this is Today’s Parent, I guess. Basically Prozac and meds like it are proven to cause suicidal thoughts and there are casesahown in the film where it has lead to suicide in teens. There are other studies on it also. But I know the struggle. I’ve dealt with anxiety and depression since about age 11 or so, right around the time my parents split, but I’ve had anxiety revolving around school stuff since grade one that I recall. I think parenting and creating that routine and structure and positive self image goes a long way. I am a mom now, and I am concerned with how things will play out for my daughter. she’s two now, and I am hoping I can prevent such behaviours in her life. I urge you not to resort to meds though at such a young age, or in general. There are much better ways to cope.


  15. Thank you for publishing this article!! I have a six year old daughter who has been diagnosed with generalized anxiety disorder. Life is challenging on most days as we navigate our way through the worries. I can relate to so many statements in this article, especially the comment by Jack about worrying about the new year of school two months later. Our family trips are burdened with worry about returning from the minute we leave, or the chance that we may encounter a dog/bee… or forget something. Thanks for making parents like me feel less isolated and alone <3. These are special kids.


  16. Jeremy needs a good pop in the mouth. He’s wrong on so many levels. I have a 12 year old who is getting stronger anxiety attacks. They are even happening in the middle of the night. Sick stomach, head aches, breathing, etc. My husband suffers from anxiety. His suggestions are as follows for the kids…..walk it off, do jumping jacks, exercise in some form to get the serotonin flowing. Also reassurance that the attack will pass, and no one ever dies from an anxiety attack. Positive reassurance, empathy and warm words. It will all get better in a few minutes. Hope this helps some of you out there. I understand what a lot of you are going through.


  17. I started reading this article and then the comments parents were writing. I have a 12 year old 6 grade student who was diagnosed with ADHD two years ago. He is a in the child study program at school. For the past two years he has complained before school about headaches and tummy aches and now it has been happening more often and while in school. We notice that it was normally before he was ready to start a new (harder) assignment. He teachers had mention anxiety. Thoughts?? I had a sleep study test done on him about 4-5 years ago which came back mild and no reason for medication. As most children with ADHD had a hard time falling asleep anyway. He does take medication for the ADHD. I have a call into his pediatrician but just curious as to what kind of test do they perform or what can I do to help him through this? Any answers or help would be appreciated as this is all new to me. I also have another child who is 17 and who is an A/B student so it is NOT our parenting as some people mentioned :)


  18. I definitely feel for all of you. My 11 year old son suffers from an inexplicable phobia that he will throw up at night. He won’t even sleep in his own bed any more (which drives his teenage sisters crazy). One important point to understand is the difference between anxiety, and a phobia. Anxiety is the general fear of change or worry that plagues many of us at some point in our lives, sometimes to the point of dysfunctionality, and of course children can get that too. A phobia on the other hand is an irrational fear about something that is going to happen, and can debilitate the one suffering from it. Obviously, Jeremy’s comments are irrelevant, but I say kudos to any parent who sticks with it, and tries whatever they can to help their own child. There is often not one path to help, but many different ones. Good luck.


  19. I am a family day carer looking after a 3.5 year old girl three days each week. Despite having a Masters in Special Education, I have never come across such anxiety and although I feel we make some progress, it’s easy for her to revert. She asks nonsensical questions all day “I don’t think my mum loves me, I don’t know what my dad does, If I die my mum and dad will be cross, I don’t know what bananas are for …” Her parents think she is not at all anxious, but admit she’s had a difficult time as they’ve coped with her elder brother’s severe epilepsy. Maybe she’s copying mum, maybe she has PTSD. They aren’t willing to seek professional help. I’ve taught her yoga and give her guided meditation on anxieties, deep breathing and lots of talk therapy. Sometimes I indulge her need to talk, sometimes I am strict with her if it’s not a good time. It is so hard to deal with because it manifests in indecisiveness “I don’t want to find work, I don’t want to eat, I don’t want to sit quietly, I don’t know what to, I don’t like to do anything …’ Any ideas would be greatly appreciated.


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