Children may get nervous from time to time, just as adults do. A trip to the doctor’s office or the first day at a new school may cause a child to worry, and that is perfectly natural. For some children, though, what seems like jitters could be something more serious – a condition known as anxiety

What is anxiety?

Anxiety is a reaction by the mind and body when it senses danger or an unfamiliar situation, causing tension, worry, and even physical changes such as increased blood pressure. It is a completely normal part of life and is expected. With anxiety disorders, however, individuals experience recurring and intrusive thoughts that can impact daily life.

How common are anxiety disorders in children?

Anxiety disorders are the most common psychiatric condition in children and adolescents. Some experts estimate as many as one in 12 children in the United States between the ages of three and 17 have an anxiety disorder. For adolescents ages 13 to 18, the National Institute of Mental Health reports as many as one in four (25 percent) have anxiety disorders. 

Signs of anxiety disorder in children

It’s important for parents to be aware of the signs of anxiety disorders in children. The following are the top signs of anxiety in four different categories that children and adolescents may experience.

1. Cognitive: the “thoughts” surrounding anxiety

  • Worry. Kids have all sorts of worry triggers. Tests at school, sports activities, and making friends in new situations can all cause anxiety in kids. Worrying about these situations is normal. “If a child can experience the worry, then move on from it, it's not an issue,” says Michael Walther, PhD, a psychologist at Bradley Hospital's Pediatric Anxiety Research Center (PARC). “However, some individuals may worry excessively, overestimate the likelihood of the threat, and are often unable to let the worry go and move on from those types of situations.” 
  • Difficulty concentrating. When children are consumed with worry about a particular topic, it's difficult to refocus on something new, pay attention in class, or stay engaged in conversation “If you notice your child’s grades suffering, it may not be a learning barrier. Rather, it could be anxiety keeping them from the concentration they need to succeed,” notes Walther.

2. Somatic: The physical and emotional response to anxiety

“If you’ve ever experienced the physical symptoms of being nervous, you know how unsettling it can feel,” Walther says. “For children, the physical symptoms of anxiety may include stomachaches, headaches, and physical fatigue. Emotionally, they may become more irritable or have extreme mood changes.” If you notice instances of these physical signs, it is worth a closer look. 

3. Behavioral: developing new habits

Anxiety can cause children to exhibit some new behaviors. Those include: 

  • Outbursts. Kids who exhibit tantrums, or cry for unknown reasons or with minimal triggers, may be wrestling with anxiety. Very young children may not be able to understand or explain fully why they’re behaving this way.
  • Avoidance. When children or adolescents start to feel worried about things and become anxious, it's natural for them to want to avoid the situation triggering the worry. “Sometimes, this can be obvious, like refusal to attend school or to go to a particular event. Other times, it's a bit more subtle. For example, they may be attending class but don’t participate or raise their hand,” Walther explains.
  • Repetitive Behaviors. In some children anxiety can cause an increase in repetitive behavior. For instance, excessive washing of hands is an example of a behavior that is rooted in anxiety—particularly if they’re very concerned about getting sick. Others may become increasingly worried about various outcomes such as grades or sports performance and may seek out validation more than usual. 

4. Byproducts: when anxiety becomes too much

When anxiety becomes too much for children to handle, there are additional symptoms that can occur, including:

  • loss of appetite 
  • sleeping more or less than usual
  • experiencing panic attack-like symptoms when placed in anxiety-inducing situations

Walther stresses, “Any significant changes in a child’s daily patterns and behaviors should be investigated further.” 

Resources for parents to help a child with anxiety

  • The pediatrician. Parents and caregivers have a great resource already in their pocket: their child’s pediatrician. It’s a perfect place to start, because that primary care provider likely has a baseline from which to assess any new or concerning symptoms. Pediatricians typically work with children from a very young age and know exactly what to look for.
  • School resources. Schools provide options like social workers, guidance counselors, and school psychologists who can help with daily observations of a child’s functioning. “Sometimes, some simple modifications to a child's day-to-day experience can be enough to help a child who is experiencing mild forms of anxiety,” Walther notes.
  • Professional help. A third option is to seek specialized help with an outpatient therapist such as a psychologist, social worker, or licensed mental health counselor. Walther says, “This could be helpful for children who are suffering with more moderate symptoms of anxiety and need additional tools and strategies to cope with what they're experiencing.”

Treating anxiety in children

“If your child's anxious tendencies prevent them from getting out of bed, going to school, or playing and talking with friends, it's time to seek professional help,” Walther comments. 

Walther stresses it is critical to identify and treat clinical anxiety in children as soon as possible. If left untreated, anxiety can worsen and allow other mental health conditions to develop. 

“Understanding the signs of anxiety in children, being aware of changes in your child's behaviors and moods and knowing how to get treatment for them can minimize any future complications and mental health challenges,” Walther says.

Cognitive behavioral therapy for anxiety

Cognitive behavioral therapy (CBT) is a treatment option to help kids manage their symptoms of anxiety. Dr. Walther recommends it for several reasons. “One is that data suggests it is the most effective type of treatment to help kids cope with their symptoms of anxiety. It also helps kids avoid certain triggers that incite anxiety,” says Walther. 

Parents and children can work together with a therapist or counselor to master CBT and manage their anxiety. “If kids are engaging in exposure therapy, if they're learning tools consistent with cognitive behavioral therapy, treatment outcomes are quite good,” he assures.

If your child is exhibiting signs of anxiety, Dr. Walther and the PARC care team at Bradley Hospital can help. Families interested in CBT for anxiety and OCD can call PARC at 401-432-1588 or learn more on our PARC website

Michael R. Walther, PhD

Michael R. Walther, PhD

Dr. Michael Walther is a psychologist at Bradley Hospital and The Warren Alpert Medical School of Brown University.