What is Anxiety?
Anxiety is a normal, healthy part of life. Anxiety is a typical reaction to stressful situations and alerts us to possible danger. However, when one feels excessive anxiety for several weeks or months and it begins to interfere with daily life, there may be a problem that needs to be addressed.The core symptoms of anxiety are worry, difficulty tolerating uncertainty, an overactive response to perceived threats (including freezing), and avoidance. Some children avoid or become overly afraid of situations or objects that trigger fears, while others react with explosive fear and frustration. That behavior is often misread as anger or opposition. In youth with phobias or social anxiety disorder, their difficulties may be attributed to “shyness,” with few people recognizing the severe distress they experience. Many young people don’t realize that their overwhelming reactions may stem from a disorder that can be treated, rather than from a personal failing.
An anxiety disorder is treatable. With the appropriate treatment and supports, people can learn to reduce and manage the symptoms of an anxiety disorder and function well in their daily lives.
Signs of Anxiety
The following are the major thinking/learning, behavioral, and physical signs of anxiety. Not all children will show all signs or show the same signs to the same degree, but a stable pattern that interferes with performance may be cause for concern.
- Concentration problems
- Memory problems
- Attention problems
- Problem-solving difficulties
- Task avoidance
- Rapid speech
- Lack of participation
- Failing to complete tasks
- Seeking easy tasks
- Stomach discomfort
- Rapid heart rate
- Flushing of the skin
- Muscle tension
- Sleeping problems
Types & Effects of Anxiety Disorders
Anxiety disorders most often start to emerge in early childhood and may persist into adulthood. The frequency of anxiety disorders in boys and girls is about the same during elementary school years, but differences between them emerge in adolescence, with girls being two to three times more likely to develop anxiety disorders. With a 10% frequency rate, a middle school class of 30 students could have as many as three students with an anxiety disorder and perhaps two of them would be girls.
Separation Anxiety Disorder (SAD)
SAD is the only anxiety disorder specific to children and is associated with fears about leaving familiar people, usually parents. In extreme situations, children might refuse to leave their home or not want to stay overnight with a friend. Sometimes, they may refuse to attend school, a pattern often termed "school phobia," although "school refusal" is more accurate. It is not unusual for preschool children to express separation anxiety, but persistent or extreme separation anxiety is atypical for school-aged children and may reflect concerns about family matters, safety, or fears of social rejection.
Generalized Anxiety Disorder (GAD)
GAD is associated with pervasive and high levels of anxiety across a variety of situations with no apparent events that trigger it. It is the most common childhood anxiety disorder and tends to persist to some degree into adulthood. These children often are described as "highstrung" and are often very concerned about doing things well; they may show perfectionist tendencies. The tendency to worry frequently about relatively minor things is a primary defining characteristic of GAD. Children with GAD tend to stay in a relatively high state of physical arousal and often appear stressed much of the time. GAD also tends to be chronic and does not dissipate over time without help, perhaps requiring professional intervention.
Posttraumatic Stress Disorder (PTSD)
PTSD is most often associated with distress as a result of a traumatic situation. The most common types of trauma in children are exposure to violent crime, auto accidents, home fires and injuries, natural disasters, domestic violence, physical and sexual abuse, and serious physical illnesses. Symptoms of PTSD include emotional numbing, avoidance, detachment from others, sleep difficulties, angry outbursts, reliving the experience through stressful memories, flashbacks, and concentration problems. Incidence rates for PTSD symptoms in traumatized children are as high as 20%, and the overall rate in children is about 3%, depending on the circumstances. Girls appear to have higher rates of PTSD than do boys.
Children who have excessive fear and anxiety about being in social situations and being evaluated by others are experiencing social phobia. The fear of social situations is out of proportion to the actual situation, although some children may not be able to identify specific stressors. The typical age of onset is in adolescence or early adulthood, although shyness and social discomfort can be seen as early as 2 or 3 years of age. Typically, onset is gradual without obvious triggering events.
Effects of Anxiety Disorders
On School Performance:
Highly anxious children tend to struggle with various demands of school and to be inattentive, perfectionistic, forgetful, or unwilling to participate due to concerns about failure or embarrassment. They may avoid difficult tasks, seek easy tasks, and not volunteer or readily participate in classroom activities. Because withdrawal is a typical response to avoid feeling anxious, anxious children may be perceived by teachers as unmotivated, lazy, or uninterested in school. In fact, the majority of these children want to do well and be involved, but the motivation to avoid feeling anxious is high.
On Social Performance:
Anxious children tend to withdraw socially to avoid experiencing anxiety, which leads to further problems of fitting in and making and sustaining friendships. Over time, more social problems and deficits may occur, making the situation worse. Avoidance and worry may offer short-term solutions but have cumulative negative effects and provide little long-term relief.
How Parents Can Help With Child Anxiety
Interventions: School & Home-based
- Establish predictable routines
- Set clear and reasonable expectations
- Break tasks into manageable units
- Have specific evaluation criteria
- Provide opportunities for practice and rehearsal
- Pair anxious students with peers who are confident and supportive
- Give special responsibilities
- Give time to relax when anxiety becomes high
- Reduce or avoid unexpected situations
- Avoid punitive and negative attitudes
- Reduce time constraints, if possible
- Move the student to a quiet setting with fewer distractions
- Be consistent in how you handle problems and administer discipline.
- Be patient and be prepared to listen.
- Avoid being overly critical, disparaging, impatient, or cynical.
- Maintain realistic, attainable goals and expectations for your child.
- Do not communicate that perfection is expected.
- Maintain consistent but flexible routines for homework, chores, activities, etc.
- Accept that mistakes are a normal part of growing up and that no one is expected to do everything equally well.
- Praise and reinforce effort, even if success is less than expected. Practice and rehearse upcoming events, such as giving a speech or other performance.
- Teach your child simple strategies to help with anxiety, such as organizing materials and time, developing small scripts of what to do and say to himself or herself when anxiety increases, and learning how to relax under stressful conditions.
- Do not treat feelings, questions, and statements about feeling anxious as silly or unimportant.
- Often, reasoning is not effective in reducing anxiety. Do not criticize your child for not being able to respond to rational approaches.
- Seek outside help if the problem persists and continues to interfere with daily activities.
For Middle and High School
If you are in need of further information, please contact your child's physician or your child's school. For middle or high school students, contact your school's counseling office. For elementary students, contact the school's main office.