Anxiety is a natural response that alerts people to situations that they find threatening. Anxious feelings are a part of life for kids, teens and adults, but when anxiety is severe, frequent and lasts for months, it requires professional treatment. Dr. Kendra Read, attending psychologist on Seattle Children’s Psychiatry and Behavioral Medicine team, works with kids and teens with anxiety disorders, helping them identify their anxiety triggers and learn how to control their worries and fears.

“Research shows that once anxiety becomes problematic, most kids do not just grow out of it,” said Read. “In fact, left untreated, anxiety can result in problematic long-term consequences that impact academic achievement, employment, substance use, and development of additional psychological disorders, such as depression.”

Normal v. problematic anxiety

It’s common for young children to experience fears, such as fear of being separated from their parents, fear of the dark, fear of dogs or fear of failure in class. Many kids progress through fears like these, and their worries naturally go away as a result of experience. They learn that their parents return to pick them up, monsters don’t show up when the lights are turned off, dogs aren’t all that scary, and it’s not that embarrassing to raise your hand in class and get the answer wrong.

During the tween and teen years, growth and development can be accompanied by intense emotions and declining self-confidence, which may appear as worry and fear. For most adolescents, these emotions tend to smooth out over time. But about 25% of 13- to 18-year-olds have an anxiety disorder, according to the National Institute of Mental Health.

It can be difficult to know when anxiety has become problematic. According to Read, if your child limits experiences because of anxiety, and their worries and fears are keeping them from being happy and successful, it’s problematic and it’s time to seek help from your child’s doctor.

“For some kids, anxiety continues to grow and persist as a ‘false alarm’ in their bodies and minds,” said Read. “Consider the level of distress and amount of impairment your child experiences when they encounter something they fear.”

How children experience and react to anxiety

Children and teens with anxiety disorders may:

  • Be overly fearful in social or performance situations.
  • Have extreme fear about specific objects or situations (flying, shots, bugs).
  • Become very upset when separated from parents or caregivers.
  • Worry a lot about something bad happening to parents or caregivers.
  • Refuse to go to school.
  • Worry excessively about things going on in the world.
  • Have extreme worries after a traumatic experience.
  • Get frightening thoughts or images stuck in their head, causing them to repeat actions, like checking, counting or washing.

When a child experiences anxiety, they may feel tense or sweaty, have a racing heart or have difficulty breathing or sleeping. These feelings can be hard for them to understand, causing them to complain of feeling sick. Headaches and stomachaches are frequent complaints of kids and teens when facing situations that make them anxious.

In order to eliminate these feelings, kids try to avoid the situations that cause them anxiety. The effort to avoid situations may result in a child throwing tantrums, being oppositional or using what Read calls “shock talk” to express how upset they are. She gave the example of a child who wants to avoid school because of social anxiety, yelling “Why don’t you love me?!”

These intense emotions can be difficult for parents to cope with. Some parents respond by helping their child avoid anxiety-producing situations, while others urge their child to just toughen up and get over it. Neither of those methods helps reduce anxiety in the long-term, but therapy with a mental health professional can.

Treatment

Anxiety is treatable and treatment doesn’t have to go on forever. It typically takes four or five months to help kids learn how to control their anxiety rather than letting their anxiety control them.

“Our goal is to help youth learn how to tolerate anxiety in order to do things they need or want to do, even though they feel frightened,” explained Read.

According to Read, the most effective treatment for anxiety disorders is cognitive behavioral therapy (CBT). CBT connects thoughts, feelings and actions, allowing kids to build new skills to cope with the situations that cause them anxiety. The therapy also teaches them how to tolerate the physical symptoms of anxiety, which dissipate with time. This is done through identifying anxiety triggers and gradually exposing the child to their triggers while using “detective thinking” to see if their thoughts are true and if they’re helpful. In some cases, medicine is used along with therapy to help kids with anxiety.

“Common myths I hear are that therapy has to last forever, and that therapy is when you go lay on a couch and talk about your dreams,” said Read. “Instead, therapy is usually short-term, problem-focused, fun and active. For a tween with an intense fear of being judged, we might work our way up to crab-walking in the clinic hallway or asking a staff member a strange question, in an effort to overcome the anxious feeling and see that nothing bad happens when you act silly.”

Tips for parents of kids with anxiety

Read offered the following tips for parents who are helping their child with worries and fears:

  • Be confident in your child’s ability to face anxiety, even when it’s difficult.
  • Encourage your child to gradually tolerate anxiety and function through it.
  • Recognize your child’s bravery with praise and rewards, even when steps are small.
  • Check in with teachers to see if your child is actively participating and turning in homework. Kids with social anxiety may practice avoidance by not talking or raising their hand, and those with extreme worries about failing may not turn in their schoolwork.
  • Model healthy ways to cope with anxiety.
  • Learn more about helping your child with anxiety. Check out Anxiety Disorders Booklist and Resources. In the Seattle area, consider attending ‘Helping Your Anxious Child,’ a nine-session parenting group that provides parents with information, support and parenting practices that are helpful in freeing your child from anxiety.

“Parents are the most powerful people in kids’ lives,” said Read. “They help their children practice the skills learned in therapy. Their positive attention and reinforcement are a big part of their children learning to cope with anxiety.”

Resources