Recognizing and diagnosing anxiety disorders in children can be really tricky. There is often a lot of overlap between anxiety, depression, ADHD, and other disruptive behavioral disorders. Anxiety disorders is a broad term that encompasses generalized anxiety disorders, obsessive compulsive disorders, separation anxiety, and phobias (including social anxiety). As you’ll see, so many of the symptoms can fit into lots of different diagnoses.

Anxiety Symptoms

Must be:

Excessively worried and anxious about a number of situations (largely over exaggerated or unrealistic).

May have:

• Guilt
• Fear
• Irritability
• Poor sleep
• Weight loss
• Sleep disturbances
• School problems (including not wanting to go)
• Poor concentration
• Restlessness
• Experience brief panic attacks (with pounding heart, shaking, fear, sweating)

Should you treat anxiety?

If the answer is yes to most or all of these, you should strongly consider treatment for your child.

1. Does the anxiety inhibit your child from normal life functioning (e.g., social interactions, school)?
2. Is the anxiety present more often than not? (Specifically, has it lasted more than 6 months, more than 3-5 times a week, lasts for hours–not just a few seconds or minutes).
3. The anxiety does not have another explanation that needs to be addressed (e.g., substance use/abuse, depression from a major life event like death or divorce).
4. Is there a strong family history of anxiety?

How do I treat anxiety?

The most effective treatments utilize a combination of techniques: behavioral therapies, medications, and counseling,

1. Behavioral therapies: these approaches work on teaching the child to changes his/her thoughts into a more positive context when faced with anxiety provoking situations. The child may learn relaxation strategies, distraction techniques, etc.
2. Medications: Most anxiety disorders are treated with a class of medications called selective serotonin reuptake inhibitors (SSRIs). Interestingly, it is one of the same classes of drugs used to treat depression. Because of the complexity of the brain and the high rate of what are called comorbid conditions (meaning increased likelihood of having more than one mental involvement at a time), your pediatrician may look into treating other things first. For example, I have had patients with both ADHD and anxiety, and we’ve opted to treat the ADHD first. Personally, I don’t like throwing too many things at a kid all at once (it makes monitoring what’s working and side effects very difficult). Sometimes, fixing the biggest problem first, makes the second problem seem nearly insignificant and easy to manage without need for more medications.
3. Counseling: I have seen some parents who have remarkable skills at being able to walk their child through panic attacks and anxiety provoking situations. While some of those parents have innate skills, many learned them through hours of counseling with their child.

What about the “not so bad, but still anxious” kid?

So if you’re reading this and thinking, ‘Yeah, but Dr. Wonnacott, what about my kid that has a tendency to be anxious, but I don’t necessarily want to medicate?’ First look at the grown-ups in your child’s world. Are any of them “high strung” or “anxious?” Is there anything you can do to help relax the grown-up who is influencing the child? Second, look into a number of the behavioral therapies that are used in kids with full-blown anxiety disorders. Even if your child doesn’t meet a complete diagnosis, many of the skills learned there can be utilized as you child encounters stresses as an adult (e.g., deep breathing, mindfulness, relaxation, counting, object focusing, body awareness).

You know your child best, and are best equipped to help him or her. If your child is really struggling, and you’re really worried, talk to your pediatrician. We’re here to help.