Anxiety in Children and Adolescents: Recognising and Helping

Many people think that anxiety in children is a phase or a minor concern. In reality, anxiety can be a significant difficulty for children to face and can impact many areas of their lives. For many children, the effects of anxiety can be profound and long-lasting. Anxiety is one of the most common health concerns in both children and adults and the mental health of children is an important consideration for families, schools and the government. 

With Mental Health UK stating that more than 8 million people in the UK are living with an anxiety disorder at any one time and approximately 50% of all lifetime mental health difficulties start before the middle teens, understanding anxiety in children and adolescents is essential for improving mental health.

Anxiety disorders that begin in childhood and adolescence often persist into adulthood if left untreated. This demonstrates the significant need for intervention during the formative years. As well as the immediate distress caused by anxiety symptoms, these disorders can have extensive consequences on various aspects of a young person’s life. From academic performance to social relationships and overall emotional well-being, untreated anxiety can affect healthy development and future opportunities.

Recognising anxiety in children and adolescents can not only help to address their immediate difficulties but can also help to promote their long-term resilience and improve their outcomes. By providing appropriate support and intervention, young people can be empowered to overcome their challenges and thrive in all aspects of their lives. Today, we will look more closely at childhood anxiety, focusing on the signs of anxiety, exploring contributing factors and discussing strategies for effective intervention and support.

Understanding Childhood Anxiety

Childhood anxiety refers to a broad range of emotional experiences characterised by excessive worry, fear or apprehension that significantly impacts a child’s daily life. Unlike typical childhood fears, which are transient (only last a short time) and are often related to specific situations or objects, anxiety disorders persist over time and can affect multiple aspects of a child’s functioning.

There are several types of anxiety disorders that can affect children and adolescents, including:

• Generalised Anxiety Disorder (GAD)
  Children with GAD experience persistent and excessive worry about a wide range of everyday events or activities, such as academic performance, social interactions, health and what may happen in the future.
• Social Anxiety Disorder
  Children with social anxiety disorder have an intense fear of social situations or performance situations where they may be judged or embarrassed. They may avoid the situations or experience them with extreme distress, leading to social isolation and impairment in academic or extracurricular activities.
• Separation Anxiety Disorder
  Common in younger children, separation anxiety disorder involves excessive fear or worry about separation from attachment figures, such as parents or caregivers. Children may experience distress when anticipating or experiencing separation, leading to clinginess, refusal to attend school or nightmares about separation.
• Specific Phobias
  A phobia occurs when a child develops an irrational fear of specific objects, animals or situations. These fears are excessive and persistent, causing significant distress and avoidance behaviour. Common examples include fear of heights, a specific animal (such as sharks or spiders), needles or storms.
• Selective Mutism
  Selective mutism is an extreme manifestation of social anxiety. It is characterised by an inability to speak in certain environments or when not with a specific person (e.g. a parent). Typically diagnosed during childhood, individuals with selective mutism may refuse to speak in particular social contexts, such as school, nursery or in social settings. Without intervention, selective mutism can contribute to reduced self-esteem, social anxiety, isolation and academic challenges.

It is essential to differentiate between typical childhood fears and worries and anxiety disorders. While it is normal for children to experience occasional fears of the dark, monsters or separation from parents, anxiety disorders involve persistent, excessive worry or fear that significantly impairs daily functioning. Additionally, anxiety disorders often involve physical symptoms, such as headaches, stomach aches or panic attacks, which are less common in typical childhood fears.

Understanding these differences is essential for early recognition and intervention, as untreated childhood anxiety can have detrimental effects on a child’s emotional well-being, academic performance and social relationships. By providing support and appropriate interventions, caregivers can help children overcome their anxiety and thrive in various aspects of their lives.

Recognising the Signs

Anxiety is an individualised condition that can affect children in different ways. However, there are common physical, emotional and behavioural signs that parents, teachers and caregivers should be aware of, including:

Physical Symptoms:

• Feeling shaky.
• Sweating.
• Feeling dizzy or lightheaded.
• Stomach aches.
• Headaches.
• Muscle tension and stiffness.
• Tiredness and fatigue.
• Changes in sleeping patterns or difficulties sleeping.
• Having panic attacks.

Emotional Symptoms:

• Excessive and persistent fear or worry.
• Having negative thoughts.
• Irritability, frustration or mood swings.
• Restlessness or agitation.
• Increased emotional reactivity or sensitivity.
• Crying or other emotional outbursts.
• Having frequent nightmares.

Behavioural Symptoms:

• Avoidance behaviours, for example, avoiding places, situations or activities that trigger the anxiety.
• Fear of being away from a parent or caregiver and becoming excessively clingy.
• Having perfectionist tendencies.
• Difficulties concentrating or focusing.
• Withdrawing from usual activities.
• Changes in eating habits, such as eating more or less than is usual.
• Using the toilet more often.
• Refusing to go to school.

While there may be some overlap in anxiety symptoms in children and adolescents, there are some key differences, for example:

Expression of anxiety:

• Children: Younger children may express anxiety through physical complaints, such as stomach aches, headaches or clinginess. They may also have difficulty verbalising their emotions and may rely on behaviours like temper tantrums or withdrawal.
• Adolescents: Adolescents are more likely to articulate their feelings of anxiety verbally. They may express worries about academic performance, social relationships or future uncertainties. Additionally, adolescents may exhibit more internalised symptoms, such as irritability, mood swings or excessive self-criticism.

Social anxiety:

• Children: Social anxiety in children may manifest as a reluctance to participate in group activities, fear of unfamiliar people or situations or excessive shyness. Children may also struggle with separation anxiety, especially during transitions such as starting school.
• Adolescents: Adolescents with social anxiety may experience heightened self-consciousness in social situations, fear of embarrassment or judgement and avoidance of social interactions or performance situations. Peer relationships become increasingly important during adolescence, amplifying the impact of social anxiety on self-esteem and social functioning.

Academic performance:

• Children: Anxiety in younger children may manifest as reluctance to attend school, difficulty concentrating or avoidance of academic tasks. Fear of failure or making mistakes can contribute to academic underachievement or perfectionistic tendencies.
• Adolescents: Academic stressors become more pronounced during adolescence, with concerns about grades, university admissions and future career prospects. Adolescents with anxiety may experience test anxiety, procrastination or difficulty managing academic responsibilities, which can impact their academic performance and overall well-being.

Risk-taking behaviours:

• Children: Children with anxiety may exhibit cautious behaviours and avoid taking risks or trying new activities due to fear of failure or harm. They may prefer familiar routines and environments where they feel safe and in control.
• Adolescents: In contrast, adolescents may engage in risk-taking behaviours as a way to cope with anxiety or seek relief from distressing emotions. This can include substance use, reckless driving, self-harm or impulsive decision-making, which pose additional challenges for caregivers and schools.

It is essential for parents, teachers and caregivers to pay attention to these signs and symptoms and to communicate openly with children about their feelings and experiences. Early recognition and intervention can help alleviate anxiety symptoms and prevent further impairment in a child’s daily functioning and overall well-being. If concerns persist or significantly impact a child’s life, seeking professional help from a mental health professional experienced in working with children and adolescents is recommended.

Factors Contributing to Childhood Anxiety

Childhood anxiety disorders arise from a complex interplay of genetic, environmental and psychosocial factors that influence a young person’s susceptibility to developing anxiety. Understanding these contributing factors is essential for effective prevention, intervention and support:

• Genetics
  There is evidence to suggest that genetics plays a role in predisposing individuals to anxiety disorders. Children with a family history of anxiety disorders are at a higher risk of developing similar conditions themselves. Specific genetic variations related to neurotransmitter functioning and stress response systems may contribute to heightened vulnerability to anxiety.
• Brain chemistry and biology
  Neurobiological factors, including imbalances in neurotransmitters such as serotonin and gamma-aminobutyric acid (GABA), are implicated in the development of anxiety disorders. Alterations in brain structures and functioning, particularly in regions associated with fear and emotion regulation, may contribute to heightened anxiety responses in children and adolescents.
• Environmental stressors
  Experiencing stressful or traumatic events during childhood can increase the risk of developing anxiety disorders. These stressors may include adverse childhood experiences (ACEs), such as abuse, neglect, parental divorce, family conflict or exposure to violence or natural disasters. Chronic stressors, such as poverty, instability or academic pressure, can also contribute to the development or exacerbation of anxiety symptoms.
• Parenting and family dynamics
  Family environment and parenting practices play an important role in shaping a child’s emotional development and coping mechanisms. Overprotective or controlling parenting styles may prevent children from learning effective coping skills and self-regulation, increasing vulnerability to anxiety. In addition, inconsistent parenting, harsh discipline or family dysfunction can contribute to feelings of insecurity and instability and can worsen anxiety symptoms.
• Social and peer influences
  Peer relationships and social dynamics significantly impact children’s emotional well-being and sense of belonging. Social stressors such as bullying, peer rejection or social comparison can trigger or exacerbate anxiety symptoms in susceptible individuals. Additionally, cultural or societal pressures to conform to certain standards or expectations may contribute to feelings of inadequacy or social anxiety.
• School environment
  Academic stressors, such as excessive homework, standardised testing and performance expectations, can contribute to anxiety in school-aged children and adolescents. High levels of academic pressure, fear of failure or perfectionistic tendencies may lead to heightened anxiety responses and academic underachievement.
• Traumatic experiences
  Children who experience trauma, such as physical or sexual abuse, accidents or witnessing violence, are at increased risk of developing anxiety disorders. Trauma can disrupt normal developmental processes, leading to persistent feelings of fear, hypervigilance and anxiety-related symptoms.

Understanding the multifaceted nature of childhood anxiety is important for preventing and identifying anxiety in young people. By addressing environmental stressors, creating supportive family and social environments and providing early intervention and treatment, young people can develop resilience and coping strategies to help them manage anxiety more effectively.

The Importance of Early Intervention

Approximately 1 in 6 children (aged 5-16) had mental health difficulties in 2020. Early detection and intervention are essential for reducing the impact of childhood anxiety and promoting healthy development. Addressing anxiety symptoms at an early age can have profound benefits for children’s well-being, academic success and long-term mental health.

Some of the benefits of early intervention include:

• Preventing academic impairment
  Untreated anxiety can significantly interfere with a child’s academic performance and learning outcomes. Anxiety-related symptoms such as difficulties concentrating, perfectionism and avoidance behaviours may affect cognitive functioning and academic progress. Early intervention can equip children with coping strategies and support systems to manage anxiety and thrive academically.
• Nurturing social relationships
  Anxiety can disrupt children’s social development and interpersonal relationships. Fear of rejection, social scrutiny or embarrassment may lead to social withdrawal, isolation or avoidance of social situations. Early intervention can help children develop social skills, self-confidence and coping mechanisms to navigate social interactions and build meaningful relationships with peers.
• Preventing long-term mental health issues
  Chronic or untreated anxiety in childhood can have lasting implications for mental health and well-being. Studies indicate that childhood anxiety disorders often persist into adulthood if left unaddressed, increasing the risk of developing other mental health conditions such as depression, substance abuse or personality disorders. Early intervention can interrupt this trajectory and promote resilience, reducing the likelihood of long-term mental health problems.
• Improving coping skills
  Early intervention provides children with the tools and support they need to cope effectively with anxiety and stressors. Cognitive behavioural techniques, relaxation strategies and exposure therapies can help children reframe negative thoughts, manage physiological arousal and confront their fears and anxieties gradually. By learning adaptive coping skills early on, children can build resilience and self-efficacy, which can empower them to navigate future challenges more effectively.
• Improving quality of life
  Anxiety can significantly impact children’s quality of life and affect their sense of well-being, satisfaction and fulfilment. Persistent anxiety symptoms may interfere with everyday activities, hobbies and interests and can limit a child’s opportunities for enjoyment and exploration. Early intervention can restore a child’s confidence, autonomy and enjoyment of life, allowing them to engage fully in activities and pursue their goals and aspirations.

Strategies for Parents and Caregivers

There are many ways that parents and caregivers can support a child or adolescent who has anxiety. For example:

• Open communication:
  – Create a safe and supportive environment where children feel comfortable expressing their feelings and concerns.
  – Listen actively and validate their emotions without judgement. Encourage them to articulate their worries and fears.
  – Use age-appropriate language to explain anxiety and reassure them that it’s okay to feel anxious sometimes.
• Establish routines and predictability:
  – Establish consistent daily routines and rituals to provide structure and stability. Predictability can help reduce uncertainty and anxiety.
  – Plan ahead and communicate any changes or transitions in advance to prepare children for upcoming events or activities.
• Teach coping skills:
  – Teach children relaxation techniques such as deep breathing, progressive muscle relaxation or mindfulness exercises to manage anxiety symptoms.
  – Encourage positive coping strategies such as engaging in hobbies, physical activities or creative outlets to reduce stress and promote relaxation.
• Model healthy coping:
  – Model healthy ways of coping with stress and anxiety in your own behaviour. Demonstrate resilience, problem-solving skills and self-care practices.
  – Avoid expressing excessive worry or anxiety in front of children, as this can worsen their own anxiety.
• Create a safe environment:
  – Create a supportive and nurturing home environment where children feel safe and secure.
  – Minimise exposure to triggers or stressors whenever possible and provide a calm and soothing space for children to retreat to when they feel overwhelmed.
• Promote self-esteem and confidence:
  – Encourage children to set realistic goals and celebrate their achievements, no matter how small.
  – Praise their efforts and strengths and provide positive reinforcement to boost their self-esteem and confidence.
• Seek professional help when needed:
  – Recognise when anxiety symptoms significantly impact a child’s daily functioning or quality of life.
  – Consult with a mental health professional, such as a therapist or counsellor, who specialises in treating childhood anxiety disorders.
  – Explore evidence-based treatments such as cognitive behavioural therapy (CBT) or play therapy to help children develop coping skills and overcome anxiety challenges.
• Involve school and educators:
  – Collaborate with teachers and school staff to create a supportive learning environment for children with anxiety.
  – Share relevant information about your child’s anxiety symptoms, triggers and coping strategies to improve understanding and accommodation in the classroom.

School and Education

Because children and adolescents spend a significant amount of time in the school environment, schools and educators play an important role in identifying anxiety in a child and supporting children with anxiety. Creating an inclusive and supportive classroom environment can make a significant difference in helping children manage anxiety and succeed academically. 

Some ways for teachers to support students with anxiety include:

• Increase awareness and understanding:
  – Educate school staff about the signs and symptoms of anxiety in children, including how it may manifest behaviourally, emotionally and academically.
  – Provide professional development opportunities for teachers to learn about evidence-based strategies for supporting students with anxiety.
• Promote a positive classroom environment:
  – Create a warm, welcoming and inclusive classroom environment where all students feel valued and accepted.
  – Encourage peer support and collaboration and promote empathy, kindness and understanding among classmates.
• Establish predictable routines:
  – Implement consistent daily routines and schedules to provide structure and predictability for students with anxiety.
  – Clearly communicate expectations and upcoming events to help reduce uncertainty and anxiety.
• Provide a safe space:
  – Designate a quiet, calm and comfortable area in the classroom where students can take a break or practise relaxation techniques when feeling overwhelmed.
  – Ensure that this space is readily accessible and free from distractions.
• Offer flexibility and adjustments:
  – Be flexible and understanding of students’ individual needs and preferences, including their preferred learning styles and sensory sensitivities.
  – Provide adjustments such as extended time on assignments, alternative assessment methods or modified classroom seating arrangements to support students with anxiety.
• Encourage self-regulation skills:
  – Teach students relaxation techniques and mindfulness exercises to help them manage stress and anxiety effectively.
  – Incorporate regular opportunities for movement breaks, stretching or deep breathing exercises throughout the school day.
• Promote positive relationships:
  Build trusting relationships with students based on empathy, respect and understanding.
  Offer regular opportunities for one-on-one check-ins with students to discuss their concerns, provide support and reinforce positive coping strategies.
• Collaborate with families:
  – Maintain open communication with parents or caregivers about their child’s anxiety symptoms, triggers and coping strategies.
  – Work collaboratively with families to develop a coordinated approach to supporting the student’s well-being both at school and at home.
• Collaborate with families:
  – Provide social-emotional learning (SEL):
  Incorporate social-emotional learning (SEL) into the curriculum to teach students valuable skills such as self-awareness, emotional regulation and social skills.
  – Include lessons and activities that specifically address anxiety management and coping strategies.

By implementing these strategies and creating a supportive classroom environment, teachers can play an important role in helping children with anxiety feel safe, valued and empowered to succeed academically and emotionally.

Seeking Professional Help

If you think your child may be experiencing anxiety, your first step will be to visit your GP. You can initially choose to speak to your GP with or without your child present. If your GP thinks your child could be experiencing an anxiety disorder, they will likely refer them for an assessment with the Children and Young People’s Mental Health Services (CYPMHS). 

Your child may then be offered treatment. The type of treatment available will depend on the age of your child, the type of anxiety they are experiencing (e.g. social anxiety, generalised anxiety or a phobia), the severity of their anxiety and the initial cause of their anxiety. Some of the common treatment options for children and adolescents with anxiety disorder are:

• Cognitive behavioural therapy (CBT)
  CBT is one of the most popular treatment options for children with anxiety. It focuses on identifying and challenging irrational thoughts and beliefs that contribute to anxiety, as well as teaching children coping skills to manage anxiety symptoms. CBT is a type of talking therapy that helps children replace anxious thoughts, feelings and behaviours with positive, healthy ones. CBT also teaches children relaxation techniques and problem-solving skills.
• Exposure therapy
  For adolescents experiencing a phobia or social anxiety, exposure therapy may be a good treatment option. Exposure therapy involves gradually exposing the adolescent to feared situations or objects in a controlled and supportive environment. Through repeated exposure, children learn to confront their anxiety and manage their thoughts and emotions, which can lead to reduced fear and avoidance.
• Anxiety counselling
  Counselling with an anxiety-approved therapist or counsellor may be recommended to help your child understand their anxiety and what is making them anxious. It provides the child with a safe, confidential space where they can talk about and try to understand their thoughts and emotions.
• Family therapy
  Family therapy involves working with the entire family to address underlying family dynamics, communication patterns and stressors contributing to the child’s anxiety. Family therapy can help improve family relationships, enhance communication and provide support for both the child and their caregivers.
• Medication
  In some cases, medication may be prescribed to alleviate severe anxiety symptoms or co-occurring conditions such as depression or obsessive-compulsive disorder (OCD). Medication is only usually prescribed if other treatment options haven’t worked and the child’s anxiety is severe. Medication will only be prescribed by a doctor who specialises in child and adolescent mental health.
• Supportive interventions
  Supportive interventions such as psychoeducation, stress management techniques and social skills training can complement formal treatment approaches. Providing a supportive and nurturing environment at home and school, as well as encouraging the child or adolescent to participate in extracurricular activities and peer support groups, can also help children manage anxiety and build resilience.
• School-based interventions
  Schools can play a crucial role in supporting children with anxiety by implementing adjustments, providing social-emotional learning (SEL) programmes and offering access to school counsellors or mental health professionals. Educating teachers and school staff about the signs and symptoms of anxiety and implementing strategies to create a supportive and inclusive classroom environment can also benefit children with anxiety disorders.

Reducing Stigma

Reducing stigma surrounding mental health issues in children and adolescents is essential as stigma can prevent people from seeking help and support. When mental health issues are stigmatised, young people may feel ashamed or embarrassed to talk about their experiences or seek support. By reducing stigma, we can create an environment where children and adolescents feel comfortable reaching out for help when they need it.

Stigma can also delay or prevent early intervention for mental health issues in children and adolescents. When mental health concerns are stigmatised, parents, caregivers and educators may be reluctant to acknowledge or address them, which can lead to delayed diagnosis and treatment. Early intervention is essential for preventing mental health difficulties from escalating and promoting positive outcomes. 

Stigma can also create barriers to social support and acceptance for children and adolescents with mental health issues. When mental health conditions are stigmatised, young people may face discrimination, bullying or social isolation from their peers. Reducing stigma can create supportive environments where children and adolescents feel accepted, understood and valued for who they are, regardless of their mental health status.

Reducing stigma can also help to normalise the experiences of young people with anxiety. Mental health challenges are common and normal human experiences that can affect anyone, regardless of age. Reducing stigma can promote the understanding that experiencing mental health difficulties is not a sign of weakness or failure and is nothing to be embarrassed about. Normalising these experiences can help children and adolescents feel less alone and more empowered to seek support and treatment.

Reducing stigma empowers children, adolescents and their families to advocate for their mental health needs and rights. When mental health issues are destigmatised, individuals feel more empowered to speak out, raise awareness and advocate for improved access to mental health services and support. Creating open conversations and empathy can address the systemic barriers and inequalities that contribute to mental health stigma.