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Answers to FAQ's About Anxiety in Children and Adolescents

How to recognize the symptoms and teach kids skills for calming their brains

As a School Counselor, one of the most common topics I am consulted on by teachers, administrators, and parents is anxiety. Anxiety disorders are the most common and pervasive mental disorder affecting children and adults in the United States. According to the Anxiety and Depression Association of America, anxiety impacts 1 in every 8 children. With rates this high, it’s important for any adult living or working with young people to have a basic understanding of this health issue.

What follows are my responses to eight of the questions I am most frequently asked about anxiety in young people:

1. What are the symptoms of anxiety in kids? How will I know if my child is experiencing anxiety?

One of the most confounding things about anxiety is the many, many different ways in which it presents. For some kids, anxiety looks like classic symptoms of worry, fearfulness, panic, phobias and social withdrawal. For others, it looks more like avoidance, irritability, or even anger. Some young people manifest their anxiety through compulsive behaviors or physical symptoms such as headaches, stomachaches and/or difficulty sleeping. Still others act out their anxiety through a fearfulness of making mistakes and/or being excessively hard on themselves when they make an error on a test or come up short in a game.

What most people who experience anxiety have in common is an overwhelming sense of unease and emotional discomfort in specific situations, usually triggered by a cascade of negative thoughts.

2. What are some of the most common anxiety triggers or causes for kids?

There are probably as many triggers for anxiety as there are kids who suffer from it, but especially common triggers include:

· Fears of all kinds: animals, insects, bad weather (thunder and lightning), fire, darkness

· Losing or being separated from a loved one

· Academic issues such as making a mistake, failing a test, making a teacher upset

· Social issues such as not being liked, not being included, being picked last

· Getting sick or dying

· Being late

· Being embarrassed or humiliated

Anxious kids often wonder "what if" and imagine extreme negative outcomes (no matter how unlikely) to situations

3. How can I help my child deal with anxiety?

I believe that knowledge is power and so even with very young kids, I like to teach them about what is happening in their brains when they experience anxiety. Kids as young as four and five can benefit from understanding that anxiety (or "worries" as I usually refer to them with children) is something that happens in everyone's brain from time to time. This helps kids to know that they are not alone in their experience of this uncomfortable emotional state,

I teach kids of all ages that our brains have a natural alarm system (known as the limbic system). When we are in a dangerous situation, our ‘alarm’ goes off to keep us safe. Having an alarm in our brain is a really good thing--these alarms keep us safe by letting us know when danger is present. However, sometimes the alarms in our brain get a little over-active and make us think there is danger around, even when danger doesn't exist. This doesn't happen because our brains are broken or bad--it happens because our brains are powerful and active and want to keep us safe.

When we realize that a false alarm has gone off, however, this is the time for us to do one of two things--breathe or move. Scientists have shown us that breathing and movement are the two best ways to turn off the alarm in our brains when it is being over-active.

Once kids understand that anxiety is not "bad" but rather a part of life, I teach them specific strategies for using movement and deep breathing to soothe their brains as needed. It is helpful to talk about and practice these strategies often; children who know how to settle their brains during periods of calm are in the best position to make use of these strategies during moments of anxiety.

Dr. Daniel Siegel’s Hand-Brain Model is my go-to strategy for teaching kids, parents, and professionals about how anxiety impacts the brain. A very helpful 2-minute video can be found here.

4. Aside from breathing and movement, what are other effective ways to help kids calm down?

Below are five quick and easy calming activities that professionals and parents can use with kids:

1. Talking to a trusted adult or friend (This helps kids put language to their emotion and moves them from the part of their brain that is dominated by emotion to the part of their brain that is dominated by logic and reason.)

2. Ask kids to write down or draw what is bothering them on a piece of paper, then allow a trustworthy adult to hold the paper for them. This symbolic gesture of "letting someone else hold on to their worries" can be enormously helpful.

3. Make it a habit to ask kids to rate the intensity of their worry on a scale of 1-10. Over time, kids learn to realistically consider the size of their problem and can develop a differentiated set of skills for managing small worries vs. medium or large ones.

4. Rhythmic sounds and movements have a naturally calming effect on the brain. Engage kids in jumping jacks, tapping on a drum, or playing an instrument to facilitate this calming effect. Singing can also be extremely soothing; without even realizing what that they are engaged in a calming activity, kids naturally regulate their breathing through the act of singing.

5. Mindfulness exercises have been shown to be helpful in calming anxious kids. Most of the things that kids worry about either already occurred (e.g. a friend turned them down for a playdate) or they fear will occur in the future ("I might get hurt," "I might fail a test.") Mindfulness exercises, such as deep breathing, help kids keep their focus on the present moment--which is the only thing they have any control over.

Quick mindfulness breathing exercise:

My go-to way to help elementary school-aged kids practice using their breathing to calm their brain is to give them a colorful pinwheel. I demonstrate for them how to take a deep breath in through my nose, while watching my stomach fill with air. Then, I show them how to breathe out slowly and steadily through my mouth, putting my lips together in such a way as to make the pinwheel spin. I encourage kids to take 3-5 slow, deep breaths with the pinwheel, then to reflect on the calm(er) feeling in their body.

Mindfulness and calming breathing works best when kids practice it over time. Using a pinwheel, a feather, or another fun object to make breathing more interesting for kids is a helpful way to ensure that they stick with the practice of mindfulness over time.

5. I feel stressed out a lot of the time. Could my stress be affecting my kids?

When adults appear stressed, kids tend to sense the tension. When adults seem fearful, kids often get the message that the situation must not be safe. They may think, "If my parent/caregiver/teacher cannot handle this situation, it must really be bad." Kids’ anxiety levels predictably rise when they see their caregivers worry and just as predictably fall back to normal levels when they see their caregivers calmly manage or control a stressful situation.

In practical terms, think about how a toddler's response to falling down usually mirrors his parents' response: if a parent gasps aloud and appears upset, the child usually cries. If the parent remains calm and normalizes the fall, the child most often gets up, brushes himself off, and moves on.

In day to day situations, professionals and parents should avoid freaking out. Maintain calm. Act as if the situation is totally manageable. Kids will take their cues from us. If we keep our cool, kids will learn to do the same in a stressful situation. The reverse is also true.

6. I have always struggled with anxiety. Should I hide my diagnosis from my child or be honest about it?

If a parent suffers from chronic or acute anxiety, hiding or denying their disorder is not helpful. Rather, parents should be role models for their kids in taking an active role in developing coping strategies and skills to manage their anxiety.

7. Do you tend to see the problem of anxiety in kids getting worse or better over the years?

A 2018 study shows that the number of children diagnosed with anxiety has increased in recent years. In my own 20 years of professional work with children and adolescents, I have definitely noted a marked increase in the incidence of anxiety as the chief complaint among young people with whom I work. Whether the prevalence of anxiety is worsening--or whether we are just talking about it more--is a subject of common discussion in mental health provider circles.

The increasing connectedness of young people--through 24/7 access to technology and social media--leaves many kids feeling more isolated and anxious than ever before. Kids are constantly plugged in and experience FOMO (fear of missing out) if they unplug. The resulting lack of downtime in kids' lives gives them very little time to unwind, decompress and just experience boredom--which can be a very relaxing thing!

Many experts also cite the dearth of outdoor, unstructured play time as a catalyst for young people's rising anxiety levels. Play is the work of childhood--it is how kids work through fears and deal with hardships in a safe way. With so many adult-led activities dominating kids' schedules, we have a generation of kids who tend to be less independent and less self-reliant--and thus more anxious when asked or expected to do things on their own.

8. How will I know if my child's anxiety is severe enough to need professional help. What is the tipping point?

Most people experience some level of anxiety from time to time. If you notice changes in your child's eating or sleeping patterns or if they start to withdraw from or avoid activities that they once enjoyed, it may be time to seek professional help. Likewise, when symptoms such as repetitive thoughts, compulsive behaviors, panic attacks, or re-living traumatic memories interferes with a child's ability to function in school or daily living, it is time to consult a professional to help your child gain strategies and skills for managing their anxiety.

Signe Whitson is the Director of Counseling at The Swain School in Allentown, PA and an international educator on bullying prevention, crisis intervention, and other topics related to child and adolescent mental health. She offers trainings for professionals, parents and students. To learn more, visit