When adults hear children or teens complain about anxiety, they often ask themselves: what is there to be anxious about? After all, adults are the ones who handle all the stressful parts of life, like working, paying bills, planning the future, and everything that goes along with being an adult.
However, children and adolescents have anxiety, too. And they can develop anxiety that meets the threshold for clinical diagnosis, as well. The National Association on Mental Illness (NAMI) reports anxiety disorders have one distinguishing feature in common:
“Persistent, excessive fear or worry in situations that are not objectively or inherently dangerous.”
That’s a good description of anxiety about school: in most cases, nothing about school is dangerous. However, nevertheless, children and teens can and do develop real anxiety about school. Data published by the World Health Organization (WHO) shows that around the world:
- Age 10-14: 3.6% report a clinical anxiety diagnosis
- Age 15-19: 4.6% report a clinical anxiety diagnosis
In addition, National Institutes of Health (NIH) and the Centers for Disease Control (CDC), show the following prevalence of a clinical anxiety diagnosis among children and teens:
- Age 3-17: 9.4%
- Age 13-18: 31.9%
- Age 13-14: 31.4%
- Ages 15-16: 32.1%
- Age 17-18: 32.3%
- Females 13-18: 38%
- Males 13-18: 26.1%
- With severe impairment, female and male, age 13-18: 8.3%
That information tells us that each year, millions of kids, adolescents, and young adults experience anxiety that reaches a clinical threshold. If you’re worried your child may have anxiety, it’s important to watch out for three types of symptoms: physical, behavioral, and psychological.
Anxiety Symptoms to Watch for in Children and Teens
Many of the symptoms on the following list are typical, healthy behavior when they happen in isolation, happen every once in a while, or happen once and fade quickly. But when two or more of these symptoms appear every day and last for more than two weeks, then that’s a sign of anxiety that reaches a clinical threshold.
Physical signs of anxiety in children or teens may include:
- Upset stomach
- Dizziness
- Difficulty sleeping
- Racing heart
- Shallow/fast breathing/hyperventilating
- Tremors or shaking
- Excessive sweating
- Excess tension
Behavioral signs of anxiety in children or teens may include:
- Impulsive behavior
- Constantly seeking reassurance
- Extremely excessive talking
- Extremely fast talking
- Repetitive behaviors, often out of context
- Avoiding friends and family
- Extreme of new shyness/timidity in social situation
Psychological signs of anxiety in children or teens may include:
- Extreme reactions to small setbacks
- Extreme/new fear of failure/not doing well enough in school
- Extreme worry about losing control in any situation
- Anger/irritability
- Problems with simple problem solving
- Declining grades
- Problems remembering basic things
- Fixed/rigid thoughts or patterns of thought
If your child or teen shows two or more of those symptoms every day for two weeks or more, we recommend seeking a full mental health and psychiatric evaluation administered by an experienced mental health professional. In the absence of professional treatment and support, symptoms of anxiety can prevent a child or teen from engaging in the essential activities of daily life. Consequences of associated with untreated anxiety may include:
- Problems forming and maintaining relationships
- Withdrawal from friends and family
- Difficulty meeting academic expectations
- Increased risk of alcohol or substance misuse
- Worsening of co-occurring mental health diagnoses
- Suicidal ideation/thoughts of self-harm
That’s why it’s important to learn how to help your child manage anxiety. There are several things you can do to help prevent symptoms from escalating.
How to Help Your Child or Teen Handle Anxiety About School?
It’s common for kids to have anxiety about school. Children or teens of any age can have anxiety, as the statistics above show. They may develop anxiety related to:
- Academics: class work, assignments, homework, and tests
- Social situations: friends and peers
- Sports: Coaches, teammates, personal ability
If you wonder how to best support your child who is experiencing anxiety at school, try these tips:
1. Validate Their Anxiety
Start by validating their feelings. Whatever you think about whether or not they should have anxiety at their age, remember that to them, it’s as real as any emotion or pattern of thought they’ve ever felt. Lead with sentences like, “I understand thinking about the upcoming school year gives you anxiety. I have your back, 100%. We can handle this: I’ll help as much as you need and want me to.”
2. Avoid Downplaying Their Emotions
Be mindful about your attitude toward their anxiety: work hard to convey sincere compassion and understanding. Remind them anxiety and nerves are a common part of life, and it’s possible to find productive ways to process their emotions around the new school year.
3. Establish Helpful Routines
Collaborate with your child or teen to build a daily routine that sets them up to have a great day at school. The routine should be custom-tailored to your family. While most families have the same things to accomplish in the morning – waking, eating, getting ready for school – every family is different. Routines can help reduce anxiety because they’re comforting, consistent, and reliable, which is a good counter to the emotions related to anxiety, which most often originate in fear of the unknown.
When you implement a solid morning routine, it reduces the likelihood of a panic attack that can derail the whole day.
4. Also Validate Social Anxiety
It’s essential to ensure your child or teen knows you’re their safe space and you’ll always be there to listen to whatever is going on in their life. With regards to social situations and social anxiety, it’s often best to ask your child to talk about it/them, and then simply listen. Once the school year starts, they may have specific details to report about friends and situations that trigger them. Again, start by listening, acknowledging, and validating.
Offer advice if they want it. For instance, say, “I hear you. How can I help?” They may ask how you would’ve handled similar situations, or they may just say, “I think I just need a hug.” In either case, do what they ask for. Try to avoid coming off as an expert on their anxiety and avoid offering facile fixes that may sound like empty platitudes. Always work from/toward sincerity and compassion.
5. Teach Them About Negative Comparing
Experts on anxiety identify comparing – especially negative comparing – as a cognitive distortion that occurs frequently among people with anxiety. It happens when a person measures their own appearance, abilities, and overall value against those of another person and then experiences painful or distressing emotions about themselves based on the measurement/comparison.
To help your child or teen with negative comparing, start by reminding them that everyone is different, and everyone has their own set of strengths, including them. Promote individuality and celebrate the unique qualities in each person. If they have a hard time listing their own outstanding characteristics, tell them what you think they are. Teach them that the only thing they need to measure themselves against is their own values, rather than how a peer or influencer looks or talks in carefully constructed social media post that probably took a hundred tries to get looking right.
6. About Instagram, Facebook, TikTok, and All the Others
With regards to social media, we all need to remember that social media is not real daily life: real daily life is real daily life, warts and all. Everyone can look like a rockstar on social media, but that doesn’t mean they actually live a rockstar life, and it definitely doesn’t mean they’re happy and fulfilled in life.
Social media posts are often carefully curated snapshots of the very best parts of a person’s life. And although it’s hard to understand why, sometimes the content is made up and the photos are doctored.
Scratch that: it’s easy to understand why: the posters are chasing likes and followers.
Your role is to teach them that the number of likes a post gets and the number of followers a person has are not a reflection of their value as a person. In the case of peers, they’re simply popularity metrics. In the case of online influencers, most post content to make money: it’s about profit, and may or may not have any connection to reality.
You can best help your child or teen by leaning into the first two bullet points on this list: they need to feel your empathy and compassion, understand you know their anxiety is real, hard to handle, and you have their back no matter what. When you lead with unconditional love and empathy, they feel it, and you increase the chance of a successful outcome.
Treatment for Children and Teens With Anxiety
Research conducted on children and teens with anxiety shows the most effective way to treat anxiety disorders is with a combination of therapy, medication, and lifestyle changes.
Evidence indicates the following approaches may help reduce symptoms of anxiety:
Cognitive-Behavioral Therapy (CBT)
CBT helps teens with anxiety recognize the connection between patterns of thought and patterns of behavior. During CBT, therapists help teen identify unhealthy patterns of thought and replace them with healthy patterns of thought, then help them replace unhealthy patterns of behavior with healthy patterns of behavior.
Dialectical Behavioral Therapy (DBT)
DBT helps teens with anxiety recognize the connection between extreme emotions and behavior. A DBT therapist can help highly reactive teens who get overwhelmed by their anxiety. DBT therapists teach teens to observe their emotions without judgment, then helps them learn to manage extreme emotions and prevent them from dominating their thoughts and behavior.
Exposure Response Prevention Therapy (ERPT)
ERP therapists work with teens to identify their fears and anxieties. Then, in a careful, stepwise manner, they expose teens to the things they identified that cause anxiety. But here’s the important part. During this process, known as habituation, an ERP therapist helps a teen work through their automatic responses until they’re no longer automatic, and no longer cause the extreme emotions and anxiety that disrupt daily life and overall wellbeing.
The two types of medications used to treat anxiety in teens include:
1. Anti-anxiety medication
Anti-anxiety medications, called anxiolytics, reduce activity in brain areas associated with behavior and emotion, thereby temporarily alleviating the symptoms of anxiety.
2. Anti-depressants
Anxiolytics affect chemicals in brain areas related to fear and anxiety, while antidepressants affect chemicals in brain areas related to low mood and depression. Because there’s significant overlap in brain activity associated with depression and anxiety, anti-depressants can help reduce the symptoms of anxiety in some patients.
Lifestyle changes that can help reduce anxiety in children and teens include:
1. Exercise.
Regular exercise or activity, every day, can help reduce symptoms of anxiety.
2. Healthy Eating
A diet high in fruits, vegetables, whole grains and lean meats creates a foundation for total health, whereas a diet high in processed foods, fast food, sugar, and caffeine can impair health and increase symptoms of anxiety.
3. Sleep
Experts advise the following amounts of sleep for kids and teens:
Age 6-12: 9-12 hours per night
Age 13-18: 8-10 hours per night
4. Mindfulness
Teens can learn mindfulness. In fact, mindfulness is an important part of dialectical behavior therapy (DBT), which we describe above, which experts recognize as an effective approach for treating anxiety in highly reactive teens. Mindfulness can help teen manage the symptoms of anxiety at any time and in any place: the skills are both portable and durable, which means they can help teens manage anxiety at home, at school, or in social situations with friends. Once they learn the skills, they’re there, at their disposal, as needed.
Professional Help and Support for Anxiety
At Bay Area Clinical Associates (BACA), we offer professional support for children and teens with anxiety. We’re committed to helping children and teens learn the skills they need to participate in school, extracurricular activities, and social activities with friends. In short, we’re committed to helping children and teens with anxiety learn the skills they need to get back to what’s most important: enjoying life as a child or teenager.
