Anxiety disorders in children

Anxiety disorders in children

It’s normal for children to feel worried or anxious from time to time, like when they’re starting school or nursery, or moving to a new area.

Anxiety is a feeling of unease, like worry or fear. It’s an understandable reaction in children to change or a stressful event.

But for some children, anxiety affects their behaviour and thoughts on a daily basis. This can interfere with their school, home and social life. If your child is anxious for a period of time and it’s impacting on day to day life you may need to speak to a healthcare professional to help support your child. For example, if they feel they cannot go to school or see their friends anymore.

So how do you know when your child’s anxiety has reached this stage?

What are the signs of anxiety in children?

Anxiety can make a child feel scared, panicky, embarrassed or ashamed.

Some of the signs to look out for in your child are:

• finding it hard to concentrate
• not sleeping, or waking in the night
• not eating properly
• quickly getting angry or irritable, and being out of control during outbursts
• constantly worrying or having negative thoughts
• feeling tense and fidgety, or using the toilet often
• always crying
• being clingy all the time (when other children are ok)
• complaining of tummy aches and feeling unwell
• being withdrawn and not wanting to do things they used to enjoy

Your child may not be old enough to recognise why they’re feeling this way.

The reason for the anxiety (if there is one) will differ depending on the age of the child. Separation anxiety is common in younger children. Older children and teenagers tend to worry more about school performance, relationships or health.

What types of anxiety do children and teenagers experience?

The common types of anxiety in children and teenagers are :

A fear or phobia about something specific

Young children are commonly afraid of things like the dark or imaginary things like monsters. This is a normal part of growing up, but has the potential to become a phobia (a type of anxiety disorder) when the fear becomes overwhelming and affects your child’s day-to-day life.

Feeling anxious for most of the time for no apparent reason

It’s normal for children to frequently have fears and worries. Some anxious children may develop a condition called generalised anxiety disorder when they get older.

Generalised anxiety disorder causes you to feel anxious about a wide range of situations and issues, rather than one specific event. It’s a feeling of constant fear or dread all the time that makes doing daily tasks hard because of feelings of anxiety.

People affected by it feel anxious most days and often struggle to remember the last time they felt relaxed.

Separation anxiety

Separation anxiety means a child worrying about not being with their parent or regular carer.

It’s common in young children, and normally develops at about 6 months of age. It can make settling into nursery or school or with a child minder very difficult.

Separation anxiety in older children may be a sign that they’re feeling insecure about something. They could be reacting to changes at home or at school, for example.

Social anxiety

Social anxiety is not wanting to go out in public, see friends or take part in activities.

Social ‘shyness’ is perfectly normal for some children and teenagers. However it becomes a problem – ‘social anxiety disorder’ – when everyday activities like shopping or speaking on the phone cause intense, overwhelming fear. Children affected by it tend to fear doing or saying something they think will be humiliating.

Social anxiety disorder tends to affect older children who’ve gone through puberty.

School-based anxiety

Some children become anxious about going to school. This could also be about schoolwork, friendships or bullying, especially if they’re changing school or moving up a level.

They may not always share these worries with you, and instead they may say they have a tummy ache or are feeling sick. One of the signs is crying or seeming tired in the morning.

This may be a problem that needs tackling if it is significantly affecting their daily life.

Less common anxiety disorders

Post-traumatic stress disorder and obsessive compulsive disorder are other anxiety disorders that can occasionally affect children, but are usually seen in adults.

When is anxiety a disorder that needs treating?

You should seek help for your child’s anxiety if:

• you feel it’s not getting better or is getting worse, and efforts to tackle it yourself have not worked
• you think it’s slowing down their development or having a significant effect on their schooling or relationships
• it happens very frequently or they feel anxious all the time
• it’s making them feel physically unwell a lot of the time like feeling sick or having constant headaches
• your child becomes very withdrawn and is anxious about doing things they used to enjoy

How serious can it be?

Long-term anxiety can severely interfere with a child’s personal development, family life and schooling.

Anxiety disorders that start in childhood often persist into the teenage years and early adulthood.

Teenagers with an anxiety disorder can also:

• experience clinical depression
• feel hopeless
• misuse drugs

What can I do to help my child?

If a child is experiencing anxiety, there’s plenty parents and carers can do to help. First, it’s important to listen to your child about their anxiety or worries.

YoungMinds has advice and resources for parents.

YoungScot has advice and support for young people.

Where should I go for help?

You can talk to your GP or someone at your child’s school like the school nurse. You might want to do this on your own or with your child, or your child might be able to have an appointment without you. The healthcare professional should listen to your concerns and offer some advice about what to do next.

Your child may be referred to the local child and adolescent mental health service (CAMHS). CAMHS staff are trained to help young people with a wide range of problems. Professionals who work in CAMHS services include:

• psychologists
• psychiatrists
• nurses
• occupational therapists
• physiotherapists
• and other specially trained professionals

They should offer help and support to parents and carers as well as the child.

More about CAMHS

Youth counselling services 

If your child doesn’t want to see a doctor, they may be able to get help from a local youth counselling service.

Youth counselling services are specially set up for young people to talk about what’s worrying them, and get advice.

For more information, search Scotland’s Service Directory for mental health and wellbeing services in your area. Counselling may also be available in your local school.

Telephone or online help

Telephone helplines or online services can be helpful for children and young people. They might feel it’s easier to talk to someone who doesn’t know them.

YoungScot has information about support organisations.

YoungMinds has information about where to get support.

How do you treat anxiety disorders?

The type of treatment offered will depend on what is causing your child’s anxiety.

It can be helpful for your child to talk in confidence about what’s worrying them to a trained person, especially as it’s someone they don’t know.

If your child is being seen at CAMHS, they might see a child and adolescent psychotherapist or a clinical psychologist. If they’re at a youth counselling service, it might be a trained youth counsellor or psychotherapist.

These sessions can help them work out what is making them anxious and how they can work through the situation.

Psychological therapies

Psychological therapies can really help with anxiety. They’re evidence based talking treatments, like cognitive behavioural therapy, that are proven to help.

Cognitive behavioural therapy (CBT) is a talking therapy that can help your child manage their problems by changing the way they think and behave.

It’s been proven to help with anxiety and is commonly offered to young people who are anxious.

Your child will work with the psychological therapist to find ways to change the way they think. They’ll help your child to find strategies for coping in situations that make them anxious. The psychological therapies matrix describes the most helpful talking therapies for anxiety.

If your child’s anxiety problem has not got better, your doctor may talk to you about trying medication.

A type of antidepressant, called a selective serotonin reuptake inhibitor (SSRI), may help your child feel calmer and differently about things.

Antidepressants usually take around 2 to 4 weeks to work properly, so you or your child may not notice the difference immediately.

It’s natural to be concerned about side effects. Your child should be aware of any possible adverse effects and should tell you or their doctor if they happen.

Why are some children affected and others not?

Some children are simply born more nervous and anxious and less able to cope with stress than other children.

Sometimes traumatic life events like an illness, or an accident, can cause anxiety. This can happen even if your child was previously confident by nature before.

A child’s anxious personality may be partly determined by the genes they’ve inherited from their parents. Parents of anxious children may recognise the signs and remember feeling and behaving the same when they were younger.

Life events

Some children can also develop anxiety after a series of difficult life events. They may be able to cope with one of these events, but several difficult events together, or a traumatic single event, may be too much for them to cope with. Examples are:

• frequently moving house and school – it can be hard to settle when you’re always expecting change
• divorce or separation of parents
• death of a close relative or friend
• becoming seriously ill or injured in an accident
• having someone in the family who is ill or disabled
• school-related issues like homework or exams, or bullying or friendship problems
• becoming involved in crime
• being abused or neglected

Medical conditions

Children with certain conditions such as attention deficit hyperactivity disorder (ADHD) and autistic spectrum disorders may experience anxiety as part of the symptoms of their condition. This is because of differences in the way their brain functions.