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Anxiety in Children and Teens Part II: Signs and Symptoms
May 2nd, 2019

In last week’s column, we looked at anxiety and what the different anxiety disorders are. Today, I will cover the causes of anxiety and how to recognize it in your children.

What Causes Anxiety?

Anxiety can be caused by biological sensitivities, genetics, stressful life events or learned behaviors. In the film Angst (an independent film addressing teenage anxiety – strongly recommend seeing it if available), one of the experts always asks a child “who in your family has anxiety?” Whether passed on genetically, or through modeling and instilling feelings of anxiety, the problem tends to run in families. When a family member, particularly a parent, experiences anxiety, they often transmit those fears indirectly to their children. The children become conditioned to have similar anxious feelings to events in their lives. This can be done through avoidance of activities and actions, and possessing an extreme sense of worry and danger.

Children also develop anxiety from frightening or traumatic events. I have found that dysfunctional inconsistent parenting, and poor limits and boundaries can lead to anxiety, as children do not feel secure and are constantly worried about what will occur, and try and develop ways to control everything around them. Since this is not possible, the result is a feeling of fear and anxiety.

When anxiety begins, it often generalizes to other areas as well. For example, someone may initially be fearful of crowds, then develop fear of going outside where crowds are, and then generalize to being fearful of open spaces (agoraphobia). As has been stated earlier, some anxiety in unfamiliar situations is a normal, healthy response. It is when it becomes exaggerated and interferes with day to day functioning, or causes one to avoid situations they should be able to engage in, that it becomes an anxiety disorder.

Physical Signs

The signs and symptoms of anxiety can be physical, emotional, or behavioral. Anxiety is often experienced in the body, in the form of headaches, stomach aches or pain with no apparent medical cause for the discomfort. Children may change their eating patterns, feel nauseous or refuse to eat in public spaces like the school cafeteria. They may show signs of nervousness, like tics, fidgeting, sweating, extreme blushing or shaking. They may avoid public places like restrooms. They may complain of chest pain or muscle pain, and may constantly try to relax themselves. Sleep disturbance is common, both in terms of falling asleep and staying asleep, as well as nightmares and feelings of fatigue despite having slept.

Emotional Signs

Children with anxiety feel on edge frequently, and are easily irritated, frustrated and act out verbally. They may appear timid and fearful of making any mistakes. Criticism of any kind is experienced as very painful, even when gentle and constructive. They can be labile and cry frequently. Their minds are always active, particularly in worrying about the future. We call that catastrophizing, which is a fundamental characteristic of anxiety.

When one catastrophizes, he/she projects into the future, often thinking about the worst that can happen. For example, your child may do poorly on a test, then think they will fail the class, then fear they will not get into college, then project they will never get a job and that no one will ever want to marry them, and so on. You get the picture. Fear of being judged is a component of anxiety, and fear of failure goes with it. Test anxiety and avoidance of school to relieve that anxiety are common.

Behavioral Signs

As stated above, much of anxiety is experienced in the school setting, and children with anxiety disorders are likely to avoid school. They may feign illness or just state they cannot go. They will likely avoid activities and avoid being around others. They withdraw, isolate and keep to themselves. Those with OCD type of anxiety may engage in excessive hand washing, arranging of items, hand tapping, mentally counting, behavioral rituals and other compulsive behaviors. They may experience separation anxiety when away from parents or home. Their anxiety may result in explosive outbursts or expressions of anger.

It is important to recognize the signs of anxiety and not to minimize your child’s feelings. Telling them not to worry or that it will go away on its own may seem like it helps, but can actually make them feel worse. In the next column, I will review some coping skills and some of the things parents can do. In the meantime, remember that anxiety is extremely common, and more importantly, very treatable.

Remember, if you have issues you would like to see addressed, please email me at askdrgelbart@gmail.com.

Moe Gelbart, Ph.D. 
Executive Director, Thelma McMillen Center