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The ABCs of Child and Adolescent Anxiety

October 23, 2019 By Dr. Caroline Adelman, PhD & Ellen Bee

At Chicago Psychotherapy, LLC, we have expertise in the treatment of Anxiety Disorders, Obsessive-Compulsive Disorders, and Mood Disorders in children and adolescents. Using gold-standard, evidence-based practices, such as Exposure-Based Cognitive Behavioral Therapy (CBT) and SPACE (Supportive Parenting for Anxious Childhood Emotions), our team supports clients and their families in meeting their treatment goals. We wrote the following post to address some of the questions we most commonly hear from parents when their children or teens struggle with anxiety.

Anxiety is currently the most commonly diagnosed mental health issue among American youth. Like many parents, you may be asking yourself, “What is anxiety and how do I know if my child is struggling?” For a parent or caregiver, it can be difficult to distinguish developmentally appropriate stress or transient fears from more problematic forms of anxiety. Additionally, it can be hard to tell when we as parents or caregivers unwittingly accommodate a child’s anxiety, versus offering appropriate levels of support. Below are some common questions and answers to help you navigate the best options for your child.

I hear so much about “anxiety” in today’s youth – what does child anxiety really mean?

Human beings are hard-wired with a threat detection and response system – a “smoke detector and alarm system” of sorts – that serves to warn us of impending danger and keep us safe in the face of threat. This in-built alarm system, often referred to as our “fight or flight” response, is why we ALL experience anxiety from time to time.

This system is highly functional when activated by genuine threats to our safety – for example, an aggressive animal trying to harm you or a car swerving toward you as you are driving. However, when a child’s “threat detection system” mistakes non-threatening situations (e.g., a school test, an awkward social encounter, or sleeping in the dark) for genuine threats, the body’s same threat response may be activated by a “false alarm.” Instead of the alarms signaling a true emergency (e.g., fire), this hijacked anxious response is akin to burnt toast setting off the fire alarm in your home (we often refer to these as “burnt toast situations” when working with children with anxiety).

While most children have transient fears that parallel age and development, such as temporary increases in anxiety when separating from parents for the first time or starting a new school year, the anxiety associated with these situations typically does not significantly impact a child’s day-to-day functioning. When children worry excessively and seek frequent reassurance from caregivers, or when their fears begin to interfere with functioning at school or at home, these are signs that anxiety may be developing into a clinically significant problem.

What are the signs and symptoms of anxiety?

As parents, how do you determine if your child struggles with clinically significant anxiety? Frequently, as providers, we see changes in four areas: cognitive, behavioral, physical, and emotional.

  • Cognitive: Children may have difficulty concentrating, struggle with excessive worry, and tend to anticipate negative outcomes.
  • Behavioral: When a child is anxious, they often withdraw, constantly seek reassurance, have an increased need for control, or exhibit avoidance patterns.
  • Physical: Children may experience increased heart rate, and complain of stomach, back, or headaches, and sleep problems.
  • Emotional: Anxiety often presents as worry/fear. However, anxious children may also appear irritable and angry when their anxiety is triggered. This anger goes hand-in-hand with the “fight” part of the fight or flight response.

What are the different types of anxiety?

Anxiety Disorders are classified according to the DSM-5, and tend to be defined by a combination of the specific triggers associated with the anxiety response (e.g., phobias) and the ways in which anxiety symptoms manifest for a particular individual (e.g., panic disorder). Following are the most commonly seen among youth struggling with anxiety:

  • Generalized Anxiety Disorder (GAD): Persistent fear of bad things happening in the present and in the future (the “expert worrier” or “threat detective”).
  • Social Anxiety: Discomfort or avoidance of social situations, particularly those in which children fear embarrassing themselves or being negatively evaluated by peers.
  • Specific Phobia: Extreme fear of a specific thing or situation, such as medical procedures or snakes.
  • Separation Anxiety: Fear of being apart from parents, often even if parents are in another room. Often associated with intrusive worries about harm befalling the parent or child.
  • Panic Disorder: Intense episodes of fear, accompanied by physical manifestations such as shortness of breath, dizziness, and heart pounding or racing.

When should I seek help for my child?

Parents should reach out for additional support if they notice that their child’s worry is out of proportion to the event and extends beyond the stressful situation. Additionally, if your child’s anxiety begins to interfere with functioning in social, academic, or home settings, it may be time to consult with a provider.

What works?

The first step in identifying what treatment is best for your child is to schedule a diagnostic clinical evaluation, which is part of the standard intake process for most mental health providers. During this process, a provider can determine what type of treatment is appropriate for your child and/or family system and recommend next steps. Treatment may involve child therapy, family therapy, or a combination of both, and providers may consult with your child’s Pediatrician, school, or other providers involved in your child’s care.

Research demonstrates that the gold-standard therapy for child anxiety is Exposure-Based Cognitive Behavioral Therapy (CBT). CBT focuses on how negative thinking patterns influence behavior and emotions. Through “exposures”, providers create scenarios that trigger the unrealistic fear or worry, helping children to lean into the fear rather than avoid it, and to understand that anxiety is tolerable. CBT also increases children’s flexibility and confidence in coping with uncertainty. The goal of therapy is not to “get rid of anxiety,” but to distinguish real vs. false alarms and increase willingness to take worthwhile risks as children grow.

In addition, SPACE (Supportive Parenting for Anxious Childhood Emotions) has been shown to be as effective as individual CBT for child and adolescent anxiety disorders. SPACE works exclusively with parents to identify accommodation cycles, teach supportive parenting strategies, and facilitate change in a child’s anxiety through parental behavior modifications. This may be especially valuable for children who are unwilling to engage in traditional CBT or do not benefit from it.

How and where do we find a good provider?

Research indicates that the best providers for child or teen anxiety have strong CBT training and experience specifically with child/adolescent anxiety. Since many providers advertise CBT, it is important to confirm they have expertise in exposure-based CBT for youth.

Where can I learn more?

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