According to the NIMH, anxiety is now the most common psychological disorder in the US, affecting nearly 40 million adults each year. Anxiety in children and adolescents is also quite common and can cause problems with behavior, sleep, and school performance.
Anxiety in children can take many forms, all of which I treat in my private practice:
- Specific fears or phobias – the dark, being alone, animals, monsters, etc…these are very common and actually the easiest symptoms to treat via exposure and other CBT techniques.
- Insomnia – avoidance of getting ready for bed, difficulty falling asleep, difficulty staying asleep, waking up too early. Children with sleep problems will often try to wake up their parents and sleep in their bed. It’s very important to quickly resolve sleep deprivation since it can increase the likelihood of other psychological disorders later in life, such as depression, anxiety, and alcoholism.
- Separation anxiety – difficulty separating from care givers, fear or worry something bad will happen to caregivers, nightmares about caregivers getting hurt, difficulty being alone. More common in young children and after a trauma.
- Generalized anxiety – uncontrollable worry, perfectionism, somatic complaints, vomiting, restlessness, asking too many questions, constant need for reassurance, worry about performance. these symptoms tend to be more diffuse which can make treatment more difficult.
- Post traumatic stress disorder (PTSD) – stems from a traumatic event such as abuse or death. symptoms include: dissociation, nightmares, flashbacks, hypervigilance, and avoidance of things that are similar to the trauma.
- Obsessive compulsive disorder (OCD) – obsessions (intrusive thoughts) and compulsions (ritualistic behaviors) that temporarily reduce anxiety about some type of fear. Examples include collecting objects, washing hands, touching objects, and checking behavior. Most effective treatment is response prevention and exposure.
- Selective mutism (SM) – children refuse to speak to certain people in certain situations for more than 1 month. Usually this starts after some type of upsetting event. School and home behavior plans with rewards work very well. SM can worsen overtime if not treated.
- School refusal – children avoid or refuse to got to school due to fear of something bad happening. It’s very important that children return to school immediately or the avoidance will worsen.
- Social anxiety – fear of being embarrassed in social situations by saying or doing something wrong. Very common in adolescents, especially those with underlying anxiety.
- Test anxiety – more common in older adolescents. symptoms include sweating, racing heartbeat, irrational thoughts, somatic complaints, vomiting, panic, freezing, and “brain fog.”
Anxiety tends to run in families, though the environment (home, school) can significantly worsen/improve symptoms. Depending on severity, treatment can include medication, psychotherapy, and/or some combination of both. I recommend families try psychotherapy first, and then add medication if needed. For anxiety, I use cognitive-behavioral therapy which includes challenging thoughts, exposure, and behavior plans. Cognitively, I teach children how to be “brave” and fight back against their “worry monster.” Behaviorally, fear hierarchies and gradual exposure are very effective. I also work with parents and teachers to implement behaviorally-oriented reward plans at home and school.
Written by Joshua Rosenthal, PsyD