There isn’t one way to be anxious so when we look for child anxiety symptoms, we need to be aware that they will manifest differently in different kids.
This is a very (very) broad overview of the kinds of anxiety disorders seen in kids. And remember, it goes from regular worry to a concerning disorder when the anxiety gets in the way of functioning.
Most Common Anxiety Diagnoses
- Generalized Anxiety Disorder
- Kids with generalized anxiety have excessive worry across a variety of situations. They worry about missing the bus, about whether the kids at camp will like him, or about the laundry getting done in time to wear her new shirt tomorrow.
- They may worry about things that didn’t happen, too. (“But what if last night’s thunderstorm DID turn into a tornado?”)
- You may feel like your child is always humming, always looking for something to worry about. You may start to feel like any television show, book or movie is a potential worry generator and you may even find yourself editing things ahead of time because you don’t want to trigger a new round of anxious “What ifs?” before bedtime.
- For these kids, the worry is pervasive and ongoing. If you find yourself constantly trying to reassure your child (often without success) then she may be struggling with generalized anxiety.
- Separation Anxiety Disorder
- Almost all kids go through a developmentally appropriate phase of separation anxiety when they’re toddlers and sometimes when they’re preschoolers. Kids who still have trouble separating by age seven should be evaluated.
- Kids who have separation anxiety are usually worried about something bad happening — often to the people and pets they love — while they’re away. Sometimes separation anxiety appears after a difficult event — a parent who was ill, a threat in the neighborhood, etc.
- For some kids, this will result in them refusing to go to school.
- NOTE: I work with a lot of attachment parenting proponents who co-sleep and homeschool and make other parenting choices that keep kids close and I think that these decisions need to be respected and understood when therapists are evaluating kids for separation anxiety. A child who is happily ensconced in the family bed at an age where our culture expects them to be out is not necessarily struggling with separation. I start looking for anxiety when their reluctance to leave mom or dad goes beyond preference. If a child is truly crippled by his anxiety — if he wants to go to a sleepover but can’t, if he wants to join his friends at the movies but can’t unless you to come, too, and sit in the back row where he can know you’re close, then separation anxiety may be an issue. I mention this because some of the assessments that therapists use are not culturally sensitive to parenting choices outside the mainstream.
- Social Anxiety Disorder
- It can be tricky to differentiate social anxiety from natural introversion. In both cases kids may have a hard time around new people and may be reluctant to join groups (at birthday parties, soccer teams). The difference is that the socially anxious child may worry more after the fact (“I probably said something stupid and won’t get invited again”) and will usually want to want to do the things that scare her while the introvert may be perfectly happy avoiding social events.
- Social anxiety is common as kids head into adolescence. Part of this is that the middle school years are HARD. Social groups start to split apart and come together in new confusing ways. Hormonal changes have everyone turned topsy-turvy. And kids start trying on new personas. An introvert may wish she was more extroverted and so she may push herself past her comfort zone. Kids become more self-critical and more worried about what other people think. Again, it’s normal but that doesn’t mean it doesn’t deserve attention and support.
- Selective Mutism (a child who won’t speak to people outside his or her family or who will only speak to friends but not adults) is a form of Social Anxiety Disorder and is usually diagnosed once a child heads to school and people notice she isn’t speaking up.
Less Commonly Diagnosed
- Obsessive-compulsive disorder (OCD)
- People tend to be confused about OCD as evidenced by the casual, “Oh your collar is crooked. I know I’m so OCD but let me straighten it.” True OCD is magical thinking run amok. It’s believing that if you don’t straighten the collar then your friend will die. We all do a little magical thinking and children in the tween years may flirt with it an awful lot (that’s the age of “don’t step on a crack or you’ll break your mother’s back”). The difference is that kids with OCD get stuck. They have Obsessions (“What if mom’s car crashes?”) and Compulsions (“If I skip every other step coming down the stairs her car won’t crash.”).
- Kids who have OCD are slaves to their rituals, which become more and more complex as a simple compulsion no longer quiets the obsession. Compulsions are like drugs — they become less effective the longer one uses them. So the staircase needs to be traversed twice. Then four times. Then eight. If they aren’t allowed to complete a compulsion, these children may fall apart.
- Children with developmentally typical magical thinking can more or less roll with it if you tell them to quit walking on just the white tiles because you need to get home before lunch; kids with OCD can’t. They don’t want to be stuck in the bank stepping on white tiles while you’re fuming but they truly can’t help it.
- Children with OCD may be constantly checking, cleaning and ordering things a certain way. They may hang their obsessions on superstitions (“I saw a black cat and now I need to walk backwards the rest of the way to school so I don’t die.”)
- OCD can be very complex. Some kids will struggle with intrusive thoughts (“What if I killed my dog”) and then have rituals to “counteract” the thoughts. Other children will hoard things because they become obsessed with the idea that they might need the candy wrappers later.
- Parents may become part of ritualized behavior without realizing it, having to repeat things in a certain way or reassure their child with particular words or phrases or to do the bedtime routine in a very specific order.
- OCD is usually diagnosed around age 10 and interestingly is more commonly seen in boys before puberty, and more commonly seen in girls after puberty.
- Panic Disorder/Somatic Symptoms
- Panic Disorder is generally diagnosed in older children but younger children may display somatic symptoms like stomach aches and headaches. Older children may have full blown panic attacks — heart racing, fear of passing out or dying. Kids are unlikely to connect their pain with worry and parents may believe they’re faking to get out of something — a test, a visit outside the home — but the children genuinely feel sick.
As you’re looking at this list you may think, “Wait, my kid does that! Should I be concerned?” My answer is that you should be aware but note whether or not the worry is getting in the way of your child’s happiness. Remember, a diagnosis depends on interference with a child’s everyday functioning.
That said, learning skills to manage anxiety is useful no matter who you are. We all have times in our life where we’re dealing with more stress than usual and learning anti-anxiety tools certainly never hurt anyone.
First in the series: Anxiety in Kids
Last in the series: Helping Kids with Anxiety