• Whole Child Counseling

Anxiety in Children: Symptoms, Signs, and How to Help

Updated: Jul 13, 2021

As educators and mental health practitioners, it is important to understand the symptoms of anxiety in children. According to the CDC (2019), approximately 4.4 million children in the United States, aged three to seventeen years old, have been diagnosed with an anxiety disorder and these rates are rising over time. Anxiety disorders also have an earlier age of onset, at about eleven years old (Kessler, Berglund, Demler, Jin, Merikangas, and Walters, 2005). In my experience, I commonly see children starting to express anxious behavior at around six or seven years old.

What Are Signs of Anxiety in a Child?

People often think of anxiety in children and teens as being displayed primarily as fearfulness and worry. This might be true when a child is afraid to leave the family in the case of separation anxiety, or having an extreme fear about something such as a phobia, or being afraid of social situations such as social phobia, or having symptoms of a panic attack such as heart palpitations, sweating, trembling, shortness of breath, etc. But in my experience, anxiety can ALSO present in children and teens in many other ways including as:

  • Oppositional behavior: becoming argumentative and/or defiant

  • Rigidity: inability or refusal to take others’ viewpoints into account

  • Inflexible thinking: difficulty accepting change, making transitions, or shifting from one activity to another

  • Somatic concerns: body complaints such as fatigue, headaches, and stomachaches

  • Cognitive focus: more attention to their own thoughts than to what is going on around them (thoughts might be racing, unhelpful, obsessive, catastrophizing, all-or-nothing thoughts, etc.)

  • Avoidance: acting in a way that allows escape from an undesired or uncomfortable activity or situation

  • Perfectionism: getting upset when making mistakes, which can look like a child who does lots of erasing to make their writing or drawings perfect, and it can even display itself as procrastination, because the child may put off doing something due to fear of not getting it right or making a mistake

When a child feels anxious, her behavior can be difficult to manage and she may act out. Seeing consistent problematic behavior in children, therefore, is an indicator to look into whether or not the child may be experiencing anxiety.

How to Help a Child with Anxiety Symptoms

Body-based Skills

Because children with anxiety tend to be “in their heads,” teaching body-based skills such as stretches can be therapeutic. In my book, Skills for Big Feelings, each week the children are taught 3 new coping skills, and I have included several of these body-based skills to help children get out of their heads, into their bodies, and to focus on the present moment. If a child is directing his energy and attention toward performing one of these activities, it will be hard for him to worry about something else - like his upcoming math test, for example.

In addition, many studies have demonstrated that body movement positively impacts children’s cognition, learning, and academic achievement (Chandler and Tricot, 2015). There are not always ample opportunities for movement throughout a school day or counseling session, and incorporating movement activities can mitigate some symptoms of anxiety in children. Try to find any way you can to incorporate movement into your day!

I am fascinated by the mind-body connection, which is one of the reasons I went back to school to become an RN after I received my master's degree in expressive arts therapy and mental health counseling.

A great book to learn about the impact of movement on the brain is called A Moving Child is a Learning Child: How the Body Teaches the Brain to Think by GIll Connell and Cheryl McCarthy. I like this book because it makes learning about the brain simple!

Connell and McCarthy (2014) write that:"Nature has created this move-to-learn process to be both dynamic and self-perpetuating, building the body and brain simultaneously. As such, the more a child moves, the more she stimulates her brain. The more the brain is stimulated, the more movement is required to go get more stimulation. In this way, nature gently coaxes the child to explore beyond her current boundaries toward her own curiosity to acquire new capabilities" (p. 7).

Since movement is so important for the brain and learning, I also created these Would You Rather Movement activities to help clinicians and educators incorporate movement in a fun kid-approved way!

Breathing Techniques

Breathing techniques have also been proven to “break the anxiety cycle" (Borysenko, 1988, p. 58), which is why there are breathing skills taught every week in Skills for Big Feelings and included in the printable children's coloring workbook that is a cornerstone of the Skills for Big Feelings program!

Paying attention to, and changing breathing patterns can deepen the mind/body connection and regulate the nervous system. We have all seen children get quickly revved up (and have probably experienced this escalation in ourselves as well!) Therefore, recognizing the signs and symptoms of anxiety in children at the onset can provide an opportunity to step in and practice coping skills by working through some regulating breathing techniques before the child loses control.

Most children benefit from direct, explicit instruction on coping skills and emotional regulation strategies. This direct instruction on taking slow, deep breaths will allow children to internalize and independently use this technique over time. It forces them to think about their current feelings and gives them space to deploy their coping skills (Regis College Online, 2020.)

Teaching Coping Skills to Children with Anxiety Symptoms

Consider Skill Deficits That Can be Built Up

Early on in my career, I was fortunate to discover the work of Dr. Ross Greene from Lives in the Balance. Dr. Greene wrote two extremely important books that I highly recommend if you work with children: The Explosive Child and