Anxiety in Children: Symptoms, Signs, and How to Help
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
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 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 Lost at School.
An important concept of Dr. Greene’s work is that kids would do well if they could do well. Dr. Greene writes: “If the kid had the skills to exhibit adaptive behavior, he wouldn’t be exhibiting challenging behavior. That’s because doing well is always preferable to not doing well” (2009).
Dr. Greene’s model allowed for an important realization that helped me in my own parenting and career: the belief that a child is not purposefully or deliberately acting out and that children, like the rest of us, do the best that they can do in any
This is why I am passionate about tier-1 social-emotional learning and believe that kids need explicit, direct instruction to learn healthy coping mechanisms!
Coping Skills for Children with Big Feelings
As the adults in these children’s lives, it is our responsibility and privilege to model how to self-regulate and to teach coping skills when we see symptoms of anxiety in children.
The challenging behavior associated with anxiety does not happen because the child is trying to be oppositional or defiant. It often stems from fear, overwhelm, or frustration.
When a child feels as though she cannot meet an expectation, or as though her expectations were not met, she may act out. While it is difficult in the moment, it is important to remember that we should not take it personally when a child behaves in a maladaptive way. Not taking things personally when working with or raising children is an extremely helpful skill to develop! I love Don Miguel Ruiz's book The Four Agreements as it has a whole chapter dedicated to not taking things personally! Miguel Ruiz (1999) writes that:
“There is a huge amount of freedom that comes to you when you take nothing personally.”
A Problem-Solving Approach to Help A Child with Anxiety
In addition, making this mindset shift will allow your attention to pivot away from thinking about what is wrong with a child and move towards a problem-solving approach by figuring out what skills the child needs to learn to be more successful.
How to Handle Avoidance with Children with Anxiety
It is completely natural to want to avoid something that doesn’t make you feel good. Letting your child with anxiety avoid something that upsets him may temporarily decrease upset feelings, these feelings will eventually become more intense and problematic later on.
Allowing avoidance leads to children experiencing anticipatory anxiety, which is more difficult to cope with than is the initial anxiety. It also robs children of the opportunity to hone healthy coping skills, so it maintains their anxiety in the long term.
A preferable way to handle a child’s desire to avoid a triggering situation is to validate their feelings and encourage them with a specific affirmation (e.g., “I know you have the tools to deal with your big feelings!”) If they do not yet have the tools to deal with their feelings, then the next step will be to figure out who can assist them with acquiring these skills.
With this shift, you can focus on figuring out the best way to help the child learn those skills. The purpose of Skills for Big Feelings is to teach children how to cope with their uncomfortable feelings more effectively by teaching them relaxation skills and giving them a structure called F-B-T-S or Feeling-Breath-Thought-Skill to work through as a coping strategy.
A Note on Caregiver Self-Care
When children misbehave, whether it is because of anxiety or some other issue, it can be extremely stressful for parents, caregivers, and the professionals who work with these children. Caregiver self-care is so important and the strategies that are written in Skills for Big Feelings were written in a fun, child-friendly way, but they are also effective for adults! This social-emotional learning curriculum was first developed and used in small groups with kids experiencing anxiety and self-regulation concerns, but when I started pushing this resource into whole-classrooms, I had some teachers comment to me that they were learning, practicing, and growing by using the skills themselves.
I encourage you to find some healthy coping skills that work well for you. Whether you are a mental health professional, parent, or educator, as a caregiver to children, it will go a long way to model self-care, acceptance, and emotional regulation on a day-to-day basis.
Skills for Big Feelings
If you want a more comprehensive resource for helping children with anxiety, please check out my Super Ultimate Skills for Big Feelings Growing Bundle. You will receive the book Skills for Big Feelings: A Guide for Teaching Kids Relaxation, Regulation, and Coping Techniques (available in both paperback or eBook editions), as well as my Coping Skills Craftivities eBook, 12 digital interactive notebooks, printable poster pack, trauma-informed guided relaxations, presentation slides, editable documents, schedules, family handouts, a coloring coping skills workbook, digital and printable games, and so much MORE! As more resources are added to this growing bundle, those who have already purchased will get access to the updates at no additional cost.
Centers for Disease Control and Prevention. (2019, April 19). Data and statistics on children’s
mental health. Centers for Disease Control and Prevention. https://www.cdc.gov/
Chandler, P. & Tricot, A. (2015). Mind your body: the essential role of body movements
in children’s learning. Educational Psychology Review, 27(3), 365-370. http://doi.
Connell, G. & McCarthy, C. (2014). A moving child is a learning child. Free Spirit Publishing Inc.
Greene, R. W. (2009). Kids do well if they can. Lives in the Balance. https://www.livesinthebalance.org/kids-do-well-if-they-can
Kessler, R. C., Berglund, P., Demler, O., Jin, R., Merikangas, K. R., & Walters, E. E. (2005).
Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National
Comorbidity Survey Replication. Archives of General Psychiatry, 62(6), 593–602. https://
Miguel Ruiz, D. (1999). The Four Agreements: A practical guide to personal freedom. Amber-
Relaxation Techniques for Kids. Regis College Online. (2020, May 5). https://online.regiscollege.edu/master-science-applied-behavior-analysis/relaxation-techniques-for-kids/