Anxiety Disorders

Introduction

The Questions and Answers that follow aim to provide an introduction to anxiety disorders for parents and other family members. Following those, we offer links to selected resources for more information and support and a list of valuable services.
More information about many topics relevant to children with anxiety disorders and many other chronic conditions and their families can be found in the left menu. Detailed information aimed at primary care doctors can be found in our Anxiety Disorders module.

What is an anxiety disorder?

Anxiety disorders cause extreme feelings of fear and worry. They may also cause changes in a child's mood, sleep, and behavior. Anxiety disorders are common in children and adults. Anxiety disorders often coexist with other conditions, including those that affect children with special health care needs. There are several specific anxiety disorders, such as obsessive-compulsive disorder, panic disorder, separation anxiety, social anxiety disorder, and others.
There are many specific types of anxiety disorders, but generally speaking, all anxiety disorders:
  • cause excessive or persistent fear and worry that is out of proportion to the cause of stress
  • last for several months or longer
  • are different from anxiety that is normal for the child’s developmental age
  • affect the child’s normal functioning and day-to-day behavior

What causes anxiety disorders?

Several things play a role in anxiety disorders. Children may inherit genes that result in brain chemistry changes that make them more prone to anxiety. Stressful life situations, such as a serious illness or loss of a loved one may also lead to anxiety. Anxiety may also be related to other chronic conditions, such as hyperthyroidism, seizure disorders, and others. Traumatic or stressful events in childhood may result in anxiety. Unless such events are caused by a parent, anxiety disorders are not a sign of poor parenting.

What are the symptoms?

Children with anxiety disorders may worry a lot, and can seem irritable or easily embarrassed. Common anxiety symptoms in children are: acting worried or afraid, crying, shaking, tantrums, refusing to do things such as talking, and intense focus on a specific concern, such as germs. Physical symptoms are: racing heart, stomach aches or nausea, headaches, sleep problems, dizziness, shortness of breath, sweating, chest pain, muscle discomfort, and tingling/prickling sensation in extremities. [Bagnell: 2011] Children may have these symptoms even without an obvious stressor.

How is it diagnosed?

Feelings of fear and worry may be normal responses to stress and change. However, an anxiety disorder should be considered when symptoms last for several months or longer, cause significant distress and/or difficulties in performing activities of daily living, are not typical for the child’s developmental age, and/or are out of proportion to the cause of stress. Different criteria exist for diagnosing different types of anxiety disorders. The same person may have multiple anxiety disorders. [Bagnell: 2011]
Certain conditions, such as Asthma and Seizure Disorders often coexist with anxiety. Anxiety may be a single problem or related to certain other conditions such as Autism Spectrum Disorder, Attention Deficit Hyperactivity Disorder (ADHD), disruptive behavior disorders, learning disorders, and mood disorders like Depression.
Anxiety disorders are diagnosed by a health care provider, such as your child’s doctor, or a mental health professional, such as a licensed counselor.

What is expected outcome?

When recognized and treated, people with anxiety disorders have better health outcomes. Many people with anxiety disorders respond positively to treatment with medication and/or therapy. Learning and practicing appropriate self-regulating and coping skills can help people with anxiety manage the condition well and live normal, productive lives.
Left untreated, anxiety disorders have been shown to lead to poorer outcomes including other health problems, difficulties in school, financial and interpersonal difficulties, and a higher risk of suicide. [Wehry: 2015] Discuss any concerns you have about other health problems, suicidal thoughts, and other difficulties with your child’s primary care doctor or medical home.

Will anyone else in the family get an anxiety disorder?

Both genetic and environmental causes play a role in the development of an anxiety disorder. When one person in the family has an anxiety disorder, the likelihood of another family member also having an anxiety disorder is increased.

What is the treatment?

Getting treatment is important—only about 1/3 of patients with anxiety disorders will improve without treatment.
Many professionals may be involved in helping children with anxiety, including a primary care doctor, psychiatrist, psychologist, social worker, nurse practitioner, counselor, and school psychologist. Counseling can help families and children build skills to manage and reduce anxiety, particularly for mild-to-moderate anxiety. Mindfulness meditation can help people with anxiety to manage distracting thoughts and reduce stress (see Mindfulness Meditation). This may lead to fewer symptoms. Medications are often needed for moderate-to-severe anxiety and can be used to treat symptoms caused by anxiety. Other medical conditions that are causing or contributing to anxiety may also be helped with medication.

How will family’s life be changed?

Families will need to develop skills to help reduce stress and anxiety. Family involvement strongly affects the ability to follow prescribed behavioral and medical therapy. Building a support network of family and friends can help manage stress in the family. Parents who are anxious, overprotective, or have extremely high expectations for their children may training and support to help their children experience less fear and worry. Accommodations may need to be made in school to help reduce anxiety or deal with the effects of anxiety.

What are the recommendations for treating anxiety in children with autism spectrum disorder?

Children with autism spectrum disorder (ASD) may be more sensitive to medications and respond to them differently than neurotypical children. Medications are typically started at lower doses and gradually adjusted as needed. Overdose or misuse of medications may be life-threatening, and it is important to keep them out of reach of children.

What are the recommendations for treating anxiety in children with ADHD?

It can be tricky to decide which to treat first, as many symptoms of ADHD and anxiety can overlap. It is often recommended to treat anxiety first, but because uncontrolled ADHD symptoms can make anxiety worse (such as worrying about doing well in school), and because medications to treat ADHD may work more quickly than medications to treat anxiety, some doctors may choose to treat the ADHD symptoms first. Asking careful questions about sources of stress and using screening questionnaires can help doctors decide which to treat first. If a child appears more anxious or agitated on ADHD medication, doctors should consider treating anxiety first. There are medications that may be helpful in treating some symptoms of both anxiety and ADHD.

How long should a child with anxiety disorder be treated with medications?

Many children and families are eager to stop medications as soon as they feel better and symptoms are under control. However, it is recommended to continue medication treatment for 6-12 months once symptoms are under control before attempting to wean medication. Some disorders may require lifelong management with medications.

How long is “reasonable” to allow a child to adjust to an anxiety-provoking situation such as a move without being evaluated and/or treated for an anxiety disorder?

To be diagnosed with an anxiety disorder, children must have symptoms for several months, although there are some exceptions. If a child is not having difficulty functioning (academic, social, or otherwise), then they may not meet criteria for a disorder. Many children experience temporary worry after life changes such as moves. Children who experience mood or anxiety symptoms after a stressor that resolve within six months may be better described as having an adjustment disorder. Medications may not be needed in this case, but therapy may be helpful in coping with life changes.

Resources

Information & Support

For Parents and Patients

Support

Anxiety and Depression Association of America
A national nonprofit organization providing information and resources for families and professionals.

The Child Anxiety Network
Parent-focused information about phobias, specific anxiety disorders in children, and treatment.

National Alliance of Mental Illness (NAMI)
A national organization that provides information and resources for families and professionals, including helpline, local chapter resources, and advocacy.

General

Anxiety Disorders Resource Center (AACAP)
Information and short videos about features, diagnosis, and treatment of anxiety disorders. Includes links to Facts for Families, brief handouts that explain diagnosis, treatment options, and when and how to find treatment; American Academy of Child Adolescent Psychiatry.

What to Do When You Worry Too Much
An interactive self-help book designed to guide 6–12 year olds and their parents through the cognitive-behavioral techniques most often used in the treatment of generalized anxiety. Metaphors and humorous illustrations make difficult concepts easy to understand, while prompts to draw and write help children to master new skills related to reducing anxiety; written by Dawn Huebner, PhD.

Anxiety Disorders (healthychildren.org)
Defines anxiety disorders for families; sponsored by the American Academy of Pediatrics.

Emotional Problems (healthychildren.org)
Helpful information about emotional difficulties, including anxiety and associated problems; American Academy of Pediatrics.

Mental Health, Naturally
Holistic health expert and pediatrician Dr. Kathi J. Kemper presents natural treatments used for mental health issues such as ADHD, depression, anxiety, stress, and substance abuse; available for purchase on American Academy of Pediatrics website.

Growing Up Brave: Expert Strategies for Helping Your Child Overcome Fear, Stress, and Anxiety
Book that helps parents identify and understand anxiety in their children, outlines effective and convenient parenting techniques for reducing anxiety, and shows parents how to promote bravery for long-term confidence; by Dr. Donna Pincus - creator of The Child Anxiety Network, Associate Professor at Boston University, and the Director of the Child and Adolescent Fear and Anxiety treatment Program at Boston University.

Patient Education

Acupressure for Stress and Anxiety (Memorial Sloan Kettering Cancer Center)
Patient information about acupressure and integrative medicine.

Drugs & Supplements Related to Anxiety: Patient Information (MayoClinic)
Describes for families precautions, proper use (includes pediatric use), and side effects of drugs and supplements used for anxiety. Can also search by first letter of drug/supplement name.

Services for Patients & Families Nationwide (NW)

For services not listed above, browse our Services categories or search our database.

* number of provider listings may vary by how states categorize services, whether providers are listed by organization or individual, how services are organized in the state, and other factors; Nationwide (NW) providers are generally limited to web-based services, provider locator services, and organizations that serve children from across the nation.

Authors & Reviewers

Initial publication: August 2016; last update/revision: February 2020
Current Authors and Reviewers:
Author: Jennifer Goldman-Luthy, MD, MRP, FAAP
Reviewer: Selena Harris
Authoring history
2016: first version: Mary Steinmann, MDR
AAuthor; CAContributing Author; SASenior Author; RReviewer

Page Bibliography

Bagnell AL.
Anxiety and separation disorders.
Pediatr Rev. 2011;32(10):440-5; quiz 446. PubMed abstract

Wehry AM, Beesdo-Baum K, Hennelly MM, Connolly SD, Strawn JR.
Assessment and treatment of anxiety disorders in children and adolescents.
Curr Psychiatry Rep. 2015;17(7):52. PubMed abstract / Full Text