Anxiety in children: What does it look like?
Do you know which mental illness people most frequently seek help from a GP for? Yep, anxiety. Do you also know that some studies suggest up to 30% of kids experience anxiety at some point in their lives? Thirty percent! And amazingly, other studies suggest that up to 80% of kids with anxiety never receive treatment! Now that is astounding. Why? Because anxiety disorders are actually really treatable!
Part of the problem is that children often lack the language to explain what’s happening, They can’t tell us how they feel when they’re anxious. And adults often don’t know how to spot the symptoms. Sometimes anxiety looks like the “shy” kid sitting in the back who doesn’t want to talk to others or participate in class discussions. But other times, it looks like the angry, defiant kid who won’t listen to you or do what you ask. And sometimes, anxious kids are really good at hiding the symptoms from everyone, but are feeling desperately unhappy on the inside. So how do you tell if your child is anxious? Let’s start at the beginning…
What is anxiety?
If you look up the definition of anxiety, you’ll likely find something about worry or nervousness. But it’s a little more than that. All children will experience some kind of anxiety during their lives. This is normal and expected. It is developmentally appropriate for your 12 month old to experience separation anxiety. For your toddler to be afraid of the dark. And for your 4 year old to become scared when there is a bad storm. But if your child is still scared to leave you at age 6, or your 10 year old still needs to sleep with the light on, or your 12 year old cannot leave the house when it rains, these things may be more of a problem.
To determine if your child’s anxiety is something that has become a serious problem, you need to look at the context in which it’s occurring. If your child’s fear is outside of the expected norm in terms of their developmental age, or of it is affecting their functioning or their emotional state, then you may be looking at an anxiety disorder. If they get a little bit worried about things sometimes, but it doesn’t interfere with their life too much, or they have skills to manage it, then you probably don’t need professional help. Everyone experiences anxiety sometimes. It is normal, and it is healthy – it’s how our brains keep us safe!
What are the symptoms of anxiety?
When we talk about “anxiety” as a mental health problem, we’re actually talking about a range of different, but related illnesses. There are a few anxiety disorders that can occur in childhood. These include separation anxiety, social anxiety, generalised anxiety, obsessive compulsive disorder (OCD), panic disorder and post traumatic stress disorder (PTSD). They all have slightly different symptoms, and are differentiated from each other based on the focus of the child’s worries. It’s not uncommon for a child to experience more than one type of anxiety in their lifetime, or even more than one type of anxiety at the same time.
The thing that all anxiety disorders have in common though, is that a child will experience cognitive, physical and behavioural symptoms of anxiety. It’s important to understand that all of these symptoms contribute to the overall experience of anxiety for a child. And to understand these symptoms of anxiety, we first need to understand what happens in the brain when a child (or anyone for that matter!) experiences anxiety.
The fight or flight response
The fight or flight response is an amazing thing. A chemical chain of events cleverly designed to protect us from danger whenever we encounter a threat. Here’s how it works:
We encounter danger. We experience fear. In response to that fear, our amygdala lights up. The amygdala (well, amygdalae – there are actually two of them!) is a small, almond shaped structure in the limbic system. It is like the brain’s emotional control centre. When the amygdala is activated, it causes other parts of the brain to release a range of hormones, including adrenaline and cortisol, the so called “stress hormone”. These trigger a range of physiological changes in the body which prepare it for action – to fight or to flee – and to therefore keep us safe from harm.
- Heart rate and blood pressure increase in order to get blood pumping to your arms and legs where it’s needed. You might feel like your heart is going a million miles an hour, about to burst right out of your chest.
- Your muscles will tense up as a result of all the blood being sent their way. This may cause you to feel a little shaky.
- Digestion slows down. You don’t need this while you’re fighting off danger so your body sends the energy your digestive system was using, to other parts of your body (like arms and legs). This may cause you to feel nauseous. And since saliva production has slowed down, you may have a dry mouth, too.
- Respiration rate increases as your body diverts oxygen to your muscles. Your breathing may become fast and shallow which can cause you to feel breathless.
- This extra oxygen your body is taking in disturbs the oxygen to carbon dioxide ratio in your blood. When your carbon dioxide levels become low, you can feel dizzy, or experience tingling and pins and needles in your hands and feet.
- Sweating increases so that you don’t overheat while fighting or running.
The problem with fight or flight
Now this all sounds perfectly reasonable doesn’t it? It’s a great system that keeps us very safe. As long as the threat is something we can fight or run away from. Like a wild animal. But what about when the threat is a biology exam? A work deadline? A public speaking event? We cannot fight or run away from these things. And that’s where the body runs into trouble.
These symptoms are really helpful when we’re dealing with short term, physical stressors. But they simply make us feel horrible when the stressor is a psychological one. Our brain still prepares us to fight or flee, because it senses a threat. But we don’t use up the adrenaline it sends us. The cortisol is still there. Just hanging around, causing problems for us. And when it’s a long term stressor, the body really struggles. Chronic stress can become quite toxic for the body. If the stress response never gets turned off, the limbic system remains in control. The prefrontal cortex – the area of the brain responsible for things like reasoning, decision making, problem solving, logical thinking – is unable to function properly. The immune system doesn’t work effectively, and we become sick. We can develop hypertension and heart problems. Our sleep can become disturbed. And we can become depressed and anxious.
Fight or flight and anxiety
In order for the fight or flight response to be triggered, we need to feel fear. We need to perceive that there is danger present. When someone is anxious, their fight or flight system becomes a little trigger happy. It works a little too well. The fight or flight response starts to be triggered even when there is no danger. The amygdala is doing its job. It’s just a little misguided. It perceives danger more frequently and overestimates the seriousness of that danger. The anxious person remains on high alert and struggles to turn off the stress response when it is being triggered so frequently. Sometimes the symptoms of the fight or flight response can even become a source of anxiety – especially for a child who may not understand why they are happening. The physical symptoms of anxiety can feel scary and confusing, and make us feel horrible.
So how do I know if my child is anxious?
If your child doesn’t have the language yet to tell you they are anxious, that’s ok. They will likely show you their anxiety in a number of ways – you just need to know what to look for.
If your child is complaining of frequent headaches, stomachaches, or other ailments, you may well be looking at fight or flight in action. If your child is complaining of a sore tummy, headaches, aches and pains or tense muscles on a regular basis, pay attention to what else is happening when these symptoms occur. Is it happening when they have to be separated from you? When they have a certain subject at school? When they are in a crowded shopping centre? Look for a pattern – it might be anxiety.
Well, it is called FIGHT or flight. If your child is anxious they may become aggressive. This is exactly what your body is supposed to be doing when faced with a threat. Remember that the thinking part of the brain shuts down when faced with a threat. They are not being “naughty”. And they are certainly not trying to make your life difficult on purpose. They have stress hormones and adrenaline flooding their little bodies and literally cannot think rationally. It doesn’t matter that you are not a threat. You represent the threat. Again, look for a pattern. If they are always aggressive in a particular situation, or in the lead up to a particular event, it may be because they are feeling worried about it.
Anxiety feels horrible. If your child knows they are going to experience anxiety in certain situations, they will try to avoid them at all costs. If your child: stops wanting to go to school, has a new reason why they can’t go to swimming lessons every week, won’t come out of their bedroom when people come over, or they stop asking to spend time with their friends, they may be trying to avoid feelings of anxiety.
Tantrums and meltdowns
If your child is suddenly melting into a puddle because you asked them to put their shoes away, or starts to cry every time you ask them if they’ve done their homework, it may be because they’re feeling anxious. Anxiety is a big, scary feeling for little people. Children often don’t understand what it is they’re feeling, or why it is happening. It feels overwhelming and they have no idea how to make it stop. They may be more sensitive or irritable than usual, because they are using up all their resources trying to deal with these feelings. It’s exhausting to be on high alert all the time!
If your child is frequently asking questions that begin with, “What if…” this may be a sign that they are worrying excessively. Especially if this is a new behaviour for them, or it has become worse recently. Anxious children are more likely than others to be worried about the future. They are constantly thinking about potential threats that could befall them or their loved ones. Their brain is running through all the possible scenarios and all the things that could go wrong. What if there is an earthquake? What if we have a car accident? What if I get it wrong? What if I fall? What if they don’t like me? Literally all.the.possibilities.
Reassurance seeking is a big one. When a child is feeling anxious, they will do whatever they can to alleviate the anxiety and feel safe. This means they will often seek reassurance from someone they trust. They want to know that everything is ok. And so they will ask you. Over, and over, and over again. If they are anxious when they are separated from you, this might look like frequent phone calls to check that you’re ok. They may ask you repeatedly to check their homework for mistakes. They may ask you multiple times if you locked the front door. They might ask you question after question about the new place they are going to today. If their friend will be there. Or they might simply ask, “Will everything be ok?”. A lot.
If your child is worrying about something you may notice a change in their sleep patterns. They may have trouble falling or staying asleep at night. They might experience nightmares or need you to stay with them while they fall asleep. They might climb into bed with you in the middle of the night when they never have before. It is very hard to switch off your brain when you’re feeling anxious, and with nothing else to do at night but lay in bed and think, it is very common for fears to become worse during this time.
Problems in class
If you have a school aged child, you may notice their grades dropping. Their teacher may mention that they seem to be having trouble concentrating or focusing in class. Worrying takes a lot of mental energy, and it can be difficult to focus on other things when your mind is constantly on the lookout for danger. They may be having trouble completing their work. This could be because they can’t concentrate, or because they are worried about it being “perfect”. If they are becoming distressed when they make errors, or writing and rewriting the same assignment or homework task multiple times, they may be experiencing anxiety.
If you notice that your child has certain rituals or routines that they need to complete, and that they become incredibly distressed if they are unable to, you may be looking at anxiety. Examples include having to line their toys up in a certain way and becoming distressed if someone moves them, counting things, checking things repeatedly, having to complete a certain routine before bed, and washing their hands a certain way, or a certain number of times. Please understand that this is different to just wanting things a certain way, This kind of behaviour interferes with your child’s ability to enjoy their life and causes great distress when it can’t be done.
Panic attacks are basically the fight or flight response on overdrive. They can come on quite suddenly, so that the child doesn’t realise it’s happening until they are in the thick of it. And it can be difficult for children to identify what has caused one. The symptoms include breathlessness, chest pain, sweating, shaking, nausea, pounding heart and dizziness. All of the things that happen when the body enters fight or flight mode. They will also experience intense fear or anxiety. Many people experiencing a panic attack worry that they will die. They think something is wrong with them. The panic attack itself becomes the source of the fear. The symptoms will usually last around 15 mins and then go away on their own as the body realises that there is no threat. Panic attacks are scary, but they are not harmful.
Now ultimately, you know your child best, and this is by no means an exhaustive list. If you notice any changes in your child and you think it may be anxiety, keep an eye on it. If they are unable to talk to you about it and/or it becomes worse, consider seeking help from a professional. A GP or a school counsellor are great places to start. And if you’d like to know how you can help your child yourself, check out the next instalment in my anxiety series, 12 Ways to Help your Anxious Child.
Sarah is a psychologist, mama of 4 and the creator of Mindful Little Minds. She has over 10 years of experience working with children, adolescents and families experiencing mental health problems and has a special interest in anxiety disorders in children. In her spare time she enjoys hugging her kids, drinking coffee, and telling anyone who’ll listen how tired she is.