Childhood Anxiety Disorders



What is an anxiety disorder? 

Childhood anxiety is when a child has extreme fears and worries. Children can develop anxiety for a number of reasons. Children can inherit anxiety genetically through other family members that have anxiety. Childhood anxiety can also occur after experiencing a traumatic event such as the loss of a loved one or if they've experienced violence and abuse. When a child is raised around adults who are anxious, they can learn those fears and develop anxiety as well. 

When a child has anxiety it can effect them in many different ways. They may have mood swings, trouble sleeping, unusual eating habits and they may also display behavioural challenges as well.



Signs & Symptoms Of Childhood Anxiety 


- Stomach pain

- Headaches

- Wetting in their beds 

- Socially withdrawn
 
- Anger

- Not wanting to go to school 

- Aggression

- Refusing certain situations 

- Sleeping issues 


- Nightmares

- Changes in their appetite

- Chewing their nails

- Tense muscles

- Tired or fatigue
 
- Changes in mood or irritability

- Avoiding situations 

- Avoiding people 

- Not enjoying things they used too 




According to the Centers for Disease Control and Prevention (CDC) here are some facts about mental disorders in U.S. children:


ADHD, behaviour problems, anxiety, and depression are the most commonly diagnosed mental disorders in children

9.4% of children aged 2-17 years (approximately 6.1 million) have received an ADHD diagnosis.

7.4% of children aged 3-17 years (approximately 4.5 million) have a diagnosed behaviour problem.

7.1% of children aged 3-17 years (approximately 4.4 million) have diagnosed anxiety.

3.2% of children aged 3-17 years (approximately 1.9 million) have diagnosed depression. 

Some of these conditions commonly occur together. For example:

Having another disorder is most common in children with depression: about 3 in 4 children aged 3-17 years with depression also have anxiety (73.8%) and almost 1 in 2 have behavior problems (47.2%).

For children aged 3-17 years with anxiety, more than 1 in 3 also have behaviour problems (37.9%) and about 1 in 3 also have depression (32.3%).

For children aged 3-17 years with behavior problems, more than 1 in 3 also have anxiety (36.6%) and about 1 in 5 also have depression (20.3%).


Types of childhood anxiety


- Separation Anxiety Disorder

- Obsessive Compulsive Disorder (OCD) 

- Selective Mutism (SM) 

- Phobias


- Panic Attacks (Panic Disorder)

- Generalized Anxiety Disorder (GAD) 

- Social Anxiety Disorder

- Post-Traumatic Stress Disorder (PTSD) 


Separation Anxiety

Most younger children tend to feel anxiety when they leave their parents to go to daycare or with a relative for the night, that's normal. They're simply not used to being away from their parents so it is an adjustment, however, when they get older and they are still really struggling, it could be separation anxiety. 

Often times, children will miss events or even days at school by pretending to be sick, in order to stay home with their parent(s). In addition, it is common for these children to be afraid of being in a different room than their parent(s) or sleeping alone in their bed without them. 

- Having tantrums

- Not wanting to go to bed

- Wanting to be picked up early from school or activities 


- Refusing to go places without their parent 

- Not wanting to go to child care or having a babysitter

- Clinging to their parents





Obsessive Compulsive Disorder

Children with OCD have repetitive thoughts about obsessions, they have compulsions, they often repeat the same phrases or words, they repeat the same actions such as hand washing, they check things all the time and they often need things to be a certain way.

Compulsions 

- Checking things over and over

- Constantly washing hands/avoiding germs 

- Repeating words, names or phrases 

- Regularly checking for reassurance 

- Counting items they see/touch, counting steps 
Obsessions

- Worrying about germs or being dirty 

- Fear loved ones will get sick or be hurt 

- Afraid of losing something they love 

- Needing everything to be a certain way in order etc. 





Selective Mutism

Children who have Selective Mutism will usually only speak to people they know very well and are comfortable with such as their parents, people at school or family members. These children get very anxious and don't speak so to most people they just appear to be shy, so often times they go undiagnosed. 



Phobias

A phobia is an extreme fear of something specific. Children may have a fear of a person, a type of person, places, animals, bugs or situations. An event or object is often what triggers them to be anxious. For the most part, all children fear the same things but it's the level of fear and degree of anxiety they are experiencing that makes these fears problematic. 

Children with phobias feel fear so intense that it can disrupt their routine and daily living, often times hindering their ability to concentrate, enjoy activities or relax. These children will cling to their parents, cry and be fearful. Here is a list of common phobias children may have:


- Getting needles (bloodwork, IV or shots)

- Spiders and bugs

- Having someone they love get sick or hurt

- Heights


- Thunder storms and lightening 

- Flying or travel away from home
 
- Enclosed spaces 




Panic Attacks

Panic Attacks are sudden unexpected anxiety. The triggers are not always obvious and can happen when you least expect it to. It can be very difficult to see your child suffering from panic attacks as they are extremely frightening for a child. 

The symptoms of a panic attack can be different for each child. When children have panic attacks in certain places or while doing certain activities, the fear of having another panic attack in the same place or while doing the same activity can lead to a develpment of  agoraphobia. 


Here are some common symptoms of panic attacks: 


- Chest pains

- Shortness of breath

- Faint or dizzy 

- Feeling sick 

- Sudden urge to use the restroom 

- Hyperventilating 



- Sweating 

- Fear of losing control

- Shaking

- Fast heart rate 

- Stomach pain 


Generalized Anxiety Disorder

Children who have generalized anxiety disorder worry excessively about a variety of things. A child who has generalized anxiety may constantly look for reassurance and seek out perfection. 

These children tend to worry about natural disasters, school work/grades, friends, family, relationships, health and how well they are doing during activities. They usually ask "what if" questions and worry about things that are out of their control.


Social Anxiety Disorder 

When a child has social anxiety they are often afraid that people may say things about them, they get embarrassed by something possibly happening or that they may not act appropriately, they are afraid that they may say the wrong thing to other children and they also don't like to bring attention to themselves. 

A child with social anxiety can feel uncomfortable talking to other kids in their class, public speaking/speaking in front of their peers, going to birthday parties, attending activities, eating in public, going to school or talking on the phone. 



Post-Traumatic Stress Disorder

Children with PTSD have experienced a traumatic event which can lead to the development of an exaggerated anxious stress response. An example of this is if they have experienced a stressful life event such as a natural disaster or if they have been abused. Children who are most at risk of developing post traumatic stress disorder are children who witnessed a traumatic event and were hurt directly or already have other anxieties prior to the traumatic event. 

A child with post traumatic stress disorder can re-experience trauma and have nightmare's or think about their past traumatic experiences. Children are resilient, the good news is that many children who have experienced a traumatic event will not develop PTSD or they will recover in a small amount of time. Signs/symptoms to look for in a child with PTSD are as follows:




- Ongoing fears

- Sadness

- Sleep disturbance 

- Nightmares

- Avoiding people, places or things that are reminders of the traumatic event


- Reliving traumatic event 

- Anger outbursts 

- Being withdrawn

- Feeling of numbness

- Reacting when something reminds them of traumatic event (seeing something, a smell etc.) 





The Fight-or-Flight & Freeze Response

Flight or flight & Freeze is when a child's body naturally prepares for an attack and gets ready for a threat. In highly anxious situations the fight or flight & freeze response is triggered. This is what our bodies do to react to dangerous situations. Anxiety is an emotion that protects us from harm and danger but for some children it can happen when they are not in danger at all. 

After a traumatic event in a child's life, they can develop an exaggerated anxious stress response. This is usually if the child has PTSD, have been abused or have experienced a stressful life events such as a natural disaster. 

It is important to explain to your children why they are reacting in fight or flight & freeze so that they don't blame themselves or believe that something is wrong with them. 

When your child is having a fight, flight or freeze response help them practice and focus on their breathing. Avoid asking them to calm down as they are unable to reason with you while they are feeling this way. Reassure them, remind them to focus on their breathing and once they begin to calm down you can start some calming activities. Sensory Activities could include yoga, heavy work activities or sensory calming activities. 


What triggers a fight, flight or freeze response?


- Sensory Processing Disorder (sensory overload SPD) 

- Transitions from one place to another 

- Feeling lonely or rejected by peers
 
- Feeling unsafe

- If they are hungry or thirsty 


- Transitioning from one activity to the next activity 

- When they feel they could be in trouble

- When their routine changes unexpectedly

- Changes they weren't expecting (unpredictability) 





What are symptoms of flight, fight and freeze? 


Freeze (hypo-arousal)  

- Feeling disconnected 

- Feeling like they can't move

- Numb 

- Difficulty speaking

- Holding their breath

- Shut down

- Heart racing 

- Feeling trapped 


Flight (hyper-arousal)  

- Fidgeting

- Restless 

- Can't sit still

- Wanting to run away or get away from the situation 

- Heavy breathing

- Hiding


Fight (hyper-arousal)   

- Yelling and raising their voice 

- Aggressive

- Arguing

- Glaring

- Stomping

- Kicking

- Hitting

- Feeling irritable

- Clenching their fists

- Tightening their muscles and being tense 

- Throwing things

- Clawing or Scratching

-Pushing

- Spitting 

- Screaming 

- Rage

- Anger 




There are many relaxation techniques that children can learn as well as therapies to help them with their stress responses and anxiety such as: 


- Deep breathing

- Yoga

- Mindful activities

- Exercise

- Coloring and painting 

- Listening to calming sounds or music

- Meditation


- Visualizing things, places or people that make them happy 

- Taking a sensory break 

- Cognitive Behavioral Therapy (CDT) 

- Acceptance and commitment therapy (ACT) 

- Supportive Parenting for Anxious Childhood Emotions (SPACE) 





How do I get help for my child who may have anxiety? When should I seek professional help for my anxious child? 

You should reach out to a professional and seek medical advice if your child is:

- Always on edge

- Constant persistent worries

 - Always nervous

- Scared about many things

- Upset several times a day

- Having several daily meltdowns/ tantrums

- Avoiding different situations 

- Displaying stress that is interfering with their daily life

- No longer has the ability to relax

- Having increased fears which disrupts their family life 

If you are concerned that your child may be experiencing childhood anxiety, find a local therapist, child psychologist or counsellor that is properly trained to treat children with anxiety disorders. Meet with them to speak about your concerns and ask how they can help your child. A therapist, child psychologist or counsellor that is trained to help children who are struggling with childhood anxieties can put together a plan with you to help your child. 

Once you have set up an appointment for your child to meet their therapist, child psychologist or counsellor encourage your child to talk about their feelings. 

Help your child face their fears gradually. It is important not to avoid their fears. You can help them by being positive and taking small steps to overcome their fears. A therapist will also be able to give you ideas moving forward in therapy. 

Remember to be patient and understanding with your child, It takes a lot of courage for your child to talk about their anxiety. It takes incredible strength to take the steps needed to work on their anxiety and get better. 

Offering comfort, understanding and positive responses to your child will help them a lot.


Here are some tips to help your child when they are struggling with childhood anxiety. 


- Make a worry box (they write down what they are worried about and put them in the box 

- Provide a bag of tools that can be calming for your child such as fidgets, weighted lap pad etc. 

- Encourage calming activities that your child can participate in to keep them calm and not stressed 

- Write their worries and fears in a journal 

- Worry dolls/worry eaters can be a great tool for kids 

- Learn and practice different breathing techniques together

- Social stories for children with anxiety can also be a great tool 


- Exercise regularly 

- Eating healthy meals 

- Start attending yoga sessions for children and parents 

- Keeping them busy gives them less time to think 

- Reading children's books about anxiety. It's important that they understand what anxiety is and why they're feeling how they do 

- When you notice that your child is being brave and doing well with their anxiety, cheer them on! Take notice and let them know they are doing a great job





Calming a child when they are anxious


- Create a calm down area at home with calming and relaxing tools 

- Give your child a cold glass of water 

- Squeeze fidgets or playing with dough

- Hugs! Hugs are a great way to help children feel calm


- Name animals alphabetically 

- Breathing exercises 

- Ask your child to close their eyes,  visualize their favorite place and describe it to you 

- Use a weighted blanket or weighted a weighted lap pad/weighted animal 


FREE Apps that can be helpful tools for children who have anxiety


Breathe, Think, Do with Sesame (FREE) 

This is a resourcful app for you to share with your child to help teach skills such as problem solving, self-control, planning, and task persistence.
Laugh and learn as you help a Sesame Street monster friend calm down and solve everyday challenges. This bilingual (English and Spanish), research-based app helps your child learn Sesame’s “Breathe, Think, Do” strategy for problem-solving. Tap and touch to help the monster friend take deep breaths, think of plans, and try them out! Your child will enjoy silly animations and playful interactions as she is exposed to important emotional vocabulary, a calm breathing technique, personalized encouragements, and more!


Stop, Breathe & Think Kids (FREE) 

Meditation and mindfulness made easy and fun for kids, to help them discover and develop their superpowers of sleep, being calm, learning to breathe or to resolve conflicts.
From the creators of the award-winning app for adults, Stop, Breathe & Think Kids is a mindful games app designed specifically for kids ages 5 - 10. Kids can check into how they are feeling using fun emojis and try recommended mindful missions and meditations tuned to those emotions. Stickers reward their progress and keep the mindful activities engaging.
The kids meditation and mindful missions in Stop, Breathe & Think Kids were developed in collaboration with activity-based mindfulness expert Susan Kaiser Greenland, creator of the Inner Kids program and author of Mindful Games and The Mindful Child.


Super Stretch Yoga (FREE) 

Top 100 Health & Wellness app on iTunes! Super Stretch is a fun, interactive yoga app created for kids, used by the whole family!
Move, play and breathe as Super Stretch introduces you to his friends and their yoga poses. Super Stretch is your guide who takes you on your journey.
Using storytelling, animation and video examples, kids enjoy making NAMASTE a part of their day. NAMASTE is The Adventures of Super Stretch’s secret code to help kids learn to find balance and strength in their lives. Be the best you can be! Practice poses, collect 12 stars and get a team photo. Each of Super Stretch's friends helps us learn how to use movement and breathing to make every day balanced. Then, real-life kids demonstrate the pose. So easy and entertaining we forget that it’s exercise.


Childhood Anxiety & Worry Books For Children
 
What to Do When You Worry Too Much: A Kid's Guide to Overcoming Anxiety
Did you know that worries are like tomatoes? No, you can't eat them, but you can make them grow, simply by paying attention to them. If your worries have grown so big that they bother you almost every day, this book is for you.
What to Do When You Worry Too Much guides children and parents through the cognitive-behavioral techniques most often used in the treatment of anxiety. Lively metaphors and humorous illustrations make the concepts and strategies easy to understand, while clear how-to steps and prompts to draw and write help children to master new skills related to reducing anxiety.

How To Tame My Anxiety Monster (Mindful Monster Collection) 
Do you have an anxiety monster that is big, and wild, and likes to visit you? Is there any way to tame him? Can he be a helpful monster that you just might not mind having around? Find out in this delightful new book with practical solutions just for kids that deal with anxiety. Your child may also feel empowered by the child in this story as he becomes more confident. While learning new coping strategies to deal with his anxiety, his monster shrinks. He may not be able to make his monster go away completely, but he can learn to tame him! In the back section of this book are some parent helps that can be great conversation starters for children and parents that deal with anxiety.

I Am Stronger Than Anxiety: Children’s Book about Overcoming Worries, Stress and Fear (World of Kids Emotions)
Often face with kids’ anxiety and still have no idea how to deal with children’s big emotions and feelings? Try this entertaining picture book and learn how to help children cope with their worry and stress.
All children worry from time to time and it is a normal part of growing up. But, when anxiety becomes overwhelming, it can greatly affect kids’ behavior. It may lead to a feeling of stress, exhaustion, isolation and many others. It is very important to be aware of these emotions and to know how to deal with them in a healthy way.

A Little SPOT of Anxiety: A Story About Calming Your Worries
Anxiety comes from feelings of being worried, scared, or anxious. When these feelings are in small amounts that’s okay because they are there to help protect us, but when they get TOO BIG, they become overwhelming and need to be managed. When a child experiences anxiety it can prevent them from doing what he/she wants and and/or needs to do, which can make anxiety a disability.
This story addresses how anxiety can affect all ages and how it can show up in all different situations. The Gray SPOT in the story creates a visual representation of Anxiety so that a child can see when it's gets too big, and how to shrink it back to a Green PEACEFUL SPOT.


Tools & Toys To Help Children with Worrying & Anxiety 

Worry Monster Soft Plush Toy Pink and Green Childrens Write Down Your Worries Cuddly Toy Gosh! Designs 9”
Meet the worry monster who will save your child from their worry's. When night falls, it's time for dreams. Nice, funny, sad or exciting dreams are fine, but being woken by a horrible nightmare is really upsetting. Fortunately for children, there are the Worry Eaters! Every night and every day they turn fears, worries or bad moods into nice stories to enjoy together or alone. Worry monster loves to eat worries - they are his favourite meal! Yum yum. Just make sure you take him with you wherever you go. The worry monster's motto is 'We eat your worries'. They are recommended by psychologists and teachers to act as a waste bin for the fears, troubles and woes that they don't always tell their parents about. Height: Approx. 35 cm Hand washable.

Worry Monster Soft Plush Toy Blue and Orange Childrens Write Down Your Worries Cuddly Toy Gosh! Designs 9”
Meet the worry monster who will save your child from their worry's. When night falls, it's time for dreams. Nice, funny, sad or exciting dreams are fine, but being woken by a horrible nightmare is really upsetting. Fortunately for children, there are the Worry Eaters! Every night and every day they turn fears, worries or bad moods into nice stories to enjoy together or alone. Worry monster loves to eat worries - they are his favourite meal! Yum yum. Just make sure you take him with you wherever you go. The worry monster's motto is 'We eat your worries'. They are recommended by psychologists and teachers to act as a waste bin for the fears, troubles and woes that they don't always tell their parents about.











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