Contents
- What anxiety in children is
- Causes and risk factors for anxiety in children
- Types of childhood anxiety
- Symptoms of anxiety in children
- Diagnosing anxiety in children
- Treatments for anxiety in children
- Complications associated with anxiety disorders in children
- Ways of preventing anxiety in children
- Recommendations for parents and teachers
What anxiety in children is
Anxiety in children is a normal and sometimes beneficial emotional reaction, marked by a state of fear, unease or worry in the face of a perceived danger or a stressful situation. However, when anxiety becomes excessive and persistent and interferes with the child's daily functioning, it can be classified as an anxiety disorder.
Although the words used to describe anxiety are old, its recognition as a clinical disorder in children is relatively recent in the history of psychiatry. It was only in the second half of the twentieth century that childhood anxiety was formally recognised and diagnosed, partly thanks to progress in understanding children's emotional and psychological development.
The standard manual currently used to diagnose mental disorders, the DSM-5, describes anxiety disorders in children through a series of criteria: the presence of excessive fear or worry, symptoms lasting at least six months (for most types), impaired social, academic or family functioning, and the exclusion of other medical or psychiatric conditions. The DSM-5 includes the following in the category of childhood anxiety disorders: separation anxiety, selective mutism, specific phobia, social anxiety disorder, generalised anxiety disorder and panic disorder.
Causes and risk factors for anxiety in children
1. Genetic factors
Studies show that genetic predisposition plays an important part in the development of anxiety disorders. Children with family members who have a history of anxiety or other psychiatric disorders are at higher risk of developing similar symptoms. Genetic inheritance can influence the reactivity of the nervous system and the level of sensitivity to stress.
2. Family environment and parenting style
An insecure, conflict-ridden or overprotective family environment can contribute significantly to the onset of anxiety. An anxious or controlling parenting style, for example, can convey to the child the idea that the world is dangerous and unpredictable, increasing the risk of excessive fear. A lack of emotional support or emotional neglect are further risk factors.
3. Early trauma and stressful experiences
Children who have been through trauma, such as abuse, neglect, accidents, illness or their parents' divorce, may develop anxiety disorders. Early stressful experiences affect the development of the brain and of the emotional regulation system, predisposing the child to disproportionate fear reactions to everyday stimuli.
4. Biological and neurological factors
Neurochemical imbalances, especially those involving neurotransmitters such as serotonin and dopamine, can influence the level of anxiety. Brain structures involved in processing fear, such as the amygdala, can also be overactive in anxious children.
5. Social and contextual factors
Difficulty fitting in socially, bullying, frequent changes of environment (school, home), academic pressure or the absence of a support system can all encourage the development of anxiety. Children who feel excluded or misunderstood in their social environment may internalise these difficulties as intense fears.
Types of childhood anxiety
1. Separation anxiety
This is one of the most common forms of anxiety in children, especially between the ages of 1 and 7. It shows itself as excessive fear of being separated from parents or main caregivers. The child may refuse to go to nursery or school, to sleep alone or to stay without a trusted adult, and may cry intensely, have panic attacks or develop physical symptoms.
2. Social anxiety (social phobia)
This shows itself as an intense fear of being judged, laughed at or rejected in social settings. Children with social anxiety may avoid speaking in public, taking part in group activities or starting interactions. They often see their own performance as inadequate and fear humiliation.
3. Generalised anxiety disorder
Children with this disorder experience excessive, persistent worries about several areas of life (school, family, health, safety). These worries are often accompanied by muscle tension, fatigue, irritability and sleep disorders. The worry appears even when there is no clear reason for it.
4. Specific phobias
These involve intense, irrational fears of specific objects or situations, such as the dark, animals, heights or medical appointments. Exposure to the feared stimulus causes panic reactions and sometimes complete avoidance of it, which can restrict the child's daily activities.
5. Selective mutism
This is a rare but significant form of anxiety in which the child refuses to speak in certain social settings (at school, for instance) even though they are perfectly able to communicate in other contexts (at home). Selective mutism is often associated with severe social anxiety.
6. Panic disorder
Although rarer in young children, this disorder can appear in preteens and teenagers. It is characterised by the sudden onset of panic attacks - episodes of intense fear accompanied by physical symptoms such as palpitations, difficulty breathing, dizziness and the fear of losing control or of dying.
Symptoms of anxiety in children
1. Excessive fear or worry
A core symptom of anxiety is fear or worry out of all proportion to the actual situation. Anxious children may fear future events, failure, illness or losing the people close to them, even when there is no real danger. These thoughts are recurrent and hard to control.
2. Avoiding situations or people
A child with anxiety may start avoiding school, extracurricular activities, social interaction or any situation that frightens them. This avoidance can lead to social isolation, academic setbacks and impaired personal development.
3. Physical symptoms (somatisation)
Anxiety in children frequently shows itself through physical symptoms such as headaches, stomach aches, nausea, muscle tension, palpitations or difficulty breathing. These often appear in stressful contexts (for example, in the morning before school) and can be mistaken for medical problems.
4. Sleep problems
Anxious children have trouble falling asleep or staying asleep through the night. They may have frequent nightmares, insomnia or refuse to sleep alone. Lack of sleep contributes to irritability and to poorer performance during the day.
5. Clinging behaviour
Another common sign is clinging behaviour towards parents or trusted adults. The child may refuse to be left alone, to sleep without an adult present or to take part in activities without a supportive figure nearby. This behaviour reflects the need for safety in an environment perceived as threatening.
6. Irritability and anger
Although they are not always linked to anxiety, irritability and angry outbursts can be expressions of inner stress. The child may feel overwhelmed by their own emotions and react impulsively to frustration, particularly when they cannot put their fear into words.
Diagnosing anxiety in children
Diagnosing anxiety disorders in childhood requires a complex, multidimensional approach. The assessment is usually carried out by a clinical psychologist or a child and adolescent psychiatrist. The process includes:
- Clinical interviews with the child and the parents, to understand the history of the symptoms and the family and school context.
- Standardised questionnaires such as SCARED (Screen for Child Anxiety Related Disorders) or RCADS (Revised Child Anxiety and Depression Scale), which assess the level and type of anxiety.
- Behavioural observation in different settings (home, school) in order to identify patterns and functional impact.
- Ruling out other medical conditions (endocrine or neurological problems) in collaboration with the paediatrician, where appropriate.
It is essential that the diagnosis is made carefully, to avoid confusion with other disorders such as ADHD, autism or depression.
Treatments for anxiety in children
1. Cognitive behavioural therapy (CBT)
CBT is considered the gold standard in treating anxiety in children. This form of therapy helps the child identify and restructure irrational thoughts, learn relaxation techniques and face their fears gradually and in a controlled way (through guided exposure). It is effective both in individual therapy and in a group format.
2. Family psychotherapy
Involving the family in therapy is crucial. Parents can learn how to support their child without reinforcing avoidance or fearful behaviour. Interventions may also aim to reduce parental anxiety and improve communication within the family.
3. Neurofeedback therapy
Neurofeedback is a non-invasive technique that trains the brain through real-time feedback on its electrical activity (EEG). During the sessions the child learns - usually through a video game controlled by the brain - to regulate their own brain activity, using neurofeedback to reduce the overactivity in the regions involved in anxiety (such as the amygdala).
4. School-based interventions
Coordination with the school is often necessary. Adjustments may include anti-bullying programmes, special breaks for the child, emotional support from the school counsellor and a plan for gradual reintegration into activities (where there is school phobia or separation anxiety).
5. Medication
In moderate to severe cases, especially where psychological therapy has no effect, anxiolytics or antidepressants may be prescribed. The decision to use medication is taken only by the psychiatrist, with careful monitoring.
6. Mindfulness and relaxation techniques
Controlled breathing, mindfulness exercises and progressive muscle relaxation are accessible methods that help the child calm their nervous system. These techniques can be built into the daily routine, at home or at school.
7. Play therapy
For young children, play is a natural form of emotional expression. In a therapeutic setting, guided play makes it possible to explore fears, build confidence and develop healthy ways of regulating emotions.
Complications associated with anxiety disorders in children
1. Somatic and physiological problems
Anxious children are more prone to functional somatic disorders such as chronic abdominal pain, migraines, nausea or digestive problems (irritable bowel syndrome). Anxiety affects the autonomic nervous system, generating excessive activation which, over time, can lead to physical exhaustion or even to endocrine and immune disorders.
2. Sleep disturbances
Untreated anxiety has a profound effect on sleep quality, which in the long run has a negative impact on cognitive, emotional and physical development. Lack of sleep can aggravate anxiety symptoms and reduce the capacity for concentration, emotional regulation and resilience to stress.
3. Delayed social development
Anxious children often avoid social interaction, which limits the development of communication, empathy and cooperation skills. Without intervention, these children may become withdrawn or isolated teenagers who struggle to build healthy relationships.
4. Declining school performance
Anxiety can lead to poor results at school, not for lack of ability but because of problems with concentration, absenteeism or freezing during assessments. Fear of failure or excessive perfectionism can become paralysing in an academic setting.
5. The risk of other mental disorders
Untreated anxiety increases the risk of developing associated disorders such as depression, eating disorders or addictions (in adolescence). There is also a higher risk of developing personality disorders or suicidal behaviour later in life.
Ways of preventing anxiety in children
1. Fostering a secure attachment
One of the most important protective factors is a secure relationship with parents or caregivers. A child who feels listened to, emotionally validated and protected develops a positive self-image and a better capacity to handle frustration or fear.
2. Developing emotional intelligence
Learning early on to recognise and express emotions helps the child manage stress and anxiety. Social and emotional learning programmes, whether at home or at school, contribute significantly to preventing emotional disorders.
3. Reducing pressure and perfectionism
It is important for parents and teachers to encourage a climate in which mistakes are accepted and seen as part of the learning process. Constant pressure to perform or comparisons with other children can induce harmful anticipatory anxiety.
4. Gradual exposure to new situations
Encouraging exploration, independence and moderate risk-taking (speaking in public, taking part in extracurricular activities) helps build self-confidence and reduces anxious sensitivity.
5. Keeping an eye on screen time
Excessive consumption of digital content, especially in the absence of real interaction, can heighten anxiety symptoms. Sensory overstimulation or exposure to alarming information can upset a child's emotional balance. A balanced lifestyle, with physical activity and time outdoors, is essential for prevention.
Recommendations for parents and teachers
Parents should pay close attention to the early signs of anxiety and avoid labelling the child as "shy" or "too sensitive". A warm, empathetic and predictable family climate helps the child feel safe. Instead of playing down their fears ("There is nothing to be afraid of"), parents can validate the child's emotions ("I know you are feeling uneasy right now") and then actively support them in facing the fear step by step. It is also essential that adults manage their own anxieties so as not to pass them on to the child unintentionally.
Teachers play a crucial part in supporting pupils with anxiety by creating an inclusive, encouraging school environment. It is important to give the child opportunities to succeed and emotional support without exposing them abruptly to stressful situations. They can, for example, offer alternative forms of assessment, encourage the child to take part in activities at their own pace and work together with parents and mental health specialists. Open communication and careful observation of behaviour are essential for early intervention.
Discover how neurofeedback can transform the way your child copes with anxiety.
This modern, non-invasive therapy trains the brain to function in a more balanced way, reducing stress and improving concentration and emotional state. If you are looking for a gentle, neuroscience-based solution to complement or replace traditional treatments, book a call with a specialist and find out whether neurofeedback is right for your child.
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