• Below is some helpful information about children and anxiety & stress. The information is not intended to take the place of a trained mental health professional. If at any time you think your child needs help dealing with anxiety or stress please contact me for referrals or assistance.

    Anxiety & Stress


    Anxiety Overview:

    ·         Anxiety can be part of normal development

    ·         Anxiety ranges from being alert to possible danger to a state of impaired functioning

    ·         One of the most common mental health conditions in children and adolescents

    ·         Everyone may have occasional moments of feeling anxious or worried, an anxiety disorder is a medical condition that causes people to feel persistently, uncontrollably worried over an extended period of time

    ·         Anxiety disorders may not be recognized both because children may try to hide symptoms & because their symptoms are experienced internally and may not be easily seen

    ·         Other conditions may also be present; having one issue does not mean a person cannot have another as well.  Other difficulties may co-exist such as, attention deficit disorder, learning disabilities, depression, etc…


    Anxiety Symptoms:

    ·         Worry, poor concentration, poor memory, poor attention, poor problem solving, over sensitivity, restlessness, nervousness, withdrawal, erratic or irrational behavior, running away, aches & pains, bed wetting, nausea, vomiting, perspiration, tension or a rapid heart rate


    When to be concerned

    ·         Morbid fears of accidents or illnesses affecting oneself or significant others

    ·         Constant seeking of reassurance about school performance, friendships, upcoming events

    ·         Frequently seeking to stay home from school

    ·         Worrying incessantly about appearance, clothing, behavior, possessions, & future events

    ·         Frequent physical symptoms related to anxiety, such as sweating, nausea, excessive talking, pacing, trembling

    ·         Sleep difficulties (especially in younger children)

    ·         Clinging to parents in public (especially in older children)


    Helping an anxious child


          Helping an anxious child- At home

    ·         Understanding the nature of the problem (consultation with a mental health professional may be needed) & realizing stress my exacerbate symptoms

    ·         Encourage the child to help develop interventions. Enlisting the child in the task will lead to more successful strategies & will foster ability to problem-solve

    ·         Be consistent in handling your child & administering discipline

    ·         Set & maintain realistic, attainable goals, & expectations

    ·         Maintain a consistent routine regarding homework, chores, activities, etc…

    ·         Transitions may be particularly difficult for these children, allow extra time for moving to another activity or location. When a child with anxiety refuses to follow directions, for example, the reason may be symptoms of anxiety rather than intentionally oppositional.

    ·         If a child has difficulty separating…a firm, caring, & quick separation is best

    ·         Develop relaxation techniques/visualization to help reduce anxiety

    ·         Provide alternative activities to distract the child from physical symptoms- calming activities may be helpful

    ·         Encourage small group interactions to develop increased areas of competency

    ·         Provide assistance with peer interactions

    ·         Reward a child's efforts

    ·         Listen & talk to your child when she or he reports feeling worried or tense about upcoming or imagined events.  Do not treat these feelings as “silly” or unimportant, because they are important to the child.  Listen with interest & concern, & give advice only when asked

    ·         Do not assume the child is being difficult, or that the problem will just “go away.”  There is evidence that some anxiety problems can persist into adulthood.  Therefore, early identification and interventions can be very important


    Helping the anxious child - In School

    ·         School faculty & parents together may be able to identify patterns of difficulty & develop remedies to reduce a child's challenges

    ·         A flexible & supportive environment.

    ·         Encourage the child to help develop interventions

    ·         Establish check-ins on arrival to facilitate transition into school

    ·         Accommodate late arrival due to difficulty with transitions

    ·         Transitions may be difficult so allow extra time for moving to another activity or location

    ·         If the child is avoiding school, determine the cause of the child's reluctance & address it, & initiate a plan to return to school as quickly as possible

    ·         Identify a "safe" place where the child may go to reduce anxiety during stressful periods. Developing guidelines for appropriate use of the safe place will help both the student and staff.

    ·         Assist with issues of social isolation or withdrawal from interactions with peers

    ·         Be aware of low self-esteem in social and academic activities

    ·         Adjust the homework load to prevent the child from becoming overwhelmed

    ·         Recognize problem behaviors, such as fights or arguments, may be a result of misunderstandings between the child & peers or staff

    ·         Be aware concentrating & work completion may be difficult due to preoccupation with anxious symptoms

    ·         Allow more time to complete certain types of assignments

    ·         Work collaboratively with parents and outside mental health professional


    Treating anxiety with a mental health professional

    ·         Individual or family counseling (identification & intervention)

    ·         Behavioral interventions & Cognitive-Behavior therapy to change perceptions, monitor level of distress, relaxation/visualization to reduce anxiety

    ·         Improvement of skills in specific areas related to anxiety:  social skills, study skills, organizational skills, anger management, etc…

    ·         When other interventions are not effective & in cases of extreme anxiety- medication may be warranted


    Types of Anxiety disorders


    ·         Generalized Anxiety Disorder (GAD)- anxiety that occurs in multiple settings, involving excessive apprehension about a number of situations on most days

    o   A child with (GAD) may have a combination of the symptoms listed:

    §  Excessive worry and anxiety about a variety of matters

    §  Repeated seeking of approval

    §  Inability to explain the worries. Children may not understand why they are so anxious.

    §  Inability to stop the worry- despite adult reassurance

    §  Difficulty transitioning from home to school or other activities

    §  Refusal, reluctance, avoidance to attend school or other activities.   Anxiety may lead a child to insist on staying at home.

    §  Self-criticism and low self-esteem

    §  Difficulty concentrating due to persistent worry, which may affect a variety of activities, from following directions and completing assignments to paying attention


    ·         School Avoidance /School Refusal/School Phobia - children with a pattern of avoiding or refusing to attend school

    o   Most stay in contact with caregivers & are frequently anxious & fearful

    o   Anxious about home issues or separating from caregiver

    o   Children may have been able to separate previously & now have an issue

    §  Due to a recent crisis, struggling in school, social concerns, transiting to a new school/grade, or students who may have missed a lot of school due to illness

    o   Best strategy is to inform the child calmly the parent will return & the child must stay, then leave quickly

    o   Rapid intervention is best- the longer the behavior occurs, the harder it is to treat


    ·         Separation anxiety- developmentally inappropriate & persistent & excessive anxiety concerning separation from home or caregivers

    o   A child may have a combination of the symptoms listed

    §  Persistent & excessive worry about harm coming to caregiver(s)

    §  Persistent & excessive worry about an event that will lead to separation from caregivers (e.g., getting lost, being kidnapped)

    §  Persistent & excessive worry about being alone & without caregiver even at home

    §  Persistent reluctance or refusal to go to sleep without caregiver near or sleep away from home

    §  Persistent Reluctance or refusal to go to school

    §  Repeated nightmares involving separation

    §  Repeated complaints of physical symptoms when separated


    ·         Obsessive-compulsive (OCD)- falls under anxiety disorders & cause repetitive, recurrent & often unpleasant thoughts, impulses, or images (obsessions) and/or behaviors (compulsions) that are severe enough to be time consuming or cause marked distress or significant impairment.  Severity can be mild to severe & impairing daily functioning

    o   Obsessions include recurrent concern such as, germ contamination, persistent worry that a family member may become sick or excessive preoccupation with perfection or tidiness

    o   Compulsions or rituals include repetitive behaviors either overt (such as washing hands, checking locks) and/or covert mental acts (such as silently counting, praying, or repeating words) that the person feels must be completed. A person who has compulsions believes that performing these rituals will prevent a frightening event (for example, "If I count to three every time I talk to my mother, then she won't die").

    o   People with obsessive-compulsive disorder may try to ignore these thoughts or avoid the behaviors but are generally unable able to do so.  Whereas adults with OCD may recognize that their obsessions or compulsions are not rational, a child may not have that awareness.

    o   Children may try to hide their symptoms or may not know how to express their underlying worries. Others may only see the end result of the symptom (hours in the bathroom, extended time alone in the bedroom, or tantrums when the child cannot do something his or her way)

    o   Children may try successfully to suppress symptoms at school and they may therefore, increase in intensity or frequency at home.




    ·        The world is full of events & situation that cause stress

    ·         Even positive events can create stress

    ·         Some stress is good but our world presents more stress than we want or need

    ·         Distinguish daily life hassles where we have learned effective coping strategies- from significant stress

    ·         Significant stressors are more likely to catch children (and adults) unprepared to cope however, compounding life hassles can also have a cumulative effect

    ·         Perception of stress may be very different from one person to another, & each person, children and adults, may handle levels of stress very differently


    ·         Stress in children is usually caused by:

    o   New, unfamiliar or unpredictable situations

    o   Unclear expectations

    o   Exceptions of something unpleasant

    o   Fear or failure (socially or academically)

    o   Major developmental “hurdles” (moving from elementary to middle school, leaving home etc…)


    ·         Symptoms of stress

    o   Often mimic symptoms of minor illnesses

    §  Irritability, sleeping, toileting or eating difficulties, fearfulness, difficulty adapting to change in routine or clinginess, or use of words such as “sad or “afraid”

    o   As children get older responses to stress may change

    §  Attention seeking behaviors, mood changes, avoidance of certain activities, isolation, school refusal or changes in quality of school-work, sleeping difficulties & physical complaints


    ·         How can parents help?

    o   Do not place undue expectations on your child- parents want expectations for behavior & performance however, when stress starts to show it is time to question if expectations are too high

    o   Listen to your children when he or she describes stressful events or situations- not only will it show your child love & support but help you understand how to help

    o   Teach your children good problem-solving skills- feeling like there is too much to do in the amount of time we have causes stress.  Teach your child to break big problems into smaller ones to handle one at a time

    o   Rehearse stressful situations- talk about how to handle stressful situations.  Go through a trial run, practice, & problem-solve possible difficulties.

    o   Be aware of “irrational thinking” patterns- be aware of thoughts that may be masking unfounded beliefs.  For example, “I need to get this assignment done right now” may translate into “If I don’t do this perfectly, then I will never get into college.” “I have to do what the other kids are doing” may translate into “If I don’t go along with my friends then no one will ever like me.”  Parents can help a child look at life, and him or herself, more realistically and more positively.

    o   Relaxation /visualization- several techniques can be used such as, sitting or lying & breathing slowly from deep in the stomach, systematically tensing & relaxing parts of the body, & imagining oneself in a favorite place (warm, inviting, relaxing).  This can be helpful in diminishing feelings of stress, but may not keep stress from occurring.

    o   Exercising- can help physically & emotionally