Treating Anxiety in Children & Teens

A child with Social Anxiety Disorder or Selective Mutism, may experience worries and anxiety about interacting with other people or with being the focus of attention.

You may notice that your child:

• often feels others don’t like him/her or that others are will think badly of him/her
• is fearful of rejection and negative feedback
• avoids meeting new people or avoids situations that would require him or her to talk with peers or others
• may speak only with select people with whom he or she feels comfortable (such as family members or close friends)
• is fearful of performing or speaking in front of others
• may avoid asking or answering questions during class time, may resist speaking directly to the teacher, avoids talking during small group activities
• may be distracted while taking tests due to concerns that others may notice he or she is slower to finish compared to peers
• fears embarrassment and avoids situations where they may potentially feel embarrassed

Treatment will likely include exposure exercises to social situations, such as:

• having your child order for themselves at a restaurant
• saying “hello” to three peers while walking down the hallway at school
• asking one question daily in class
• attending social events and talking with others
• performing in front of others

Our experienced child therapists will create a program of gradual exposures after your child has learned coping skills to help them experience increased confidence over time in these previously feared situations.

Children may experience school refusal for multiple reasons. Your child may avoid attending school due to social anxiety, separation anxiety, generalized anxiety, Obsessive Compulsive Disorder (OCD), health anxiety or depression. Sometimes, children avoid attending school due to stress related to challenges in learning.

You may notice that your child:

• resists getting out of bed in the morning on school days 
• demonstrates tearfulness or irritability while getting ready for school
• needs to be prodded to stay on track to finish their morning routine, often leading to late arrival at school
• often complains of stomachaches, nausea, headaches, or other physical symptoms on school days
• has an unreasonable amount of absences
• often calls home during the school day and requests to come home due to physical symptoms
• often complains of physical symptoms or has difficulty falling asleep on Sunday evenings in anticipation of returning to school after the weekend or from break in school attendance due to holidays or illness.

Your child’s treatment will begin with a thorough assessment to determine the cause of their school refusal behavior. If your child has missed school and refuses to return to the school environment, it is important that your child return to school as soon as possible to prevent anxiety from intensifying.  Our experienced child and adolescent therapists will work together with your child’s school administration and staff to help your child return to school.

An exposure plan may include:

• having your child visit the school after other children have left at the end of the school day
• attending school for a short period of time until the child becomes more comfortable and gradually increasing time at school
• identifying “safe adults” for the child to talk to when distressed, including going to the school nurse’s or counselor’s office to take a break and calm down.

A child with Separation Anxiety Disorder may experience worries and anxiety about being separated from you or from other important people in his or her life, or being away from the home. Your child may also worry about the safety, health and well-being of loved ones when separated from them.

You may notice that your child:

• resists being away from home or away from a parent
• objects with tearfulness, tantrums or yelling when parent leaves them
• refuses to stay at social gatherings such as parties without a parent being present
• will not participate in sleepovers
• becomes nauseous or has stomachaches or headaches when away from parents or away from home
• refuses to fall asleep alone or refuses to stay in own bed without a parent being present
• frequently seeks reassurance about parents’ safety, health and well-being when they are apart from their parent

Treatment will likely include exposures to separation from parent and/or home.

Examples of typical exposures include:

• being alone in a room at home or having the parent or loved one outside of the home while the child is in the home (at an age-appropriate level) for gradually increasing periods of time (one minute gradually building up to one hour)
• having a babysitter for gradually increasing periods of time
• engaging in sleepover with grandparents or other close relative for gradually increasing periods of time (begin sleepover at 8 pm and end sleepover at 8 am)
• planning for and allowing your child to speak on the phone with a parent when they are away for gradually decreasing number of times during separation exposures
• having your child and you sleep at a hotel close to home for gradually increasing periods of time (begin “practice vacation exposure” at 8 pm arrival at hotel and leave hotel at 8 am to end “practice vacation exposure”)

Treatment may also include a reward component when your child engages in the identified exposure to provide them an incentive to participate and to tolerate the discomfort that may arise during the exposure exercise.

Parental involvement is important to the success in these exposures, including creating the opportunity for your child to engage in the exposure exercises consistently, as well as displaying an attitude of confidence in the child’s ability to tolerate the exposure.

Your child may be experiencing a panic attack if he or she suddenly has symptoms of intense anxiety, including:

• dizziness
• shortness of breath
• pounding heart
• shaky limbs
• “hot” feeling
• nausea or feeling like they might vomit
• feeling as if they are choking
• feeling as “if they are in a dream” (derealization)

Panic Attacks are usually time limited and typically end in 30 minutes or less. Panic attacks often appear to be random, which adds to a child’s fear and worry that they may have a panic attack in the future.

Following a panic attack, your child may develop Panic Disorder. In Panic Disorder, your child or adolescent has a fear of experiencing another panic attack.

This fear of experiencing a panic attack can become so overwhelming that your child may:

• frequently attempt to avoid situations he or she associates with experiencing panic attacks (examples can range from refusing to go to specific places or anticipating taking tests)
• demonstrate extreme behaviors such as yelling, tantrumming, or tearfulness when he or she is required to engage in situations in which they fear they may experience a panic attack
• repeatedly ask for reassurance that he or she is okay and has difficulty believing the reassurance you provide
• often tells you during a panic attack they think they might be dying or that they might faint
• exhibit extreme restlessness, such as pacing or intense fidgeting
• frequently worry that they will have another panic attack

Treatment for your child typically involves learning coping skills to decrease their physical symptoms, education about what is happening to them when they have a panic attack, and learning more helpful ways of thinking about panic attacks and the situations they fear may trigger a panic attack.

Exposure exercises are a central component for treatment of Panic Disorder. Examples of typical exposures for panic disorder can include:

• Exposure to the physical symptoms of panic such as a heart pounding sensation or shortness of breath (by running in place for two minutes) or dizziness (by spinning for two minutes in a chair).
• Exposures to the situations that your child often avoids due to fear of experiencing another panic attack, including imagining being in the situation they fear may bring on a panic attack, talking about experiencing a panic attack, and eventually being in the situations that they had previously experienced a panic attack.

It is important to provide opportunities for your child or adolescent to practice their cognitive behavioral skills and to engage in the recommended exposure exercises. Your child’s therapist may also recommend a reward program as part of your child’s treatment to give them an incentive to tolerate distress they may experience in exposure exercises.

If your child or adolescent exhibits an intense fear associated with a specific type of object or situation, they may be experiencing a phobia. There are many different types of phobias, however, some of the more common phobias in children and teens include fear of flying (Aviophobia), fear of vomiting (Emetophobia), fear of animals (Zoophobia), or fear of needles (Trypanophobia).

You may notice your child or adolescent may:

• experience intense anxiety or panic attacks (See Panic Attacks) when he or she comes into contact with the feared object or situation. At times, your child or teen may experience anxiety or a panic attack while just thinking about approaching the feared object or situation.
• repeatedly seek your reassurance about their safety when in contact with the feared object or situation
• intensely resist coming into contact with the feared object or entering the feared situation (becoming teary, having a tantrum, crying, or running away from the feared object/situation)

Your child’s therapist at the Anxiety and Depression Center will devise a treatment plan for your child that will include learning coping skills to calm their anxiety related to the phobia and help them to identify more helpful thoughts regarding what they are afraid of.

Your child will also engage in exposure exercises to the object of the phobia, which may include imagining being around the feared object/situation, looking at videos of the feared object/ situation, and actually being present with the feared object/situation. You may be taught how to conduct the exposure exercises for your child, so that your child can continue to practice exposure exercises between treatment sessions. Frequent exposure exercises are recommended as they can help your child overcome their fear in a relatively short period of time.