Anxiety in children and young people

Feeling anxious and worried about something is an experience that virtually all children and young people will experience at some point in their life. At different ages and stages of development, it is typical for children to experience particular worries and fears, such as a young child expressing distress and worry about being separated from their primary carer, or an older child feeling anxious about an upcoming test at school.

The development of a diagnosable Anxiety Disorder differs in that the worries and anxieties persist over time, they are usually more intense or excessive, have a significantly unhelpful and sometimes pervasive impact upon the child/young person’s wellbeing and day-to-day functioning, and may be developmentally inappropriate to the chronological or developmental age of that child or young person. It is important that a child or young person with a possible anxiety disorder is referred for a specialist mental health assessment of their difficulties, as without appropriate treatment many anxiety disorders will persist and continue into adulthood to the detriment of the individual. Anxiety disorders may include more generalised difficulties with anxiety across many different settings and experiences, as well as anxiety that is more specific to particular situations (such as those who develop a phobia, panic attacks or experience obsessive compulsive behaviour).

What can cause an anxiety disorder in childhood?

This is complicated to explore and there are usually a number of related variables that combine to impact on the likelihood of a child or young person developing an anxiety disorder. Certainly, as discussed in our previous sessions, there is evidence to suggest that some children and young people are more vulnerable or at greater risk of developing a mental health disorder, like an anxiety disorder, than other children and young people. Often it is a combination of internal factors of the child or young person (such as their temperament or genetic predisposition) alongside more external factors within the child or young person’s immediate (family) and social (community) contexts.

What might worries and general anxiety look like in a child or young person?

All children are different and therefore will demonstrate their anxiety in different ways, and this can be influenced by their chronological and developmental age, the child’s temperament and social and family context. Usually, anxiety can be observed in a range of physical, emotional, cognitive and behavioural ways. Many of the examples listed in the table below are typical experiences seen in many children; it’s important to note that the experience of some of these occasionally will not indicate a child or young person has an anxiety disorder. However, the level of persistence over time of these experiences, the quantity and intensity of experiences, and increasing negative impact upon the child or young person, will help indicate whether they may possibly have developed an anxiety disorder and would benefit from specialist mental health support.

• Physical indicators: Could include frequent and persistent headaches, tummy aches, nausea and vomiting, dizziness or feeling faint, restless or agitated behaviour
• Emotional / Psychological indicators: Could include a fear of specific contexts (such as going to unfamiliar places or the dark), anger, irritation or verbal outbursts, embarrassment and shyness, particularly in social situations
• Cognitive indicators: Could include worries that something is going to happen to them or someone they care about, repeated requests for reassurance, or fear or anxiety expressed out of proportion to the actual threat or danger
• Behavioural indicators: Could include a refusal to go out of the home or be alone, showing age-inappropriate clingy behaviour, a refusal to sleep in their own bed, or ‘freezing’ in situations they find anxiety-provoking