When Anxiety is a Concern for Children and Adolescents
By Sydney Jenkins, MSSA, LCSW
Even before the pandemic, the rate of children and adolescents experiencing clinical-level anxiety had increased significantly over the past decade. According to data collected in 2022-2023 by the Center for Disease Control (CDC), 11% of US children ages 3-17 had current, diagnosed anxiety. Anxiety disorders are the most common mental health diagnosis in children ages 3-11, affecting nearly 1 in 12 children and 1 in 4 adolescents. While some of this increase may be due to increased screening, awareness, and access to mental health services, there are also environmental, biological, and social disruptions contributing to this change.
I work with children and adolescents ages 3-17, many of whom have diagnosed anxiety disorders. While these children come from a variety of socioeconomic, cultural, ethnic, and religious backgrounds, their levels of anxiety are often equally severe. Some children worry about gun violence or abuse while others worry about making decisions or social interactions. Regardless of how insignificant some of these concerns may seem to an outside viewer, they are negatively impacting these children in very similar ways.
I often explain anxiety to children as the “smoke alarm” or “guard dog” in our brain. If a bear suddenly walked into the room, our body would release chemicals to help protect us from this danger. Our brain might increase our heart rate so we have more blood in our legs to run (flight). It might increase our awareness so we can look around for something to use to defend ourselves (fight). Or, it might make us stop moving completely so maybe the bear won’t notice us (freeze). Sometimes our brains can use anxiety to help us, like when we need extra motivation to finish a project on time, or we need to pay more attention in an unsafe situation. With clinical anxiety, the brain/body often feels like the bear is in the room, even when the situation is not life threatening.
Because many of us don’t often find ourselves in bear-in-the-room levels of immediate danger, anxiety in children often presents differently. Fight might look like irritability, tantrums, or verbal/physical aggression. Flight might look like avoidance and incomplete tasks. Freeze might look like “zoning out” or their minds going blank. The racing thoughts that could help them escape a bear attack might instead make it difficult to sleep or make decisions.
Sometimes it can be difficult to know when anxiety is “normal” or if a child might need additional support, such as therapy and/or medication, in order to decrease the frequency and intensity of their symptoms. Some signs that a child’s anxiety may be of concern are:
Physical symptoms such as frequent unexplained stomachaches, headaches, wetting the bed, or trouble sleeping
Avoidance such as refusing to go to school, try new activities, or attend social events
Behavioral changes such as irritability, emotional dysregulation, clinginess, or frequent reassurance seeking
Negative academic performance
