Top 10 Signs of Anxiety in Kids
From the Show: Bradley Hospital
Summary:
Air Date: 3/3/23
Duration: 10 Minutes
Dr. Mike Walther, an expert on pediatric anxiety, breaks down the top 10 signs and symptoms of anxiety in kids.
Transcription:
Dr Anne Walters: Anxiety is often thought of as something negative or bad or something you must get rid of, but the reality is some anxiety is a good thing. In fact, it's a normal response to a stressful situation. When anxiety gets in the way of living life is when anxiety becomes a problem. If your child's anxiety prevents them from getting out of bed, going to school, and playing or talking with friends, then it's time to seek professional help. Addressing your child's anxiety early is key. If left untreated, anxiety can worsen and allow other mental health conditions to develop. Knowing the signs of anxiety in children, being aware of changes in your child's behaviors and moods, and knowing how to get treatment for them can minimize any future complications and mental health challenges.
Today, we welcome Dr. Mike Walther, staff psychologist at Bradley Hospital's Pediatric Anxiety Research Center. Dr. Walther is here to help us understand the top 10 signs of anxiety in kids and, most importantly, how to know when it's time to get help. Welcome to our podcast, Mike.
Dr Mike Walther: Thanks for having me. Good to see you. Good to see you too, Greg.
Dr Greg Fritz: Yep.
Dr Anne Walters: This is Mindcast: Healthy Mind, Healthy Child, a podcast from the mental health experts at Bradley Hospital, leaders in mental healthcare for Children. I'm Dr. Anne Walters, here with my colleague, Dr. Greg Fritz.
Dr Greg Fritz: So, it's interesting to think that anxiety could be a good thing, right? I mean, we've all had that feeling of butterflies in our stomach or maybe our heart was pounding out of our chest when we were about to take a test or give a presentation, or even the first time we were going to host a podcast. How can that be a good thing? Or at least, if not a good thing, it's certainly is a familiar thing, that's for sure.
Anyhow, anxiety can be crippling. But for the most part, we all learn to manage those feelings and carry on. But today, we're here to talk about kids that, for whatever reason, can't do that and anxiety is getting in the way of their actually living.
Dr Mike Walther: That's right. And to your point, Greg, anxiety can actually be a beneficial thing. And so using your examples, if you're taking an important exam or giving a presentation, what anxiety will do is help orient you in that situation to the things that are important and actually aid in performance. And that can be too much of a good thing where, when those feelings of anxiety become more intense and interfering, that's when kids start to struggle. And one of the things that we'll talk about today is how to tell the difference between those two things and what are the signs and symptoms to look out for.
Dr Anne Walters: So if you had to give a top 10 list of signs and symptoms that absolutely shouldn't be ignored in children and teens, what would you say?
Dr Mike Walther: So, I'm going to break up these 10 signs and symptoms into four different categories. So, anxiety is an emotion, and what we know about emotions is that all emotions contain three main components. There's the cognitive or thought part of anxiety. There's the somatic or feelings part of how it feels in our body. There's the behavioral component of anxiety in terms of what behaviors we engage in when we experience that emotion. And then, the fourth category I'll talk about are the different kinds of outcomes that parents can observe when anxiety is present.
So in terms of thoughts and cognitions, one of the hallmark features of anxiety is what we call worry. Again, it's very normal for kids to worry in certain situations and if they're able to move on from it, then it's not an issue. What we see with some individuals though is an excessive amount of worry where they're overestimating the likelihood of threat or unable to move on from those types of situations. And so, worry content is that first sign or symptom. Another cognitive element of anxiety is difficulty concentrating. When kids are consumed with worry about a particular topic, it's really hard to move on and pay attention in class, pay attention to conversation, things of that nature.
In terms of somatic signs of anxiety, kids will report feelings of nervousness in a variety of different ways. Stomach aches, headaches, changes to how their body is feeling, as well as emotional difficulties as well, such as irritability or changes in their mood.
From a behavioral standpoint, the signs and symptoms that we're looking for are tantrums, crying. Sometimes anxiety is the underlying cause of those types of behavioral outcomes. One big thing that we also look for is avoidance. When kids are starting to feel worried about things, when they're starting to feel very anxious, it's very natural for them to want to avoid situations where those worries or triggers are happening. Sometimes this can be really, really obvious, like refusal to attend school, refusal to go to a particular event. And sometimes it's a little bit more subtle, like they're in class, but they're refusing to raise their hand, for example.
And then finally, when it comes to behavioral signs and symptoms to look for, are repetitive behaviors. If a child is worried about getting sick, you might see an uptick in handwashing. If a child is worried about particular outcomes, maybe they're seeking a lot of reassurance from a parent. And those are the behavioral signs and symptoms.
And then finally, there are a couple outcomes as byproducts of excessive anxiety to look for, including difficulty sleeping, as well as changes in appetite or food intake that can occur.
Dr Greg Fritz: So if a kiddo is suffering several of these symptoms, any combination of them, it's fair to expect that the whole family's suffering, right? And so, what would your advice be to parents who are in that situation and what steps should they take, the first steps and subsequent?
Dr Mike Walther: So, I think that most families will have a couple resources already available to them that they should first tap into. The first would be to talk to a pediatrician or a trusted doctor that's already in your network. Pediatricians are oftentimes a point of first contact when it comes to parents who are expressing some concerns when they've noticed some of these signs and symptoms. So doing something like a well-check with your pediatrician where they would want to learn more about what your're observing as a parent, and then having any particular recommendations that are stemming from those observations.
In addition to seeing your pediatrician, we'll be tapping into school-based resources that are available at your child's school. A school social worker, a guidance counselor, a school psychologist, maybe gathering some observations about what school officials have observed in terms of a child's functioning in that setting. And it might be the case that some modifications of a child's day-to-day, some recommendations that the pediatrician has for, in particular, children who are experiencing mild forms of anxiety could certainly be enough.
And a third option would be to seek specialized help with a provider. An outpatient therapist such as a psychologist, social worker, or licensed mental health counselor could be really, really helpful for individuals who are suffering with more moderate symptoms of anxiety and need additional tools and strategies to cope with what they're going through.
Dr Anne Walters: So if a pediatrician does refer the family, I imagine parents themselves are concerned about potential diagnosis and maybe wondering and even worrying a little bit about what treatment is going to look like.
Dr Mike Walther: Absolutely. And I think that seeking help from a professional, talking to a pediatrician can help orient families around what to expect. And oftentimes, individuals want to do what's called an assessment to gather more information about what parents are observing. An assessment is basically just a lengthy conversation about what parents are observing information from the child about what they're experiencing across a number of domains like the signs and symptoms that we just talked about. How is school going? What have you noticed about your appetite? How are you sleeping at night? With family members, "What are you observing?" And then, the outcome of that assessment is hopefully some concrete recommendations about what to do.
For some individuals, it could be more of a wait-and-see approach. "Hey, it sounds like this is a mild form of anxiety. Overall, your functioning seems like it's going pretty well. Parents, please try to keep an eye on this," or "Boy, this does sound like it's getting in the way of your day-to-day. Here's a list of professionals that we recommend that you follow up with."
Dr Greg Fritz: So, when it comes to treatment, I think that there's a lot of confusion about that, especially some of the common ones. Would you talk a bit about CBT and exposure with response prevention and like any other ones that you think need the high point?
Dr Mike Walther: Absolutely. So, thanks for asking about that, Greg. So, cognitive behavioral therapy is a treatment that's been developed to help kids manage their symptoms of anxiety. It's a treatment that I would recommend parents seek out specifically for a couple of reasons. One is that we have pretty good data suggesting that is the most effective type of treatment that we have in order to help kids cope with their symptoms of anxiety. And then secondly is that it directly intervenes on some of the processes that I described earlier.
Dr. Kemp was on this podcast a little while ago. And he gave a lot of really, really helpful information about CBT, in particular, a type of CBT called exposure with response prevention. And one of the points that Dr. Kemp had made is that a natural byproduct of the experience of anxiety is to avoid your triggers. And one consequence of that natural byproduct is that that strengthens the anxiety cycle. And so if a child, for example, is in school and they're nervous about making a mistake in front of others, and they avoid raising their hand as a result. Oftentimes what will happen is each instance that that builds up a child's anxiety will be reinforced as, "Whew, thank goodness I did not raise my hand. I could have embarrassed myself. I could have given an incorrect answer." And then, they feel a sense of relief that they didn't take a risk. And then, the anxious cycle kind of builds from there over and over with each iteration of that.
And so, what exposure therapy aims to do is to help kids confront some of those triggers in a slow and gradual way, so they can develop mastery and confidence over those types of situations. In addition to exposure therapy in CBT, kids also learn effective coping strategies in terms of managing those feelings of being overwhelmed, and that can help aid in their day-to-day functioning as well.
Dr Anne Walters: Which is so tricky, right? Because, I think, parents and professionals working with children who maybe don't recognize the anxiety cycle are going to be looking to help reduce children's distress, which then also gets that anxiety cycle reinforced.
Dr Mike Walther: It really does. And that was one of the examples of the signs and symptoms, right? Is a child who is feeling anxious and very naturally coming to a parent to say, "Hey, can you check my temperature?" "Hey mom, am I going to be okay at school tomorrow?" "Hey dad, what if blank happens?" And it's very natural in those types of situations for a parent to want to rush in and reassure their child, "No, no, no, you're going to be fine" or "Gosh, we just checked your temperature for the 10th time tonight, and I showed you that it's 98.6 degrees and you don't have a fever. Things are going to be okay." And for the vast majority of children, that approach is going to be fine. But when parents are finding themselves stuck in that loop over and over again, that's certainly a sign that something could be awry, like anxiety.
Dr Anne Walters: So, how common is anxiety these days?
Dr Mike Walther: It's quite common of the class of disorders that psychologists and psychiatrists treat. Anxiety represents the most common class of diagnoses. Current estimates are that about a third of teenagers are experiencing some degree of problematic or impairing anxiety. One of the complications with that as well is that, in addition to those signs and symptoms of anxiety, if left untreated, anxiety can oftentimes then morph into other types of problems such as mood, like depression, as well as behavioral problems.
The current estimate suggests that anxiety is slightly higher in females compared to males. And that the complexity of anxiety and a number of diagnoses can increase with age. And so if anxiety symptoms are not treated early on, it can become more severe, more impairing, and more complex over time. And that's a shame because the data also suggests that of the disorders that are out there, anxiety is actually one of the more treat. If kids are engaging in exposure therapy, if they're learning tools consistent with cognitive behavioral therapy, treatment outcomes are quite good. And unfortunately, many individuals are not able to find therapists or not able to get the help that they need.
Dr Greg Fritz: So if we're thinking about the major take-home from our discussion today, my guess would be that for parents, if they're worried about their child's anxiety, to not just sit on it, but to get help, because there's so much that can be done for it and it doesn't hurt anything, huh?
Dr Mike Walther: Exactly, exactly. Be proactive. Anxiety is easier to treat in its earlier stages. And, the quicker you seek kelp, the better.
Dr Greg Fritz: Great. Well, thanks for being with us today, Mike. Thank you. And before you go, maybe you could say something, I'll twist your arm here to say something about the PaRK Program and your research.
Dr Mike Walther: Absolutely. Thanks for asking, Greg. So the Pediatric Anxiety Research Center or PaRK is an organization devoted to the care of anxious youth with anxiety disorders and obsessive compulsive disorder. There are three main components of PaRK. One would involve providing services and intervention for kids and families who need it. A second area of PaRK is conducting research on effective treatments for individuals with anxiety and OCD and then the third arm of PaRK involves training professionals how to do the treatments that I talked about today.
Dr Greg Fritz: Great. Well, thanks for being here. And if you found this podcast helpful, please share it with your friends and families on your social channels and check out our entire podcast library. This is Mindcast: Healthy Mind, Healthy Child, a podcast from the experts on Children's Mental Health at Bradley Hospital. I'm Dr. Greg Fritz here with my colleague, Dr. Anne Walters. Thanks for listening.
Dr Anne Walters: Anxiety is often thought of as something negative or bad or something you must get rid of, but the reality is some anxiety is a good thing. In fact, it's a normal response to a stressful situation. When anxiety gets in the way of living life is when anxiety becomes a problem. If your child's anxiety prevents them from getting out of bed, going to school, and playing or talking with friends, then it's time to seek professional help. Addressing your child's anxiety early is key. If left untreated, anxiety can worsen and allow other mental health conditions to develop. Knowing the signs of anxiety in children, being aware of changes in your child's behaviors and moods, and knowing how to get treatment for them can minimize any future complications and mental health challenges.
Today, we welcome Dr. Mike Walther, staff psychologist at Bradley Hospital's Pediatric Anxiety Research Center. Dr. Walther is here to help us understand the top 10 signs of anxiety in kids and, most importantly, how to know when it's time to get help. Welcome to our podcast, Mike.
Dr Mike Walther: Thanks for having me. Good to see you. Good to see you too, Greg.
Dr Greg Fritz: Yep.
Dr Anne Walters: This is Mindcast: Healthy Mind, Healthy Child, a podcast from the mental health experts at Bradley Hospital, leaders in mental healthcare for Children. I'm Dr. Anne Walters, here with my colleague, Dr. Greg Fritz.
Dr Greg Fritz: So, it's interesting to think that anxiety could be a good thing, right? I mean, we've all had that feeling of butterflies in our stomach or maybe our heart was pounding out of our chest when we were about to take a test or give a presentation, or even the first time we were going to host a podcast. How can that be a good thing? Or at least, if not a good thing, it's certainly is a familiar thing, that's for sure.
Anyhow, anxiety can be crippling. But for the most part, we all learn to manage those feelings and carry on. But today, we're here to talk about kids that, for whatever reason, can't do that and anxiety is getting in the way of their actually living.
Dr Mike Walther: That's right. And to your point, Greg, anxiety can actually be a beneficial thing. And so using your examples, if you're taking an important exam or giving a presentation, what anxiety will do is help orient you in that situation to the things that are important and actually aid in performance. And that can be too much of a good thing where, when those feelings of anxiety become more intense and interfering, that's when kids start to struggle. And one of the things that we'll talk about today is how to tell the difference between those two things and what are the signs and symptoms to look out for.
Dr Anne Walters: So if you had to give a top 10 list of signs and symptoms that absolutely shouldn't be ignored in children and teens, what would you say?
Dr Mike Walther: So, I'm going to break up these 10 signs and symptoms into four different categories. So, anxiety is an emotion, and what we know about emotions is that all emotions contain three main components. There's the cognitive or thought part of anxiety. There's the somatic or feelings part of how it feels in our body. There's the behavioral component of anxiety in terms of what behaviors we engage in when we experience that emotion. And then, the fourth category I'll talk about are the different kinds of outcomes that parents can observe when anxiety is present.
So in terms of thoughts and cognitions, one of the hallmark features of anxiety is what we call worry. Again, it's very normal for kids to worry in certain situations and if they're able to move on from it, then it's not an issue. What we see with some individuals though is an excessive amount of worry where they're overestimating the likelihood of threat or unable to move on from those types of situations. And so, worry content is that first sign or symptom. Another cognitive element of anxiety is difficulty concentrating. When kids are consumed with worry about a particular topic, it's really hard to move on and pay attention in class, pay attention to conversation, things of that nature.
In terms of somatic signs of anxiety, kids will report feelings of nervousness in a variety of different ways. Stomach aches, headaches, changes to how their body is feeling, as well as emotional difficulties as well, such as irritability or changes in their mood.
From a behavioral standpoint, the signs and symptoms that we're looking for are tantrums, crying. Sometimes anxiety is the underlying cause of those types of behavioral outcomes. One big thing that we also look for is avoidance. When kids are starting to feel worried about things, when they're starting to feel very anxious, it's very natural for them to want to avoid situations where those worries or triggers are happening. Sometimes this can be really, really obvious, like refusal to attend school, refusal to go to a particular event. And sometimes it's a little bit more subtle, like they're in class, but they're refusing to raise their hand, for example.
And then finally, when it comes to behavioral signs and symptoms to look for, are repetitive behaviors. If a child is worried about getting sick, you might see an uptick in handwashing. If a child is worried about particular outcomes, maybe they're seeking a lot of reassurance from a parent. And those are the behavioral signs and symptoms.
And then finally, there are a couple outcomes as byproducts of excessive anxiety to look for, including difficulty sleeping, as well as changes in appetite or food intake that can occur.
Dr Greg Fritz: So if a kiddo is suffering several of these symptoms, any combination of them, it's fair to expect that the whole family's suffering, right? And so, what would your advice be to parents who are in that situation and what steps should they take, the first steps and subsequent?
Dr Mike Walther: So, I think that most families will have a couple resources already available to them that they should first tap into. The first would be to talk to a pediatrician or a trusted doctor that's already in your network. Pediatricians are oftentimes a point of first contact when it comes to parents who are expressing some concerns when they've noticed some of these signs and symptoms. So doing something like a well-check with your pediatrician where they would want to learn more about what your're observing as a parent, and then having any particular recommendations that are stemming from those observations.
In addition to seeing your pediatrician, we'll be tapping into school-based resources that are available at your child's school. A school social worker, a guidance counselor, a school psychologist, maybe gathering some observations about what school officials have observed in terms of a child's functioning in that setting. And it might be the case that some modifications of a child's day-to-day, some recommendations that the pediatrician has for, in particular, children who are experiencing mild forms of anxiety could certainly be enough.
And a third option would be to seek specialized help with a provider. An outpatient therapist such as a psychologist, social worker, or licensed mental health counselor could be really, really helpful for individuals who are suffering with more moderate symptoms of anxiety and need additional tools and strategies to cope with what they're going through.
Dr Anne Walters: So if a pediatrician does refer the family, I imagine parents themselves are concerned about potential diagnosis and maybe wondering and even worrying a little bit about what treatment is going to look like.
Dr Mike Walther: Absolutely. And I think that seeking help from a professional, talking to a pediatrician can help orient families around what to expect. And oftentimes, individuals want to do what's called an assessment to gather more information about what parents are observing. An assessment is basically just a lengthy conversation about what parents are observing information from the child about what they're experiencing across a number of domains like the signs and symptoms that we just talked about. How is school going? What have you noticed about your appetite? How are you sleeping at night? With family members, "What are you observing?" And then, the outcome of that assessment is hopefully some concrete recommendations about what to do.
For some individuals, it could be more of a wait-and-see approach. "Hey, it sounds like this is a mild form of anxiety. Overall, your functioning seems like it's going pretty well. Parents, please try to keep an eye on this," or "Boy, this does sound like it's getting in the way of your day-to-day. Here's a list of professionals that we recommend that you follow up with."
Dr Greg Fritz: So, when it comes to treatment, I think that there's a lot of confusion about that, especially some of the common ones. Would you talk a bit about CBT and exposure with response prevention and like any other ones that you think need the high point?
Dr Mike Walther: Absolutely. So, thanks for asking about that, Greg. So, cognitive behavioral therapy is a treatment that's been developed to help kids manage their symptoms of anxiety. It's a treatment that I would recommend parents seek out specifically for a couple of reasons. One is that we have pretty good data suggesting that is the most effective type of treatment that we have in order to help kids cope with their symptoms of anxiety. And then secondly is that it directly intervenes on some of the processes that I described earlier.
Dr. Kemp was on this podcast a little while ago. And he gave a lot of really, really helpful information about CBT, in particular, a type of CBT called exposure with response prevention. And one of the points that Dr. Kemp had made is that a natural byproduct of the experience of anxiety is to avoid your triggers. And one consequence of that natural byproduct is that that strengthens the anxiety cycle. And so if a child, for example, is in school and they're nervous about making a mistake in front of others, and they avoid raising their hand as a result. Oftentimes what will happen is each instance that that builds up a child's anxiety will be reinforced as, "Whew, thank goodness I did not raise my hand. I could have embarrassed myself. I could have given an incorrect answer." And then, they feel a sense of relief that they didn't take a risk. And then, the anxious cycle kind of builds from there over and over with each iteration of that.
And so, what exposure therapy aims to do is to help kids confront some of those triggers in a slow and gradual way, so they can develop mastery and confidence over those types of situations. In addition to exposure therapy in CBT, kids also learn effective coping strategies in terms of managing those feelings of being overwhelmed, and that can help aid in their day-to-day functioning as well.
Dr Anne Walters: Which is so tricky, right? Because, I think, parents and professionals working with children who maybe don't recognize the anxiety cycle are going to be looking to help reduce children's distress, which then also gets that anxiety cycle reinforced.
Dr Mike Walther: It really does. And that was one of the examples of the signs and symptoms, right? Is a child who is feeling anxious and very naturally coming to a parent to say, "Hey, can you check my temperature?" "Hey mom, am I going to be okay at school tomorrow?" "Hey dad, what if blank happens?" And it's very natural in those types of situations for a parent to want to rush in and reassure their child, "No, no, no, you're going to be fine" or "Gosh, we just checked your temperature for the 10th time tonight, and I showed you that it's 98.6 degrees and you don't have a fever. Things are going to be okay." And for the vast majority of children, that approach is going to be fine. But when parents are finding themselves stuck in that loop over and over again, that's certainly a sign that something could be awry, like anxiety.
Dr Anne Walters: So, how common is anxiety these days?
Dr Mike Walther: It's quite common of the class of disorders that psychologists and psychiatrists treat. Anxiety represents the most common class of diagnoses. Current estimates are that about a third of teenagers are experiencing some degree of problematic or impairing anxiety. One of the complications with that as well is that, in addition to those signs and symptoms of anxiety, if left untreated, anxiety can oftentimes then morph into other types of problems such as mood, like depression, as well as behavioral problems.
The current estimate suggests that anxiety is slightly higher in females compared to males. And that the complexity of anxiety and a number of diagnoses can increase with age. And so if anxiety symptoms are not treated early on, it can become more severe, more impairing, and more complex over time. And that's a shame because the data also suggests that of the disorders that are out there, anxiety is actually one of the more treat. If kids are engaging in exposure therapy, if they're learning tools consistent with cognitive behavioral therapy, treatment outcomes are quite good. And unfortunately, many individuals are not able to find therapists or not able to get the help that they need.
Dr Greg Fritz: So if we're thinking about the major take-home from our discussion today, my guess would be that for parents, if they're worried about their child's anxiety, to not just sit on it, but to get help, because there's so much that can be done for it and it doesn't hurt anything, huh?
Dr Mike Walther: Exactly, exactly. Be proactive. Anxiety is easier to treat in its earlier stages. And, the quicker you seek kelp, the better.
Dr Greg Fritz: Great. Well, thanks for being with us today, Mike. Thank you. And before you go, maybe you could say something, I'll twist your arm here to say something about the PaRK Program and your research.
Dr Mike Walther: Absolutely. Thanks for asking, Greg. So the Pediatric Anxiety Research Center or PaRK is an organization devoted to the care of anxious youth with anxiety disorders and obsessive compulsive disorder. There are three main components of PaRK. One would involve providing services and intervention for kids and families who need it. A second area of PaRK is conducting research on effective treatments for individuals with anxiety and OCD and then the third arm of PaRK involves training professionals how to do the treatments that I talked about today.
Dr Greg Fritz: Great. Well, thanks for being here. And if you found this podcast helpful, please share it with your friends and families on your social channels and check out our entire podcast library. This is Mindcast: Healthy Mind, Healthy Child, a podcast from the experts on Children's Mental Health at Bradley Hospital. I'm Dr. Greg Fritz here with my colleague, Dr. Anne Walters. Thanks for listening.