Sam Cohen* is a bright 7-year-old boy who notices everything. If a paper clip is out of place on my desk, Sam is the first to comment. Though he’s always been intelligent, Sam’s parents have also noticed that their son has been a worrier for as long as they can remember. His thoughts often include fears like: What will the other children at school think of him? What if his parents’ car crashes on the way to the grocery store? What if he tries to do his math homework and gets the answer wrong?

“Is this normal?” Mr. and Mrs. Cohen asked me, concerned. “What can we do?” 

Child anxiety is a tricky balance. On the one hand, worry is a normal part of development for both adults and children. Who doesn’t worry occasionally? On the other hand, how does a parent know when these worries cross the line from normal, to knowing when to seek help?

Anxiety in childhood

Anxiety, like all emotions, is a part of life. This can be a good thing, as a little fear can be motivating. For example, a child may study for exams because of a fear of failure, and adults may dress nicely for dates because they feel anxious about rejection. Our anxiety can therefore fuel us to act, and move us towards our goals. The presence of anxiety itself, especially during challenging times, does not signal that anything is wrong.

This applies doubly for children. The nature of childhood is that change is ubiquitous. From constantly learning new skills, to entering a new classroom with a new teacher every year, to growing out of clothing every few months, children are in a constant state of change and development. It is no surprise that 90% of children report having one or more fear, though the contents of those fears may change as they grow. While infants are most typically afraid of things like loud noises and strangers, preschoolers tend to fear things that are imaginary and uncontrollable, like the monster under the bed.  As children grow older, their fears become more specific and realistic, i.e., social fears, like being left out by peers, or making a mistake at school.

Therefore, many cases of childhood anxiety are developmentally appropriate and require no intervention. However, childhood anxiety disorders can be real and require professional intervention. According to some estimates, 15-20% of children – that’s up to 1 in 5 – will face significant anxiety at some point during their development. If left untreated, these cases can worsen, and symptoms can persist into adulthood.

How can I tell if my child’s anxiety is a problem?

When mild to moderate anxiety in children is transient, occurs during a period of change and is not accompanied by any major behavior change, intervention is not usually needed. In these cases, parents should simply wait out the period of change and see what happens. If the anxiety persists, worsens, or the child starts to develop problematic behaviors, a consultation with a professional may be in order.

It is generally difficult for children to describe their emotions using words. Though they are aware that they are uncomfortable and experiencing negativity, they may not be able to express specific thoughts or feelings, and may therefore express themselves behaviorally rather than verbally. This means that a child experiencing anxiety may have difficulty making friends, will refuse to attend school or social events, refuses to be apart from parents or loved ones, complains about physical ailments, or becomes aggressive. If your child is displaying such behavioral difficulties, it is worth consulting with a professional to determine whether the child might be experiencing anxiety. Sometimes it is easy to assume that a child is just being “difficult” or “lazy,” which masks the underlying anxiety, and can make the problem worse.

What are my options?          

If your child is having difficulties with anxiety, there are some excellent therapies that fall under the category of Cognitive Behavioral Treatment (CBT) that can help children reduce anxiety, challenge anxious thinking, and counter longstanding fearful behaviors. These therapies are based on research, and typically show change in as little as a few weeks to a few months. CBT uses a variety of strategies to teach children skills to reduce anxiety, including education about the nature of negative emotions, relaxation skills, and how to face their fears. With younger children, CBT usually incorporates a family component, teaching parents how to best help children cope with their worries.

Sam’s parents decided to try CBT for their son, and were amazed by the changes that they saw. In treatment, Sam learned to recognize his worry, and learned steps to decrease his fear. He used relaxation techniques to calm himself when he felt overwhelmed, and learned to use self-talk to cope with anxiety. With those skills under his belt, we created a “Worry Ladder,” where we listed and described situations that Sam was anxious to face, starting with the more manageable fears, and ending with the items that caused a high amount of anxiety. Sam then gradually began to face these fears, head on, with help from the treatment team, his family, and a reliance on his new skills. He did his math homework, for example, and turned it in without a parent checking it over, knowing that he might have the wrong answer. Though this may seem counter-intuitive, it gave him confidence that getting the wrong answer will not result in the teacher berating him, or his getting kicked out of class, as he feared. Instead, he realized he could tolerate the consequences of the situations that he previously feared. By confronting situations that had previously worried him, Steven began to realize that he was brave enough to manage his fears. His parents told us that he was more confident and happier with friends, and that they were surprised that they could see such a change in less than four months!

As Sam’s family discovered, CBT is safe, quick, and highly effective. This is great news for families dealing with anxiety; learning and using these techniques care greatly enhance the lives of both children and their parents.

*Names and some details have been changed to protect privacy.

Regine Galanti, PhD is the Director of the Center for Anxiety’s Brooklyn office. She a Cognitive Behavioral Psychologist who specializes in working with children with anxiety, OCD, and behavior problems. She can be reached at 646-837-5557 or info@centerforanxiety.org.