Anxiety is different for kids

Claire Gillespie

You know how to do CPR and have a fully stocked first aid kit. At home and in the car. But it's not enough. Today's parents need to know how to deal with their kids' mental health as well as their fevers and grazed knees.

According to statistics from the National Institute of Mental Health, around a third of adolescents have an anxiety disorder, which can come in various guises (including panic disorder, social anxiety disorder, obsessive-compulsive disorder, and separation anxiety disorder) and is characterized by excessive anxiety and related behavioral disturbances.

In the midst of what's arguably one of the biggest public health challenges of all time, we're all more aware of the prevalence of anxiety and other mental health issues, more clued-up about how mental illness can present itself, and what we can do to help both ourselves and others. But there's an important qualifier when talking about kids with anxiety: They don't display it in the same way adults do.

"Typically, when a child is anxious, you'll see a change in their behavior," says New York-based therapist Dana Carretta-Stein, M.S., LMHC, LPC.

That child could be the 8-year-old who throws the epic sort of tantrums you'd expect from a toddler. Or the 10-year-old who's snappy and irritable every single day, for no apparent reason. Or the 12-year old who gets a stomach ache every morning before school, without fail. It manifests itself in a range of ways, Carretta-Stein says. "While every child is different, some kids may become more aggressive (which is the fight in the fight/flight response), whereas other children may become very shy (the flight response)," she explains.

Kids with anxiety may be clingy or tearful, reluctant to go to school, take part in activities, or be separated from their parent, says Michigan-based therapist Carrie Krawiec, LMFT. They may have persistent headaches or stomach aches, or display obsessive-compulsive or rigid behaviors, like being in distress when something isn't a certain way or checking something over and over.

All behavior serves a function, Carretta-Stein notes, so changes in your child's behavior shouldn't be ignored. But that doesn't mean you react to it. Carretta-Stein prefers the term "mindfully respond." She teaches parents the "'STOP" technique to deal with a child with anxiety.

"STOP stands for Stop, Think, Observe, and Plan," she explains. "Stop and resist the urge to react to your child with emotion. It only adds fuel to the fire and will not help alleviate the anxiety. In fact, it can make it worse. Next, think about what your child is currently feeling. Then observe their behavior and consider what's at the root of the issue. Finally, plan how you would like to respond."

For many parents, that might be the difficult part. It's one thing to notice something is up; another thing to know how to try to make things better. But don't overthink it. Like most parenting matters, it's best to keep it simple.

"You could say to your child, 'I notice you're acting differently. Is something bothering you? Or are you nervous?'" Carretta-Stein suggests. "Even if you're wrong, it will help your child feel seen by validating their emotional experience."

Another parenting truth: Kids learn what they see. "Parents should evaluate their own anxiety and make sure they're not modeling any excessively anxious thoughts or behaviors," Krawiec says. "Of course, some anxiety is good, keeps us safe, and helps us to know right from wrong, but too much of it can be limiting psychologically, socially, and developmentally. Kids can learn anxious responses, and interpret anxiety, from their parent — trauma reactions can be passed through generations."

There's a name for this in psychology: social referencing. "This refers to the idea that children look to adults to understand how to regulate and manage their own emotions, says licensed clinical psychologist Melanie English, Ph.D., MSW.

"An adult might imagine being on an airplane with some turbulence; we might look around at other passengers to see if they are concerned or not with the turbulence," she says. "If those passengers aren't bothered we might feel fine; if we see others becoming upset, we might also feel upset. Like this example, our children will look to us to interpret a situation and how to react to it."

If parents can positively address the negative feelings they experience (anxiety, stress, conflict, etc.), they can mirror that their kids — and you have a potentially life changing teaching moment right there. "Our children will inevitably see our anxieties, struggles, conflicts, bad days, and worst moods (welcome to life!), but we can identify and model to them why we might feel that way and how we handle it," English says. "In turn, they will understand that there are sometimes uncomfortable feelings and emotions in this world but there are tools to try and address them."

Like all mental health issues, anxiety is complex and can mirror other things, English adds. For instance, your child might think they feel anxious about an upcoming event, but they're actually excited. Or they might think they feel anxious about a test, but really they feel unprepared.

"Anxiety is typically future-based and can be addressed in kids similarly to how adults address it: talking it out, knowledge, self-care, having fun, exercising, creating structure, etc.," English says. "Encourage your child to describe what they are feeling, then try to come up with ways to reduce or eliminate that feeling."

Additional complications may be diet, lack of sleep, family problems, friend problems, health issues, and numerous organic, biological components. In those cases, English recommends exploring individual or family therapy (there are professionals who specialize in controlling for anxiety), medication, or other mechanisms.

And remember, asking for help does not mean you're an inadequate parent; it means you have your kid's back.

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