What Does Anxiety in Children and Teens Look Like?

This week Orlando Counselor Juliana Ochoa shares her experience and expertise regarding anxiety and how it manifests in children and teens.

Juliana Ochoa, MA
Registered Mental Health Counselor Intern

According to the Child Mind Institute Children’s Mental Health Report (2015), 80% of children with a diagnosable anxiety disorder do not get treatment. Untreated anxiety can lead to lower self-esteem, lower academic performance, lack of social skills, engagement in substance use, and in time, it can even lead to depression. In addition, childhood anxiety has been found to be a precursor for adult anxiety, especially for children who do not receive treatment. With treatment and support, however, children can learn practical strategies and tools to manage their symptoms and overcome their anxiety.

Anxiety is a natural human reaction, and everyone experiences it from time to time. Although it is uncomfortable, anxiety is our body’s natural fight/flight/freeze alarm mechanism. Every child goes through phases as they try to make sense of their world, so anxiety in children looks different at different ages. Anxiety can be helpful, helping us stay alert and motivated, but it can also be problematic, when it is overwhelming. It becomes problematic for our children when it interferes with successful functioning, whether that is in the academic setting, in the home, or in relationships with peers.

There are a number of different types of anxiety often seen in children, and I will discuss the most common I see in my work –social anxiety, obsessive compulsive disorder, separation anxiety, and generalized anxiety disorder. I’ll explain how these present in children, touch on how to recognize if it may be a problem for your child, and offer some helpful strategies you can begin to utilize at home to help your child manage his or her anxiety.

Social anxiety occurs when a child feels extreme shyness and self-conscious and this fear of embarrassment prevents him or her from interacting with new friends, talking in a big group, or participating in classroom discussions. They are usually okay with close family and friends, but will really seek to avoid and dread social activities.

Obsessive compulsive disorder manifests in children as recurring thoughts of fears, doubts, and worries, which can be scary and stressful and may keep children from being able to focus on anything other than these thoughts. To get relief from their obsessive thoughts, children resort to compulsive rituals to make sure things are “okay.” It can become a frustrating problem for teachers and parents when the ritual doesn’t bring the relief it once did and the child gets stuck, paralyzed in a way, because something is just “not right.”

Separation anxiety is a normal stage of development, and the intensity of emotion surrounding a separation decreases as children get older. In early childhood, it is normal for children to cry, throw a tantrum, or become clingy – and in the school setting, we see this most often with pre-K children or kindergarteners who are entering school for the first time and experiencing the longest separation from a caregiver. This is normal. As a parent, you can comfort your child through this phase by staying patient and setting consistent limits so your child knows what to expect from you. If separation anxiety doesn’t go away as the child gets older and it begins to interfere with school and friendships, it may be a sign of a larger problem.

Generalized anxiety disorder is characterized by excessive worrying about past, present, and future events, and children with this disorder worry excessively about past things they said or were said to them, things they have done or neglected to do, events that are coming up, issues with family and friends, etc. They spend so much time worrying that it begins to interfere with their daily life and functioning.

What does anxiety in children look like? We can think of children’s experience of anxiety at three levels – thoughts, feelings, and behaviors. So with thoughts – there’s unrealistic worry about every day things, always expecting the worse, and having an inability to stop the worry. With feelings in their body – heart pounding or racing, sweating, headaches, or stomach “butterflies.” And lastly, the behaviors are typically avoidance of tasks, people, and situations, looking for constant reassurance, crying, and even anger outbursts and fighting.

What can we do to help children manage intense emotions? It is helpful for kids to feel felt, and so being able to tune in to their emotion and name that emotion for them, is a good first step to de-escalating a meltdown (or managing a shut down reaction). Take a look at Dan Siegel’s “Being versus doing with your child” video, available on YouTube, for more information on brain science and attunement, and how to utilize this knowledge to connect with your child during difficult and emotional times. When your kids are having trouble with an overwhelming feeling, you can be there and be a calm and safe presence, and in time, your child will be able to match your state of calm. Being able to breathe with them so that again, they can match a state of relaxation. It is helpful to have practiced breathing exercises when your child is not experiencing a heightened anxiety level so that it is easier for them to be able to access this skill in times of emotional overload.

Since children with anxiety worry constantly, engaging in positive self-talk is a useful strategy to try to rewrite their negative internal dialogue. Practicing turning negative statements into positive statements can be a skill you can all work on as a family – even us as adults are guilty of being hard on ourselves from time to time. Trying to work on changing those patterns ourselves will help our children tremendously with changing their negative thoughts to more positive and helpful ones.

Other techniques that are helpful to your child involve visualization of the worries going away – an example is blowing bubbles, with the bubble floating off and carrying with it a specific worry. Visualizing a calm, happy, and safe place is also helpful for children as they learn to self-soothe with this strategy in virtually any setting they might find themselves in. Meditation and mindfulness are other tools that have become increasingly available in our society today. Meditation is a technique for resting the mind – clear, relaxed, and inwardly focused. It simply means to be able to tune out the outside world and focus on our internal experience. With practice, children are able to fall deep into states of balance and peace. Mindfulness, similarly, invites us to practice attention and awareness on the present moment, without judging it. Encouraging our children to practice mindful listening, mindful eating, and taking mindful walks are some exercises that help calm down their mind activity and relax their bodies.

It is important to consider the amount of anxiety your child is feeling, the level of anxiety, how long it has been going on, how much it is getting in the way of their healthy functioning, and how distressing it is to your child and family. If it happens to often and interferes with normal every day things at school, home, or with friends, it is important to seek help.


If you feel your child might need help and support in learning how to manage their symptoms and overcome their anxiety, give us a call at 407-355-7378 to set up a free phone consultation at Life Skills Resource Group Orlando. We will talk with you about how one of our Orlando Relationship CounselorOrlando Individual Counselors, Orlando Life Coaches, Orlando Teen Counselors, or Orlando Child counselors can begin to help you and your child.  Click to read more about Juliana Ochoa’s approach to helping clients.


Juliana Ochoa