Children with Anxiety Disorders

My Child has an Anxiety Disorder

If your child has an anxiety disorder, the most important piece of advice is: Don't blame yourself and don't blame your child. Certainly no one would ever want these symptoms or wish them on someone they love. Anxiety disorders can be especially frustrating if they are accompanied by a lot of avoidance or other “safety“ behaviors (e.g., having a parent or other safely object with them in feared situations, compulsions, etc.). Please try to be patient with your child and remember...if it were so easy to “just stop“ these frustrating behaviors, it would have already happened. Tell your child that you love them despite any anxiety problems. Let them know that even though they may have some worries that don't make sense or some “bad habits,“ they are not a bad person.

It is also often beneficial to educate your child a bit about the problem so that they no longer feel so alone or “crazy“. This discussion should be tailored to your child's age, developmental level, and their concerns or insight about the problem itself. For example, some children with OCD may think that others are just “gross“ for not also washing their hands 10 times before leaving the bathroom; sometimes, children with trichotillomania do not seem to care about the effects of hair pulling on their appearance. In addition, sometimes children may engage in some anxiety related behaviors with only minimal awareness (because these behaviors have become so automatic), so they may not honestly know what behaviors you are referring to (or not be aware of their frequency).

Do Anxiety Disorders Affect Family and Friends?

Absolutely. Frequently, those with anxiety disorders alter their lifestyles and those of loved ones due to the “rules“ that their anxiety disorder makes them adhere to. These lifestyle alterations can run the gamut from mild to very severe. For example, a child with a specific phobia of dogs may insist that the family does not go to any parties at people's houses if they own a dog (i.e., relatively minimal life interference), but a child with severe checking OCD may insist that his family return home twice every time they leave the house to check that the front door is really locked (i.e., severe life interference). Thus, even though family members may not share or even understand the fears that are present, they conform to the “rules“ made by the anxiety disorder so that their loved one is not distressed. It is not uncommon for children to become very upset, cry, or have a tantrum if these “rules“ are disregarded.

One of the most common ways that anxiety disorders are identified in children is due to a change in their previous functioning. It is not uncommon for children with anxiety disorders to begin avoiding certain activities or contact with particular objects/people due to their fears. These indicators are often confusing to parents because they frequently involve things that their child formerly enjoyed (such as going to the beach or a playground). Some children will state their fears, but it is probably more common for children to instead make up excuses like “I'm tired“ or “I don't like doing that anymore“ rather than reveal that they are frightened to do certain things or go to specific places. For certain anxiety disorders, such as OCD, the number of avoided things often grows over time and symptoms worsen. Thus, time formerly spent having fun with family and friends is now spent engaging in anxiety related behaviors (e.g., dwelling on the worry, compulsions) or in avoiding things that are feared.

Treatment for Children with Anxiety Disorders

Typically the same treatments are used for children as are used with adults -- with some slight differences. For example, the disorders are explained in ways that they can better understand and a reward system is usually implemented for all their hard work in attempting therapy assignments. Reward systems tend to be especially helpful in keeping younger children on-track, given that the results of therapy are usually not seen for several weeks and children have a tendency to easily give up if they see no immediate benefit. Older children and adolescents may see standard reward systems as being “treated like a baby,“ so they frequently prefer that treatment be conducted in the same way as it is administered with adults or that monetary incentives are instead given.

The most essential element to successful treatment is that the child is self-motivated to change these anxiety related behaviors - and they are not solely in treatment because of parental pressure.

What Role does the Family Play in Treatment?

The role of family members usually varies depending on the age of the child. For younger children, more parental involvement is usually necessary (in part because children sometimes have a harder time reporting accurately on their symptoms, therapy assignments, and progress). Adolescents usually prefer to keep their sessions more private and only periodic check-ins with parents are usually implemented.

It is usually very beneficial for the family to have some role in treatment so that they can be further educated about the anxiety disorder and understand the sometimes frustrating symptoms that accompany them. The degree of family involvement usually depends on the child/adolescent and on the family itself. For some families, taking a step back and letting your child take the reins (with the help of their psychologist) in overcoming their symptoms is most helpful.

For some families, it may be beneficial for the parents to know about the treatment plan that has been designed by the psychologist. This is frequently helpful because then they will know where to look for successes and where to not yet expect improvements (until later). If family members are engaged in “helping“ their child with any anxiety related behaviors (e.g., compulsions), they can also learn how to gradually separate themselves from these fear-related behaviors. The biggest role that the family can play is by helping their child to implement the weekly goals that have been set between their child and the psychologist. Because each family is very different and has its own specific needs, you will have to work together with your psychologist to decide how you can best help your family member with their anxiety disorder.

If you are interested in learning more about anxiety disorders and their treatment, and you live in the Los Angeles area, contact Dr. Nelson at (310) 963-4891 or e-mail her at