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A Parent’s Guide to Child & Adolescent Anxiety

One of the most difficult parenting moments we may experience is seeing our child in distress and feeling powerless in our ability to help him or her feel better. There will be a time in the life of every parent in which his or her child is struggling and the path to understanding and overcoming this struggle is unclear.

In order to help a child overcome distress, it is first important to identify the problem. Anxiety disorders are among the most common psychological difficulties in children and adolescents, affecting approximately 13% of youth in the United States.

Anxiety disorders in childhood are the greatest predictors of anxiety, mood, and substance abuse difficulties in adulthood; thus, it is important to identify and treat anxiety difficulties as early as is feasible.

Early identification and intervention is associated with positive long-term outcome.

A Parent’s Guide to Anxiety Disorders

Anxiety is a healthy, normal, and adaptive response to stress. It is our body’s way of alerting us to danger. It can be motivating and helpful to us in meeting our goals. However, in excess, it can cause us to feel overwhelmed and leave us unable to carry out our daily activities.

There are a number of anxiety disorders common to children of which parents should be aware:

Generalized Anxiety Disorder (GAD) :

Generalized Anxiety Disorder is characterized by persistent, pervasive worry that is difficult to control.

Children with GAD often worry about issues such as their family relationships, friendships, romantic relationships in adolescence, school performance, or recreational activities.

These children commonly report worries about not meeting the expectations of others. They may exhibit difficulties with sleep, reassurance seeking, irritability, stomachaches, and headaches. Their concerns are often related to real-life problems, but are exaggerated and excessive.

Separation Anxiety Disorder :

Separation Anxiety Disorder is characterized by acute distress when separated from caregivers and typically begins prior to 10 years of age.

Some degree of separation anxiety is a normal stage of child development which begins in late infancy and may persist for a significant period of time; however, this anxiety becomes clinically significant when it interferes with the child’s ability to engage in age-appropriate activities such as school, play dates with peers, or recreational activities.

Children with separation anxiety may appear excessively clingy to their caregiver, avoidant of activities which would require separation, and fear of his or her family being in danger when separated from him or her. It may also manifest itself in physical symptoms such as stomachaches and headaches.

Social Anxiety Disorder :

Social Anxiety Disorder is characterized by excessive concern about being judged by others. That extends well beyond being shy.

Children experiencing social anxiety are extremely worried about the possibility of embarrassing themselves. The anxiety typically centers around performing in public, such as in having to speak, eat, write, or engage in some other behavior which can be observed and judged by others.

Children who experience social anxiety disorder fear being criticized or humiliated. Older children may be avoidant of situations they anticipate may cause them to be socially anxious, while younger children may exhibit distress by acting out (i.e., crying, displaying tantrums or other defiant behavior).

They may also experience physiological symptoms of arousal when faced with their fears, including racing heart, breathlessness, trembling, dizziness, lightheadedness, sweating, or gastrointestinal distress.

Selective Mutism (SM):

Selective Mutism is a disorder in which anxiety causes a child to be unable to speak in certain settings, while able to talk and interact in other settings.

SM may be seen in settings such as schools in children who are experiencing this extreme level of distress.

This disorder typically presents itself in a child as being able to talk freely at home and other comfortable settings, while nonverbal in other settings such as school or in the presence of others with whom they are not familiar.

These children may use gestures or other nonverbal efforts to communicate, but appear unable to speak.

Specific Phobia :

Specific Phobias are characterized by excessive and irrational fears about a particular object or situation that is not typically considered to be dangerous.

Children with specific phobias are commonly fearful of dogs or other animals, storms, insects, blood/injections, or heights to the extent that it interferes with their functioning.

Children may not have insight into the unreasonableness of their fear and may avoid exposure to these anxiety-provoking stimuli or demonstrate acting out behavior (i.e., crying, displaying tantrums or other defiant behavior).

They may also experience physiological symptoms of arousal when faced with their fears, including racing heart, breathlessness, trembling, dizziness, lightheadedness, sweating, or gastrointestinal distress.

Obsessive Compulsive Disorder (OCD) :

Obsessive Compulsive Disorder is characterized by recurrent and persistent intrusive thoughts, images or impulses (obsessions) and repetitive behaviors and/or mental acts that one feels driven to perform in response to the obsession or in accordance with rigidly applied rules (compulsions).

Compulsions are enacted with the goal of reducing or neutralizing anxiety or distress brought about by the obsession.

This disorder, which can manifest itself in early childhood, may be exhibited by excessive hand washing, locking and relocking doors, checking behaviors, reassurance seeking, touching or tapping in a certain order or to the count of a particular number, re-writing, re-reading, carrying out specific behavioral sequences, or counting.

Common obsessions concern a fear of contamination/germs/illness or harm coming to oneself or one’s family and being responsible for that harm which is perceived to be preventable by engaging in compulsive rituals.


A Parent’s Guide to Action

Anxiety becomes problematic when it begins to interfere with a child’s everyday functioning.

Parents should consider whether a child’s anxiety is excessive, when:

a. It is unrealistic or irrational

b. The level of distress far exceeds the seriousness of its cause

c. It results in the child having unrealistically high expectations of him/herself (i.e., perfectionism)

d. It is unwanted and uncontrollable

e. It results in avoidance or inability to engage in activities the child would otherwise enjoy

In discussing fears with a child:

a. Be open, honest, and listen to a child’s concerns.

b. Ask open-ended questions to learn more about the child’s experience.

c. Avoid judgment or unintentionally dismissing a child’s feelings, such as may occur by conveying any message that the child is being “silly” or “dramatic.”

d. Refrain from reinforcing the fear by appearing anxious themselves.

e. Avoid unintentionally reinforcing the fear by providing reassurance or allowing avoidance behavior or school absence.  Although this will reduce anxiety in the short-term, it will reinforce their anxiety and prevent children from having the opportunity to learn adaptive coping skills or to learn that their anxiety was unrealistic, not harmful, and would diminish even when faced with their fear.

f. Model good coping and problem-solving skills.

g. Be mindful that anxiety tends to increase when that which is causing anxiety is unpredictable, unfamiliar, or imminent.

h. Prepare children for anxiety provoking situations by discussing them in advance, covering what could happen, how they may feel, what they may do, and if the worst were to happen, how would they manage that.

Lastly, if anxiety is excessive and is negatively impacting a child’s daily functioning, seek professional help.

Psychologists specialized in providing evidence-based cognitive behavioral therapy have the ability to successfully treat these difficulties and help children to overcome their anxiety.

When therapy alone is insufficient, medication may also be a useful supplement to an effective treatment plan.


Dr. Deibler

Lead photo available at 123rf

A Parent’s Guide to Child & Adolescent Anxiety

Marla W. Deibler, PsyD

Marla W. Deibler, Psy.D., is a clinical psychologist and nationally-recognized expert in anxiety disorders and the obsessive-compulsive spectrum, including trichotillomania and other body-focused repetitive behaviors, obsessive-compulsive disorder, hoarding, and tic disorders. She is the Founder and Executive Director of The Center for Emotional Health of Greater Philadelphia in New Jersey, an outpatient facility specialized in providing evaluation and evidence-based, cognitive-behavioral therapies for these and other difficulties. She currently serves on the Board of Directors of OCD-NJ, the New Jersey affiliate of the International OCD Foundation (IOCDF). Dr. Deibler gained her formative clinical experiences at the National Institute of Mental Health (NIMH) at the National Institutes of Health (NIH), Children’s National Medical Center, and the Kennedy Krieger Institute at Johns Hopkins University Medical Center. She gained specialized behavior therapy experience in the treatment of obsessive-compulsive spectrum disorders at the nationally-recognized Behavior Therapy Center of Greater Washington. Dr. Deibler served as a clinician at the National Center for Phobias, Anxiety, and Depression. She also served as Director of Behavioral Sciences at the Temple University School of Dentistry and served on the clinical faculty at Temple University Schools of Medicine and Allied Health as well as Temple University Children’s Medical Center. Dr. Deibler has published scientific research in peer-reviewed journals and has presented clinical training seminars and research findings at national and international meetings. She has appeared on the Dr. Oz Show, A&E’s “Hoarders”, TLC’s “Hoarding: Buried Alive”, CBS News, ABC News, FOX News, It’s Your Call with Lynn Doyle (CN8, Retirement TV), and CBS’s “Swift Justice with Nancy Grace”. She has been quoted by media outlets, including the Wall Street Journal, CNN, Philadelphia Inquirer, Philadelphia Daily News, and the Connecticut Post, among others. Dr. Deibler holds licenses to practice psychology in New Jersey (Lic. No. 35S100438000) and Pennsylvania (Lic. No. PS0157790). She is an active member of the American Psychological Association, Trichotillomania Learning Center, International OCD Foundation, OCD-New Jersey, Association for Behavioral and Cognitive Therapies, and Anxiety Disorders Association of America. Dr. Deibler resides in suburban Philadelphia with her husband (who is also a psychologist) and three children.

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APA Reference
Deibler, M. (2013). A Parent’s Guide to Child & Adolescent Anxiety. Psych Central. Retrieved on May 26, 2020, from


Last updated: 3 Feb 2013
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