OCD & Anxiety Disorders
Anxiety disorders are common mental health conditions that often manifest in childhood and adolescence.
While it can be alarming to see your child struggle with anxiety, it's important to know that anxiety disorders can be well-managed with the right treatment and allow your child to live a full life. This guide is meant to be informative, answer common questions about anxiety disorders in children and adolescents, and provide resources for caregivers and families.
What do anxiety disorders look like in children and teens?
Common signs of anxiety disorders in children and teens are:
Excessive worry or fear about everyday situations, such as school, friends, or family.
Difficulty sleeping or frequent nightmares.
Rigidity.
Struggling to concentrate or complete tasks.
Physical symptoms, such as stomachaches, headaches, or fatigue.
Avoidance of social situations or activities that cause anxiety.
School avoidance.
Irritability or mood swings.
Persistent, unwanted thoughts or ideas that cause anxiety or distress.
Repetitive behaviors or mental acts that a child feels they must perform to reduce anxiety or prevent a feared event.
Excessive cleaning or hand washing.
Extreme perfectionism or an excessive need for symmetry or order.
In addition to the above, anxiety often manifests in the following ways that are less frequently talked about:
Inability to enjoy free time due to worry about school, friends, family, or extracurriculars.
Fear of being called on in class to answer a question or read aloud.
Excessive worry about things that are out of a child or teen’s control (what friends are doing, what others think of them, what will happen far in the future).
Asking questions repeatedly that have already been answered because they want to “make sure.”
Excessive checking (that the door is locked, that there’s nothing “weird” in their food or that it is not expired, that something is clean).
Excessive and unwarranted reassurance-seeking (“Is this okay?” “Are you mad at me?” “What if I get sick?” “Is it clean?” “What if ______ happens?” “You’re picking me up at ___ time, right?”).
Fear of and/or refusal to talk to unknown adults in typical social situations (ordering at a restaurant, introducing themselves, buying something at a gas station/store/etc.).
It’s important to remember that every child and teenager is different, and they may experience anxiety differently.
What are the treatments for anxiety disorders in children and adolescents? What will my child and I learn?
When seeking treatment for a child or teen with an anxiety disorder, it’s important to find a clinician who uses interventions that are effective and backed by research.
The most common evidence-based treatments are:
1. The CALM (Coaching Approach behavior and Leading by Modeling) adaptation of Parent-Child Interaction Therapy (PCIT)
Ages: Children under 8yo
During this adaptation of PCIT, parents and caregivers are coached in-vivo on how to model and praise brave behavior, and how to help their child overcome their fears. This is typically the most effective intervention for children of this age because they do not have the cognitive development to effectively engage in cognitive behavioral therapy (CBT) interventions.
2. Cognitive Behavioral Therapy (CBT) with Exposure and Response Prevention (ERP)
Ages: 8yo+
During CBT with ERP, children learn about their anxiety disorder, how their brain functions, and the importance of confidently facing their fears. Exposures (facing fears) are a crucial aspect of treatment. Our brains cannot be convinced that something is not scary or is safe; we must experience these things and allow our brains to learn.
Caregivers play a vital role in the intervention and learn how to appropriately encourage and positively reinforce their child’s approach to a feared situation. ERP may seem intimidating, but exposures can be fun and are only done when a child is ready. Your child’s therapist should always be conducting exposures with your child during sessions.
Some common in-session exposures include:
Touching something “dirty” like a toilet seat or drawing pictures outside in the dirt and waiting to wash hands (fear of germs, contamination)
Wearing clown noses and walking around the office or outside (social anxiety, fear of embarrassment)
Spreading glue on hands (fear of germs, contamination)
Saying an intrusive thought out loud or writing it down
Going on a scavenger hunt that involves asking other therapists in the office for items or their signature (social anxiety)
Talking in a loud(er) voice (selective mutism)
Doing a silly dance (social anxiety, fear of embarrassment)
Walking back to the treatment room without a caregiver (separation anxiety)
Playing catch with a fake spider (fear of spiders)
Making fake vomit (fear of vomit or of vomiting)
3. Acceptance and Commitment Therapy (ACT) alongside CBT with ERP
Ages: 12yo+
In addition to CBT with ERP, ACT can be a valuable addition to treatment for adolescents 12 years and older. ACT involves helping adolescents and teens accept their thoughts and feelings, and commit to taking action in line with their values. ACT uses a teenager's identified values to promote psychological flexibility, acceptance, and tolerance of the unknown. For instance, if a teenager experiencing social anxiety and fear of crowds values friendships and wants to attend Austin City Limits with their close friend, they would work on how to achieve their goal (go to ACL), work towards their values (spending time with their close friend), and practice acceptance of uncomfortable emotions and thoughts that may be holding them back (anxiety in crowds, fear that their friend's friends won't like them, the thought "what if something bad happens?").
4. Supportive Parenting for Anxious Childhood Emotions (SPACE) (parent intervention)
It's not surprising that some children and teenagers may not have the motivation or desire to face their fears, as it can be scary for adults to do so. SPACE is a great intervention in these situations and can also be used in conjunction with individual therapy. During SPACE, parents/caregivers learn to reduce the ways in which they may be unintentionally enabling their child's anxiety and avoidance. For example, if a child repeatedly asks their caregivers, "is the door locked?" at night, a therapist may have the caregivers decrease the number of times they answer this question while also providing appropriate and helpful attention to their child's emotions.
How do I know if I should seek therapy for my child?
If you are unsure whether therapy is suitable for your child or adolescent, you can schedule an intake session with a therapist to discuss what is happening and share your concerns. This way, you can receive feedback from the therapist on the appropriateness of treatment. In general, a good question to ask yourself is, "Is my child/teen's anxiety interfering with their functioning?" If the answer is yes, seek therapy as soon as possible.
Some signs that a child or teenager's anxiety is interfering with their functioning include:
They are not attending school, frequently leave school early, or frequently miss school
They are missing out on social experiences
Your family’s schedule or routine is being impacted by your child’s anxiety
Your child’s anxiety is preventing them from learning
It’s important to note that this is not a complete list and that every child and teenager is different.
While anxiety can be daunting and it can be difficult to witness your child struggling, it's crucial to remember that treatments can be highly effective and enable your child or adolescent to lead a happy and fulfilling life.
Here are some additional resources for caregivers of children experiencing anxiety-related disorders:
