Anxiety Signs, Symptoms, Disorders, and Support

Anxiety Disorders in Children: What Parents You Need to Know

Anxiety is one of the most common difficulties children face. And yet it is also one of the most misunderstood. It can look like anger, defiance, physical illness, or simply a child who refuses to go to school. It can be loud or completely invisible.

As a clinician who has worked with anxiety in children for over twenty six years, I want to help you understand what you might be seeing, when it crosses into disorder territory, and what actually helps.

According to NHS England, one in five children and young people aged eight to twenty five had a probable mental disorder in 2023. Anxiety disorders are among the most common, and yet they often go undetected and untreated for far longer than they should.

Normal anxiety versus an anxiety disorder

Anxiety itself is not the problem. It is a normal and necessary part of life. Children feel anxious before tests, when starting a new school, or when meeting new people. That kind of anxiety is usually short lived and does not significantly interfere with daily life. It can even build resilience.

An anxiety disorder is different. It is persistent, disproportionate to the situation, and gets in the way of a child being able to function day to day. It does not just pass with time or reassurance.

The American Psychiatric Association distinguishes between fear and anxiety in a way I find genuinely useful:

Fear is the emotional response to real or perceived imminent threat. Anxiety is anticipation of future threat. Fear is associated with surges of arousal and escape behaviours. Anxiety is associated with muscle tension, vigilance, and cautious or avoidant behaviours. (APA 2013)

In other words, fear is about now. Anxiety is about what might happen. And for many children, that anticipation becomes a constant background hum.

What anxiety can look like

Anxiety does not always look like worry. It can show up as anger, physical symptoms, avoidance, or a need to control. I have written about this in detail in my blog Anxiety in Children: What to Look For and How to Help. That is a good place to start if you are trying to make sense of what you are seeing.

The six anxiety disorders

Separation anxiety

Some degree of separation anxiety is developmentally normal, particularly in young children. However when it persists beyond the expected age, intensifies rather than eases, and begins to prevent a child from taking part in everyday activities, it becomes a disorder.

Children with separation anxiety disorder often complain of tummy aches or headaches before separations. They may cling, have nightmares with themes of separation, refuse school, or find it very hard to be alone, including at night. And it is not just young children. Teenagers can experience separation anxiety too, though it may look different and be harder to recognise.

Generalised anxiety disorder

Children with GAD worry about almost everything, chronically and intensely. Unlike situational anxiety, the worry in GAD is not tied to a specific trigger. It is pervasive and hard to control.

You may notice your child asking many what if questions, seeking constant reassurance, and struggling with uncertainty in any form. Reassurance helps briefly but never resolves the underlying anxiety. Negative thinking patterns, sometimes called cognitive distortions, are common. Unlike adults, children often cannot recognise that their beliefs are outsized or unrealistic.

Panic disorder

More common in older children and young adults, panic disorder involves repeated episodes of sudden, intense fear accompanied by physical symptoms such as racing heart, shortness of breath, dizziness, and sweating. These episodes can feel terrifying and can lead to avoidance of situations where a child fears they might happen again.

Specific phobia

An intense and disproportionate fear of a specific object, animal, activity, or situation. The fear causes real distress and can prevent children from taking part in normal daily activities. Over the years I have worked with children with fears of insects, rain, dentists, and many other things. The specificity matters less than the impact.

Social anxiety

Children with social anxiety feel intense fear in social or performance situations, particularly when they feel observed or judged. They may worry about doing something embarrassing or humiliating, avoid situations that trigger the fear, or participate with extreme discomfort. School can be a significant trigger, particularly for speaking aloud, performing, or being in groups. In severe cases this can lead to selective mutism.

Selective mutism

Selective mutism is when a child consistently does not speak in specific situations, most commonly school, despite speaking confidently at home or in comfortable environments. It is not a communication disorder and it is not wilful. It is anxiety preventing speech in situations that feel unsafe. Children with selective mutism are often described as confident at home and completely silent elsewhere.

When does anxiety become a disorder?

A helpful framework is the three Ds.

Distress. How much is your child suffering? How frequent and severe are the symptoms?

Duration. How long has it been going on? Anxiety disorders are characterised by symptoms persisting for six months or more.

Disruption. Is it significantly affecting daily life, school, friendships, or family functioning?

If all three are present, please do seek support. Evidence shows that most children with anxiety disorders do not access clinical services, and untreated anxiety can lead to significant difficulties in adolescence and adulthood.

Sleep and anxiety

Anxiety and sleep are deeply interconnected and this is something I feel strongly about. A child who is anxious during the day will almost always struggle at night too. The nervous system does not switch off at bedtime. It carries everything with it.

Nighttime is often when anxiety is at its loudest. The distractions of the day have gone, the mind is left with whatever it has been holding, and worries that felt manageable at three in the afternoon can feel enormous at two in the morning.

Equally, poor sleep makes anxiety worse. A tired nervous system is a more reactive one. The two feed each other in a cycle that can be very hard to break without support.

I offer sleep consultations specifically for children and families where anxiety is part of the picture. This is not just about sleep hygiene or bedtime routines. It is about understanding what is driving the difficulty and addressing it at the root.

You can read more about the connection between anxiety and sleep in my free guide When Darkness Comes.

What helps

Cognitive behavioural therapy is the primary evidence based treatment for anxiety disorders in children and has a strong track record. However it is not suitable for everyone.

Younger children, particularly those under eight, may not yet have the cognitive capacity to engage with CBT techniques. For them, play therapy, sand play, or art therapy are often more effective and developmentally appropriate.

Children who are neurodivergent may also find traditional CBT challenging and need an adapted approach that takes account of how they process information and experience the world.

A note on trauma

Sometimes what looks like ordinary anxiety is actually something deeper. If your child’s anxiety followed a specific frightening event, a hospital stay, a loss, an accident, or if it’s part of a wider pattern that’s been building for a long time, it’s worth reading my page on Trauma: Signs, Symptoms and Support alongside this one. Anxiety and trauma can look very similar from the outside, and many parents don’t immediately realise trauma might be part of the picture.

Interested in Working with me

If any of this resonates, I would love to hear from you.

I work one to one with children and young people with anxiety, using approaches tailored to their age and what is actually driving the difficulty. For younger children that might be play therapy or sand play. For older children and teenagers, talking therapy adapted to where they are.

I also work with parents, because understanding your child’s anxiety and knowing how to respond to it makes an enormous difference. You do not have to wait until things reach crisis point. Coming early is always better.

And if sleep is part of the picture, I offer sleep consultations specifically for anxious children and families. This goes far beyond bedtime routines. It is about understanding what the nervous system needs to feel safe enough to let go.

Whatever is bringing you here, you are in the right place. Get in touch via my contact page and we can think together about what might help.

Free resources

My free guides are a good starting point if you want to understand more about what is happening in your child’s nervous system when anxiety takes over.

Understanding Your Child’s Guard Dog Brain

Holding in the Storm

When Darkness Comes includes specific support for anxious children at night.

All free to download.

And if you would like occasional guidance and support straight to your inbox, you are very welcome to join my newsletter.

With warmth,
Catherine