Conditions

Anxiety

What is anxiety?

Anxiety is a normal feeling of being worried, nervous or uneasy. It is the body’s alarm system, and it can help keep a child safe by letting them know they might be in danger. Everyone feels anxiety at times. The level can change from person to person.

By itself, anxiety is not necessarily a problem, and it can even be helpful. But anxiety may become a problem if:

  • It’s too high for the situation, like a fire alarm going off when there is no fire.
  • It keeps your child from doing what they want or need to do.
  • It happens often for many weeks or months.

If this is the case, your child may have an anxiety disorder. Treatment helps to reduce anxiety by helping young people face their fears so they can function better and enjoy life more.

Anxiety disorders are the most common mental health conditions in children and teens. About 1 in 10 young people will have an anxiety disorder between the ages of 4 and 20.

  • An anxiety disorder is not just 1 thing. There are many types, including:

    • Separation anxiety disorder — Feeling more afraid and stressed than typical for the child’s age about being away from home or away from a parent, caregiver or other important person in their life, or feeling this way longer than typical for their age.
    • Selective mutism — Not speaking in 1 or more situations (such as at school), even though they can and will speak in other situations when they feel more comfortable (such as at home).
    • Generalized anxiety disorder — Worry about several topics (such as school, family, health or safety, world events, natural disasters and the child’s own social standards, such as their reputation). The worry stays around and interferes in many parts of life. Your child or teen also has at least 1 body symptom (such as stomachache, headache or backache from muscle tension) due to worry.
    • Specific phobia — Feeling so afraid of an object or situation (like bugs, flying, shots or vomit) that it causes them great distress or they avoid it.
    • Social anxiety disorder — Feeling uncomfortable or afraid in 1 or more social settings out of concern about being judged or evaluated. Often, people with this type of anxiety appear shy or withdrawn, but sometimes they appear outgoing even though they feel a lot of distress inside.
    • Panic disorder — Repeated times of intense fear that happen for no clear reason (there is no specific cue). This can cause feelings in the body like a sense of dread, choking, fast heartbeat, shakiness, feeling faint or having wobbly legs that peaks in about 10 minutes and then goes away.
    • Agoraphobia — Feeling afraid or anxious about 2 or more situations (such as being on public transportation, in open spaces, in enclosed spaces, in lines or crowds, or outside of home alone). This may involve fear that it will be difficult to get out of a situation the child doesn’t want to be in.
    • Obsessive-compulsive disorder — Having unwanted ideas, thoughts, images or urges (obsessions) that are unpleasant and may cause a child to feel worry, guilt or shame. Compulsions, also called rituals, are behaviors a child feels they must do to ease upsetting feelings or stop something bad from happening.

    Sometimes anxiety doesn’t fit neatly into any of these types, and sometimes it comes from a medical condition, like a brain tumor, or from a medicine or other substance.

    Other mental health conditions that involve feelings of anxiety or distress are depression or attention deficit hyperactivity disorder. Anxiety is a common feeling in children and teens who have been through a traumatic event. However, not all youth who are anxious have experienced trauma.

Anxiety at Seattle Children’s

Seattle Children’s Psychiatry and Behavioral Medicine providers specialize in short-term cognitive-behavioral therapy for anxiety in children and teens. We have a stepped-care approach to our program that features many levels of care, including group-based therapy, individual therapy and intensive outpatient programs. Our goal is to help your child face their fears and live a full and active life.

    • Your child is cared for by a team that may include mental health therapists, psychiatric nurse practitioners, psychiatrists and psychologists.
    • Our stepped-care approach allows us to get you the help you need in the quickest manner possible, improve health equity and select the best treatment for your child based on responses to our intake questions.
    • We focus on skills and strategies known to help, like exposure therapy, the most successful treatment for anxiety disorders. We’re also doing research to learn more about how to make treatments work better for everyone.
    • We’re experts in dealing with the unique challenges of anxiety in children and teens and in the ways it affects families. But we realize that you know your child best. We work with you and your child to develop a treatment plan that addresses your child’s individual needs.
    • Everyone on our team is specially trained to understand and meet the specific needs of children and teens. Our pediatric experts tailor care to your child’s age and developmental stage.
    • The Early Childhood Clinic sees children age 5 or younger who have anxiety, behavior issues, sleep problems, neurodevelopmental problems or prenatal (before birth) exposure to alcohol or drugs. We also see children who have other medical conditions along with a behavior or emotional problem.
    • The Mood and Anxiety Program sees children ages 6 to 18 who have mood disorders, anxiety disorders, obsessive-compulsive disorder (OCD) or other related conditions. We offer weekly groups, individual therapy, an Anxiety Intensive Outpatient Program and an OCD Intensive Outpatient Program.
    • The Psychiatry and Behavioral Medicine Unit (PBMU) treats children ages 3 to 18 who are in crisis due to complex mental health issues and need hospital-based care. The PBMU also treats people ages 19 to 21 who are developmentally delayed and in crisis.

What are the symptoms of anxiety?

Anxiety can look many different ways. If your child is anxious, you may notice 1 or more of these symptoms:

  • Fears or worries about being away from parents or caregivers, or having a hard time separating from them.
  • Not speaking in situations that youth typically speak in, despite being able to speak.
  • Extreme fears about 1 specific thing (such as bugs, flying, shots or vomit).
  • Fears or worries about what others think of you or about being embarrassed or making mistakes in social situations.
  • Avoiding or refusing to go to school or other activities. Some children may have angry outbursts or other challenging behavior in order to avoid an activity.
  • Putting in much more time or effort on a task than is typical to avoid the chance of failure.
  • Worries about doing well in school, the health and safety of oneself or loved ones, the future, going to the doctor or dentist, global warming or earthquakes.
  • Seeking much more reassurance from caregivers (parents, teachers or other important people in their life) than is typical for their stage of development.
  • Not doing as well in school or not seeming able to pay attention. This may happen if their attention is being taken up by fears or worries.
  • Concerns around being contaminated by dirt or germs, being responsible for something terrible happening or intrusive scary thoughts.
  • Excessive washing, checking, redoing and having to do things in a certain order or routine.
  • Body symptoms like:
    • Racing heart
    • Trouble breathing
    • Feeling shaky, dizzy, hot and sweaty or cold
    • Headaches
    • Stomachaches
    • Tense muscles
    • Restlessness
    • Feeling tired
    • Trouble sleeping or eating
    • Being irritable

How is anxiety diagnosed?

To diagnose anxiety, a mental health professional will talk with you and your child at an in-person office visit or a telehealth (virtual) visit. We will ask questions developed by researchers to help tell whether your child has an anxiety disorder (or another condition) and which type. We adapt the questions and the conversation to fit your child and family.

We may talk with a young person and their main caregivers together or separately. It depends on your child’s symptoms and needs.

We take into account things like:

  • Do your child’s feelings and behavior fit with their developmental stage?
  • Do your child’s feelings and behavior fit with the culture of their family and community?
  • How much distress is your child in?
  • Does their anxiety keep them from doing things they want or need to do in their daily life, family or social relationships?
  • When they are not in the situation that upsets them, are they able to recover from their distress?
  • How long has the problem been going on?
  • What else might explain your child’s feelings?
  • Are any outside stressors affecting your child, or have they experienced trauma?

After an initial evaluation, a mental health professional will work with you to develop a treatment plan for your child.

How is anxiety treated?

Treatment for anxiety disorders focuses on helping your child build skills to cope with things that cause them anxiety. The goal is not to get rid of anxiety altogether because it is a normal feeling that we all have. Instead, treatment helps young people face their fears in order to adjust their “alarm system” so it’s less sensitive and no longer gets in their way.

There are two main parts of treatment:

  • Cognitive-behavioral therapy focuses on helping your child gradually face the fears and worries they have been avoiding. Research shows this method (exposure therapy) is the most effective treatment for anxiety disorders. It involves facing the feared situation over and over again in real life or in their imagination and practicing ways to respond. More practice leads to better results.

    At Seattle Children’s, you as a parent or caregiver are an important part of the process. You learn how to coach your child on what to do when they feel anxious. You also learn how to reduce avoidance or unhelpful ways of dealing with anxiety.

    It might seem natural to avoid things that make a child anxious. But over time avoidance keeps the cycle of anxiety going. The key to success is to resist avoiding normal, safe situations. This gets easier for both children and caregivers with practice and support.

  • Selective serotonin reuptake inhibitors (SSRIs) are common medicines used to treat anxiety in youth. They are often helpful when combined with CBT. Other medicines can also be helpful. Many families start with CBT and then consider adding medicine if needed.

At Seattle Children’s, we provide stepped care (PDF). This means we offer treatment formats from lower to higher intensity. Families step up to higher levels of care based on need. Stepped care allows us to serve more families sooner.

  • Families start with group-based CBT in our Anxiety and Obsessive-Compulsive Disorder Treatment Program. Weekly group sessions give you and your child a place to work on your goals alongside other families who are dealing with similar concerns. We have options for children of different ages and their caregivers or just for parents or caregivers of children with different needs. Read more (PDF).

  • The next step up in care, if it’s needed, is individual therapy. This may be a brief course of therapy with a Seattle Children’s provider or therapy from a provider outside of Seattle Children’s. We can help connect you with therapists in your area. At this step, your child’s team may also recommend an evaluation to see if medicine might help your child. Read more about services for ages 5 and younger or ages 6 to 18.

  • For children who need a higher level of care, the next step is our Anxiety Intensive Outpatient Program or Obsessive-Compulsive Disorder Intensive Outpatient Program. These programs for a child and their caregiver run 3 hours per day, 4 days per week for 8 to 12 weeks. It is mainly a group format with some individual therapy as well.

  • For children who are in crisis due to complex mental health issues and who need hospital-based care, the Psychiatry and Behavioral Medicine Unit (PBMU) treats children ages 3 to 18. The PBMU also treats people ages 19 to 21 who are developmentally delayed and in crisis.

How to Get Services

We often have more requests from new patients than we have openings. To make an appointment, you need a referral from your child’s primary care provider. Learn more about how to get mental health services at Seattle Children’s.

If you have a referral, call 206-987-2164.

Providers, see how to refer a patient.

Related Links

In Crisis?

If you, your child, family or friend needs help right away, call or text 988. Chat is another option. The 988 Suicide & Crisis Lifeline provides free and confidential support for people in distress, as well as prevention and crisis resources. The Lifeline is available 24 hours a day, 7 days a week in the United States.

Hotlines for Youth provides other options for immediate help for children and teens.