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.

• Types of anxiety disorders

  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 Often, people with this type of anxiety appear shy or withdrawn, but sometimes they appear outgoing even though they feel a lot of distress inside.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.

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.

• The experts you need are here
  • 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.
• Care from birth through young adulthood
  • 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 4 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 5 to 18 who have mood disorders, anxiety disorders, obsessive-compulsive disorder (OCD) or other related conditions. We offer weekly groups, individual therapy and an OCD Intensive Outpatient Program.
  • The Psychiatry and Behavioral Medicine Unit treats children ages 3 to 17 who are in crisis due to complex mental health issues and need hospital-based care. 
• Resources for your child and family
  • We often have more requests from new patients than we have openings. Even if we do not have openings, it is important to get care when your child needs it. There are many outside resources in the community that can help.
  • Find more resources on anxiety, selective mutism, obsessive-compulsive disorder and related conditions and treatments from Seattle Children’s, including these and many others:
    • Anxiety and OCD Treatment Program (PDF) (Spanish)
    • Anxiety Disorders: Facts for Families (PDF) (Spanish)
    • Anxiety 101 - 1. What Is Anxiety? (Video. 6:44)
    • Guidelines for Choosing a Mental Health Provider (PDF) (Spanish)
    • What to Expect During an Assessment for Anxiety or Obsessive-Compulsive Disorder (OCD) (PDF)

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 (CBT)

  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.

• Medicine

  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.

• Group-based treatment

  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).

• Individual therapy

  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.

• Intensive outpatient program

  For children who need a higher level of care, the next step is our Obsessive-Compulsive Disorder Intensive Outpatient Program. This program for a child and their caregiver runs 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.

• Inpatient care

  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.