Does my child have an anxiety disorder? Here are the signs parents should look out for

It may have been monsters under the bed, robbers breaking into the house or ghosts lurking in the darkness sending shivers down your spine when you were young.

Many people might vividly remember their most troubling childhood fears, but they tend to outgrow the worries that once caused sleepless nights. For some children and their parents, however, it can be difficult to determine when fears are typical and when they are developing into more serious phobias or anxiety disorders.

Fears are a normal part of human development and serve as survival mechanisms, helping prevent children and adults from engaging in risky behavior. But once fears become debilitating or impair daily function, they can be classified as a phobia or anxiety disorder, said Thomas Ollendick, University Distinguished Professor Emeritus of Psychology at Virginia Tech, who is known for his work with children and adolescents.

If anxiety disorders and phobias are left untreated, children are at risk of additional psychiatric or medical problems, which could follow them into adulthood, according to Wendy Silverman, director of the Yale Child Study Center’s Anxiety and Mood Disorders Program, Alfred A. Messer Professor of Child Psychiatry, and professor of psychology at the Yale School of Medicine.

Common fears at different developmental stages

Children may develop phobias or anxiety disorders for a variety of reasons, including genetics, direct negative experiences with an event or object, observation of others or overhearing frightening information, Silverman said.

Phobic and anxiety disorders are also relatively common in children. As many as 1 in 3 children and adolescents are affected by these disorders, and these rates have increased substantially since the start of the Covid-19 pandemic, according to “The Parents’ Guide of Psychological First Aid: Helping Children and Adolescents Cope With Predictable Life Crises.” (Silverman contributed to this book.)

New fears and anxieties tend to develop and vary as children and adolescents grow and adapt to new environments, Silverman said.

Infants and toddlers often show fears of loud noises, unfamiliar people and separation from their parents. By the time children start engaging in more imaginative play once they reach preschool age, they may develop fears pertaining to ghosts, monsters and small animals.

When children reach adolescence and start having more real-world experiences, it’s common for them to develop fears around social anxiety, particularly when facing the scrutiny of others.

Distinguishing fear from anxiety disorders or phobias

The first step in addressing an anxiety disorder or phobia is recognizing symptoms that fall outside the boundaries of a common fear.

Parents may struggle to detect certain anxieties, especially if a child doesn’t display classic symptoms — rejecting food, nausea or refusing to leave the house — or has reservations about sharing their fears, Ollendick noted.

To help parents distinguish whether a fear may develop into a more serious disorder, experts such as Ollendick and Silverman look at the frequency, intensity and duration of a fear.

Frequency helps determine how often a fear is occurring. Parents and children can note whether the fear is something that’s popping up once a year compared with a daily struggle.

It’s also important to assess the intensity of a fear, which parents can judge based on how their child responds when a situation isn’t handled in the way that they want. Ranking your child’s reactions on a scale of one to 10 can help parents and psychologists better understand the severity of these instances.

Finally, duration is crucial in knowing when it might be time to seek professional support. Psychologists recommend giving your child’s fears some time to settle to see if such worries are more of a phase or long-lasting issue.

Citing the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, Ollendick and Silverman noted that fears should last for at least six months before they are considered a clinically significant phobia or anxiety disorder.

However, if a fear is preventing a child from developing or functioning properly, impairing family function or negatively affecting academic performance, it’s possible the fear has developed into a clinically significant problem, and it may feel unreasonable for parents to wait to seek professional support, Silverman said.

How parents can provide support

When managing children’s fears, many parents instinctively want to intervene to shield their distress. However, Silverman warns against this approach, referred to as parent protection or accommodation, which provides temporary relief for the child but reinforces the fear instead of helping overcome the root of the concern.

If parents have specific anxieties that cause them to spiral and act inappropriately, it’s essential to admit that they can demonstrate healthier reactions, which could help their child model better behavior in the future.

Additionally, parents should attempt to find a balance between acknowledging their child’s concerns and discussing safety precautions and emphasizing the possible harms and negative outcomes of an event or object, Ollendick said.

It can be especially tough to navigate children’s fears of real-world threats such as school shootings or natural disasters. However, Ollendick and Silverman highly recommend fostering open dialogue to help reduce worries or feelings of isolation and shame.

Parents can also share their emotions, in an age-appropriate manner, to show that it’s healthy to talk about heavy topics and be vulnerable with others.

In some cases, explaining that certain fears are linked to low-probability events or creating a plan can provide reassurance, Silverman said.

For those who live in coastal areas more susceptible to hurricanes, your child may find comfort in discussing the actions family members would need to take if they were in danger.

Parents should encourage children to face their fears instead of falling into avoidant behaviors. Especially for younger ones, positive reinforcement can help children feel motivated to confront their fear. Small gifts or privileges such as playing a game or spontaneously getting ice cream should be offered as soon as possible after children have engaged in such behavior to build their confidence, according to Silverman.

Seeking professional help

If your child’s anxieties persist beyond six months, despite your efforts at home, it’s vital that parents seek qualified professionals for help, Silverman said.

When pursuing professional support, younger children may struggle to recognize and articulate their emotions. Parents can provide helpful insights to psychologists by tracking behaviors and gathering feedback from teachers or other caregivers, Ollendick said.