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Anxiety disorders are the most common mental illness in the United States. Anxiety disorders affect nearly onethird of children between 13 and 18 years old, with the 17 and 18-year-old group being most affected.

People screening at risk for anxiety over the last year are reporting struggling the most with loneliness and isolation. Left untreated, children with anxiety disorders are at a higher risk of poor school performance, poor social functioning, and substance abuse. There is also an increased risk for depression, attention deficit hyperactivity disorder, eating disorders, and adult anxiety disorders.

Anxiety disorders develop from a set of risk factors including gender, age, genetics, personality factors, brain chemistry, family history and dynamics, social factors, learned behaviors, traumatic events, and medical conditions. Other possible contributing factors to the increase in childhood anxiety include high expectations and pressure to succeed, social media, and a world that feels scary and threatening.

Anxiety disorders include disorders that share features of excessive fear and anxiety and related behavioral disturbances. Fear is the emotional response to real or perceived imminent threat. Anxiety is anticipation of future threat.

Anxiety disorders differ from each other due to the types of objects or situations that induce fear, anxiety, or avoidance behavior, and the associated cognitive ideation. This differs from normal developmental fear by being excessive or persisting beyond appropriate developmental periods.

Every child is going to feel anxious at some point, but it becomes problematic when it interferes with the functioning that you would expect from a child of a particular age or developmental stage. Among children, separation anxiety, social anxiety, specific phobia, and generalized anxiety are the most common types of anxiety disorders.

Children with separation anxiety experience excessive fear of being separated from their home or caretakers. Children with social anxiety experience anxiety in social settings or performance situations. Children with specific phobia fear a specific object or situation. Children with generalized anxiety disorder experience chronic, excessive anxiety about multiple areas of their life (family, school, social situations, health, natural disasters).

In adolescence, panic disorder is common as well. Children with panic disorder experience unexpected, brief episodes of intense anxiety without an apparent trigger, characterized by multiple physical symptoms. These physical symptoms may include heart palpitations, sweating, nausea, and hyperventilation.

It is important that parents become aware of the signs and symptoms of anxiety. The physical effects of anxiety in children include headaches, sleep problems, fatigue, and recurrent stomach aches. Symptoms and signs to watch for include persistent and excessive worry, restlessness, muscle tension, sleep disturbance, irritability, poor concentration, change in appetite, poor grades, school avoidance, chronic physical complaints, recurring and uncontrollable fears and worries, changes in behavior, avoiding social and school activities, social isolation, and substance use.

Anxiety disorders are highly treatable, especially if they are diagnosed early. Psychotherapy is the first-line treatment for anxiety disorders of mild severity. The most widely used evidence-based form of psychotherapy for anxiety disorders is cognitive behavioral therapy (CBT). CBT is an effective and appropriate treatment for children and adolescents.

CBT focuses on changing how the child thinks about the fear, increasing exposure to feared situations, relaxation strategies such as deep breathing, muscle relaxation, and positive selftalk. A type of CBT, exposure therapy, increases exposure to feared objects or activities.

CBT addresses negative patterns and distortion in the way we look at the world and ourselves. This involves cognitive therapy examining how negative thoughts, or cognitions, contribute to anxiety. It also involves behavior therapy, which examines how we behave and react in situations that trigger anxiety.

The basic idea of CBT is that our thoughts, not external events, affect the way we feel. It’s not the situation that determines how you feel, but your perception of the situation. The goal is to identify and correct these negative thoughts and beliefs. The idea is that if you change the way you think, you can change the way you feel.

Therapy can also help uncover underlying causes of fears and worries, learn how to relax, look at situations in new, less frightening ways, and develop better coping and problem-solving skills.

When anxiety is severe or a child is only partially responding to psychotherapy, adding medication may be helpful. Another important part of treatment is learning good self-care—having a healthy eating plan, getting the recommended amount of sleep each night, participating in physical activity each day, cultivating connections with other people, and practicing relaxation and mindfulness techniques.

There are ways that parents can help children escape the cycle of anxiety. The goal is not to eliminate anxiety but to help your child manage it. Don’t help your child avoid things just because they make the child anxious. Help your child face their fears.

Express positive but realistic expectations. Before you try to reason with your child, help him or her relax. I recommend deep belly breathing. Respect and validate the child’s feelings but don’t empower the fears. Ask open-ended questions in order to encourage your child to talk about their feelings. Don’t reinforce the child’s fears by unintentionally sending a message that the child should be worried.

Encourage your child to tolerate their anxiety. It will drop over time as the child continues to have contact with the stressor. Build confidence with a baby step plan rewarding progress along the way. Try to keep the anticipatory period short.

Talk things through with your child and have a plan. Model healthy ways of handling anxiety by letting them see how you cope with anxiety yourself. Families can help reduce their children’s stress by providing routines at home in order to help them feel in control and that things are predictable. Parents can help their children by being aware of their mental health, talking to their children about their concerns and worries, and asking for professional help. Anxiety is both common and treatable.

Katie Harley, a licensed clinical social worker, works as a child and adolescent therapist at the Arrowhead Center in Virginia. Katie lives in Virginia with her husband and three children.

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