Anxiety | BH360 | Connected

My child has been diagnosed with an anxiety disorder, now what?

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Kids and teenagers with anxiety have a lot more worry and fear about things than others their age. They might try to avoid things they are scared of and sometimes their bodies give clues that they are anxious (like sweating, hearts beating really fast, having trouble breathing, feeling sick, or feeling shaky). There are a few different diagnoses in this category with some important differences between them. • Your child may have separation anxiety if they: have a really hard time being away from caregivers or feel scared that something bad will happen to people they love. It’s pretty common for kids with separation anxiety to feel sick (like getting a headache or saying their stomach hurts) when they have to be away from caregivers. • Your child may have selective mutism if they: have a hard time speaking in certain situations (for example, at school) even though they know how to speak and communicate well in other places. • Your child may have a specific phobia if they: are very scared about something specific, such as flying, heights, certain animals, or going to the doctor. • Your child may have social anxiety if they: are very scared or worried about being in social situations where people might watch them or judge them. • Your child may have panic disorder if they: have panic attacks, or times when they are unexpectedly very scared and their bodies show signs of anxiety like a fast heart rate, sweating, shaking, feeling like they can’t breathe, feeling dizzy, or feeling nauseous or sick. • Your child may have agoraphobia if they: are scared of being in public places and not being able to leave if they feel scared or worried. Public places include public transportation like trains or buses, open spaces like parking lots, enclosed places like stores, lines or crowds, or being anywhere else outside of the home by themselves. • Your child may have generalized anxiety if they: are scared and worry about a lot of different things. They might have a hard time relaxing, feel really tired, have a hard time focusing on things, seem irritable or angry, and have trouble sleeping. https://www.youtube.com/watch?v=FfSbWc3O_5M https://www.youtube.com/watch?v=odg02IGrDKo https://www.youtube.com/watch?v=f3_Ew7ejOo4 Anxiety disorders are different from normal worry and fear because they are so intense and kids feel like they can’t control their worry. It’s normal for everyone to feel scared or worried sometimes, especially when trying new things. But if your child is so worried that they can never be away from you, or there are things they can’t do because of their anxiety, or their bodies have a lot of physical signs that show when they are scared and worried, these could be signs of an anxiety disorder and should be evaluated by a professional.

Anxiety disorders are not caused by just one thing – there are a few factors that can make it more likely that a child will develop this kind of disorder: Genetics & personality: kids with a parent, grandparent, or sibling who has an anxiety disorder are probably more likely to have one too. There are also certain chemicals in the brain that can work differently in kids who have anxiety. Environment: there are some things that can happen to kids that make it more likely they’ll have an anxiety disorder. Kids who have a lot of stress early in their lives might be more likely to develop anxiety. We also know that more kids are experiencing anxiety after COVID-19 – this could be both because there was a lot of fear and worry about COVID-19 itself, and because kids stayed at home more and missed opportunities to spend time with others and try new things. And we also know that using social media can make kids feel more anxious, so it’s a good idea to talk to your child about their social media and phone use.

Anxiety is really common in kids; about 15-20% of kids and teenagers have an anxiety disorder. More girls than boys are usually diagnosed with anxiety, and anxiety gets more common as kids get older and are in their teenage years. Anxiety shows up differently in younger kids – even little kids can feel worried or scared, but they can’t usually tell you what they’re feeling and thinking, so it shows up more in their bodies. If your child tells you they’re feeling sick a lot, has a lot of strong feelings or temper tantrums, or tries to avoid certain places or things, these could be signs of anxiety, even if your child can’t tell you that they feel worried (keep an eye out, because avoiding certain places or things can also be a sign of trauma, so if your child does seem very scared or worried, it’s important to know if there’s a reason for those feelings. You can learn more about trauma here.)

There are a lot of things that you can do to help your child who struggles with anxiety – and you’re already taking a big step by learning more! Many kids & caregivers see a lot of improvement with the right support. Here are some treatments that scientists have found to help with anxiety and panic: COGNITIVE BEHAVIOR THERAPY (CBT) CBT is a form of therapy that scientists know works well for people with anxiety. Kids have to be able to talk and tell us a little bit about how they think and feel to participate in CBT, so if you have a very young child with anxiety, keep reading to learn more about play therapy. CBT focuses on how a child’s thoughts, feelings, and behaviors are connected and a therapist will work with you and your child to help them learn new skills and tools to change their mood and the way they think when they are scared and worried. EXPOSURE THERAPY Exposure therapy can be done as part of CBT or on its own. Exposure treatment involves working with kids to understand their anxiety and worry and teaching them to respond in different ways that are more helpful for them. There is also a specific type of exposure therapy for kids who have panic attacks, which is called Interoceptive Exposure Therapy. This type of exposure therapy specifically helps kids to deal with physical symptoms that happen during panic attacks. The first step in exposure therapy is usually creating a list of things that make your child feel very scared or worried. You and your child will rank these things from the ones that bother them the least to the ones that make them the most upset and scared. Your child’s therapist will usually choose some of the things that don’t bother them as much to start with, and will gently have your child think about these things more or have them do things that make them feel a little bit worried. They will also work with your child to keep them from avoiding the situation and to manage their fear and worry by thinking and acting differently. This can be hard for kids and caregivers at first, but it teaches your child that worry and fear doesn’t last forever and that they can learn to deal with it. Once your child gets comfortable with things that are lower on their list, their therapist will start to expose them to things that make them feel more scared, because they will have new skills to manage those things. When treatment is successful, your child won’t feel like they have to avoid scary things anymore, because they can manage their fear and worry on their own. PLAY THERAPY Lots of therapy for anxiety in adults and older kids involves talking about how you think and feel. Young kids aren’t usually able to do this, so the best way to communicate with them is through play. Kids tell us a lot about what they are thinking and feeling when they play, and sometimes kids who are scared or worried about things will act it out in the way they play. When a therapist plays with them, they are actually communicating about their anxiety in an age appropriate way – and playing in therapy can also help teach them different ways of dealing with their feelings. Often, therapists will also teach parents new ways to play with their kids that help them think and feel differently and to support a strong relationship between parents and kids that will help them overcome anxiety. MEDICATION Sometimes kids with anxiety use medication to help their brains manage their fear and worry. Usually medication helps the most when kids take medication and do therapy at the same time. Medication won’t totally stop your child’s anxious thoughts and feelings, but it helps make them less strong so that your child can work on them in therapy. Usually doctors recommend medications called SSRI’s (selective serotonin reuptake inhibitors) for anxiety in kids. There are other types of medication for anxiety too, but these are usually the safest and work the best for kids, so most doctors start with these and then try other medications if SSRI’s don’t work well for your child. Zoloft, Prozac, and Paxil are some pretty common SSRI medications. These medications make serotonin (a chemical that sends messages in the brain) more available. Serotonin has a lot to do with how people feel and how they manage their feelings, so having the right level of serotonin in your brain can help you feel your best.

Anxiety disorders are diagnosed when kids are very worried or scared about things. Explore the questions below to learn how to recognize the signs, understand what causes it, and discover effective treatment options.

Understanding Anxiety Disorders

Anxiety Disorders are diagnosed when kids have a lot more worry and fear about things than others their age. They might try to avoid things they are scared of and sometimes their bodies give clues that they are anxious (like sweating, hearts beating really fast, having trouble breathing, feeling sick, or feeling shaky). There are a few different diagnoses in this category:

Separation anxiety: kids are scared of being away from caregivers

Selective mutism: kids have a hard time talking in certain situations because they are scared or worried

Specific phobia: kids are very scared about one specific thing, such as flying, heights, certain animals, or going to the doctor.

Social anxiety: kids are very scared or worried about being in social situations or talking to other people.

Panic disorder: kids have times when they are unexpectedly very scared and their bodies show signs of intense anxiety

Agoraphobia: kids are scared of being in public places and not being able to leave if they need to.

Generalized anxiety: kids are scared and worry about a lot of different things and this impacts them most of the time.

These symptoms can cause problems for kids at home, in school, and in their social lives. As a parent, it’s important to think about whether the way your child feels and thinks makes sense based on their age and what they are scared of. It’s normal for all kids to feel a little worried about talking to new people, or going somewhere new by themselves, but if your child can never be away from you, has a hard time breathing because they are so worried, or can’t go to certain places because they are scared, these can be signs of something more serious. The good news is, anxiety is well researched and very common, and there is a lot of support available to help you and your child.

Getting support for anxiety disorders starts with knowing what to ask for. Use the questions below to find out how to get help, talk with providers, and access the tools your child may need.

There are a few ways to get diagnosed with an anxiety disorder. Here is how you can get started: Ask a mental health professional. Therapists, psychologists, and psychiatrists can help assess your child. Psychiatrists can prescribe medication if needed, and both therapists and psychologists can diagnose anxiety and work with your child to help them learn ways to manage anxiety. Click here to find a provider. Talk to your child’s pediatrician. They can do a basic screening and refer you to someone else if needed. If your child has physical symptoms they are worried about, like a fast heart rate, trouble breathing, or feeling sick a lot, their doctor can also examine them to make sure they’re okay and there’s nothing else going on that would make them feel this way. Work with your child’s school. Kids who have anxiety and panic often have a really hard time focusing in school, because their brain is focused on things they are scared of and their bodies are on edge and feeling worried. If you’re worried about your child falling behind in school or they seem to need more support, you can request an evaluation for accommodations at school (these are usually called IEP’s or 504 plans). Schools typically don’t diagnose anxiety, but they can help tell you where your child is struggling and offer some help in the classroom. Click here on how to talk to your child’s school.

Exposure therapy Sometimes called exposure therapy or exposure and response prevention (ERP), this is an important part of therapy for kids with anxiety because it teaches them to face their scary thoughts and they learn that fear doesn’t last forever. It can be hard for kids and families at first because it might make kids feel sad or upset or scared when they think more about the things that make them anxious. But it’s kind of like getting a shot at the doctor’s office or cleaning a scraped knee before you put a bandage on it – it hurts a little at first, but in the long run it will help your child feel so much better! Cognitive restructuring Part of therapy for anxiety is helping your child learn to think differently. When people feel scared or anxious, they often don’t think about things very logically or accurately – that’s part of the problem with anxiety! For example, a child who is scared of being away from their caregivers might think “If I am away from my mom, she could get hurt. If she gets hurt, she could die. If she dies, I will never see her again and she won’t be able to take care of me. If no one is there to take care of me, what will I do?” It’s important to stop these thoughts from spiraling, or catastrophizing, and take a more realistic approach. Yes, people sometimes do get hurt and die, but it’s highly unlikely that will happen in an hour while your child is at their friend’s house for a playdate. Caregivers and providers can work together to understand how your child thinks and how you can work with them to think about things more accurately. Mindfulness and relaxation Teaching kids how to help their bodies relax is also really important and helpful when they feel worried or scared. Sometimes this can involve focusing on certain parts of their body and trying to relax those areas. It can also involve deep breathing, where kids try to take deep breaths into their bellies to help naturally relax their bodies. Sometimes it just means being present in the moment and trying to focus on what is happening around them. You can learn more about ways to practice mindfulness and relaxation at home here.

Advocating

for Help

Getting the right support for your child who has an anxiety disorder can feel overwhelming, but you don’t have to do it alone. This section guides you through how to start the conversation with professionals, understand what a thorough assessment looks like, and recognize key treatment components that make a difference. You’ll also find practical tips for working with your child’s school to secure accommodations and how to find the right providers to support your family’s unique needs. We’re here to help you confidently advocate for the care your child deserves.

Progress

Over Time

Once your child has been diagnosed and is getting treatment, there are still more ways you can support them – and yourself. Here are some next steps to consider: Read helpful books and seek out resources. There are some excellent, practical reads written for caregivers like you: • “Breaking Free of Child Anxiety & OCD: A Scientifically Proven Program for Parents” by Eli R. Lebowitz, Ph.D. • “Freeing Your Child from Anxiety: Practical Strategies to Overcome Fears, Worries, and Phobias and Be Prepared for Life – from Toddlers to Teens” by Tamar E. Chansky, Ph.D. • “Why Smart Kids Worry: And What Parents Can Do to Help” by Allison Edwards, LPC • “Anxious Kids, Anxious Parents: 7 Ways to Stop the Worry Cycle and Raise Courageous and Independent Children” by Reid Wilson, Ph.D. and Lynn Lyons, LICSW Join a parent support group or online community. Connecting with other caregivers who get it can make all the difference. Websites like Other Parents Like Me (link) offer both resources and a sense of community. Websites like Good Inside (link) offer research-based parenting support, workshops, and other resources to support parents. Ask your provider to track progress with measurement tools. You can ask your child’s therapist or doctor to use things like anxiety rating scales or thought records to track what’s improving – and what still needs support. You can even do some of this tracking and implementation on your own – apps and programs like Mightier (link) offer research based game interventions where kids wear heart sensors while they’re playing to learn to self-regulate and be more aware of how their bodies feel. Keep in touch with your child’s school. Even if your child already has support at school, it’s worth checking in regularly. Ask for updated reports, suggest team meetings, and make sure accommodations are still working. You can also request changes to your child’s IEP or 504 plan if needed. For more information, see this page on Talking to Your Child’s School.

It’s hard to see your child struggling, especially when it feels like things are getting more intense, not better. You’re not alone—and there are steps you can take to get support and stabilize things. Start with your child’s provider. Let them know what’s changed. Sometimes therapy needs to be more frequent or focused differently, or something needs to be changed in your child’s routines or environment. Be specific about what you’re seeing: more aggression, bigger meltdowns, school issues, more frequent outbursts, etc. This will help your provider to identify areas of change that might help your child. Ask about crisis planning. Every family should have a plan for what to do if things get worse or if you or your child feel unsafe. This might include knowing who to call during a crisis (like a mobile crisis team or behavioral health urgent care), when to head to the ER, or how to calm things down safely at home. Your provider can help you build a plan that fits your family. Look into adding medication support. If your child doesn’t seem to be improving with therapy interventions only, you might consider adding medication to provide them with additional support. You can talk to your child’s pediatrician or a child psychiatrist about what medication might be helpful for their symptoms. Take care of yourself, too. When your child is struggling, it can take a toll on your whole family. Connecting with other parents, talking to a therapist, or simply having a support system in place can help you stay grounded while you’re supporting your child.

Your child spends a big part of their day at school—so it’s important that their learning environment supports their needs. You don’t have to be an expert in education law to advocate for your child. Here’s how to get started: Request a meeting with the school. If your child already has a 504 Plan or IEP, you can call a meeting anytime – not just during annual reviews. Share your concerns, ask for updates, and discuss if changes need to be made. If your child doesn’t have a plan yet, you can formally request an evaluation to see what supports they qualify for. Bring data and observations. Schools respond best to clear examples. Keep track of patterns—like missed assignments, behavior changes, or stress around certain subjects. You can also ask your provider to write a summary of concerns or diagnoses to share. Learn about your rights. Resources like Wrightslaw (https://wrightslaw.com/)explain special education laws in parent-friendly language. Knowing your rights helps you feel more confident in meetings and ensures your child gets what they’re entitled to. Explore tools from other parents. Understood.org (https://understood.org/)and wapave.org (https://wapave.org/behavioral-health-and-school-key-information-for-families/)is a great website full of free tools, templates, and stories from families navigating similar school challenges. It can help you figure out what to ask for and how to phrase it. Consider getting extra help. A behavioral health consultant or educational advocate can go to meetings with you, help interpret school evaluations, and suggest goals that actually match your child’s needs. This kind of support can make a big difference—especially if meetings feel overwhelming or you’re not sure what to ask for.

This section offers a few extra tools to help you along the way. Whether things are going smoothly or getting more challenging, these resources can support you as your child grows and their needs change.

You’re doing great work. Just by showing up and staying engaged, you’re already well on the journey of supporting your child. This path isn’t always easy—it can feel like a long hike with ups, downs, and unexpected turns—but you’re not walking it alone. This section offers a few extra tools to carry with you as you go: ideas for building on the care your child is already receiving, support for when things feel like they’re getting harder, and guidance for working with your child’s school. Whether you're exploring advanced behavior strategies, needing help during a rough patch, or advocating for better support at school, these resources are here to help you keep moving forward. Every step counts—and you’re already making meaningful progress.

Progress Over Time

Advocating For Help

Parent Toolkit

Caregiver Tool Kit

This section offers simple, practical tools to help you support your child—from building routines and healthy habits to improving communication and recognizing their strengths. It’s also a reminder that taking care of yourself is part of the plan—you’re not alone on this journey.

Monitor technology usage Most kids use technology and social media almost every day, and there are parts of this that are helpful, but there are also a lot of negative effects of social media use in kids and teenagers. It’s a good idea to talk to your kids early and often about social media and technology, how they are using it, and what types of things they see, hear, or read about. Parents should be involved in helping kids set boundaries around technology and social media, and it’s also important to make sure your child is involved in a lot of real life activities and hobbies outside of technology, because this is where kids can best learn emotion regulation and coping skills that they need to deal with mental health problems. Sleep hygiene It’s important for all kids and teenagers to get enough sleep. If kids are struggling with an anxiety disorder, it’s extra important – because when they don’t sleep enough it can make the anxiety worse and harder to manage. Kids who have anxiety might also have a harder time falling asleep in the first place because they are scared or worried, so parents may need to provide extra support and help during their bedtime routine and find some calming things they can do at bedtime to quiet their brains (mindfulness and relaxation strategies are good things to start with!) Model neutral responses to scary thoughts Show your child that it’s okay to have a neutral response even when scary thoughts come into your brain. If your child tells you what they’re thinking about, respond calmly and neutrally. For example, if your child tells you they are scared about getting germs that make them sick, you could say “That’s an interesting thought,” or “We’ll have to wait and see what happens,” or “Yes, sometimes we get sick, and sometimes we don’t!” By responding, you are telling your child that you hear what they are saying, but a calm response shows them that they don’t have to let a scary thought take control of their brain. Gentle exposure If your child is seeing a provider who does exposure & response prevention treatment (ERP), you’ll have an important role in helping them outside of therapy. In ERP, kids will get exposed to things that make them worry and they will feel like they want to do certain things or avoid those worries to feel better. Part of treatment is making sure they don’t avoid their worries and fear, so they can start to learn that the things they worry about won’t happen just because they behave in a certain way. It’s important to involve a provider in this treatment and not to do it on your own, because a therapist or other trained professional can monitor your child to make sure the exposure isn’t making them so anxious that they can’t function. Once your provider helps you and your child figure out some ways to gently expose them to things that make them worry, you can practice these things with your child at home. Keep living life Sometimes families will stop doing things they enjoy because their child is so worried and scared about bad things happening. This might help them feel better for a bit, but scientists actually tell us that avoiding things will make them worry more in the long run. It’s important for families to keep doing things they enjoy and inviting children with anxiety to participate as much as they can. Eventually, with the proper treatment, your child will hopefully be able to do more and more, and start to enjoy life again. Don’t fix all their problems Parents sometimes try to reassure their kids that nothing bad is ever going to happen, so they don’t have to worry. No parent wants their kid to feel worried or scared! But reassuring your child too much can actually cause problems too – bad things happen sometimes, and it’s okay for kids to learn to manage fear and worry on their own. We don’t always know exactly how things will go or what will happen, and you can’t fully protect your child from everything. When they ask questions or tell you that they’re scared, let them know how much you love them and want to protect them, but be realistic too. Make sure they know that they have people who love them and want to support them, even if bad and scary things do happen sometimes. Externalize the problem Reframe the issue – your child isn’t the problem, their anxiety is. For young kids, you can even give their anxiety symptoms a funny name (maybe their anxiety is an imaginary villain, or a type of animal, or a silly sounding name). It helps you and your child talk about their symptoms and separate them from their thoughts and behaviors. It gives them some creative language to tell you when they notice anxious or scary thoughts in their brain, and you can create imaginative stories about beating their anxiety in the same way a superhero fights a bad guy. Remember, you’re on the same team fighting this bad guy together! Books like “The Huge Bag of Worries” by Virginia Ironside, “Ruby Finds a Worry” by Tom Percival or “Don’t Feed the WorryBug” by Andi Green can help kids externalize their anxiety and understand it in a fun and creative way. Videos like these can help kids understand how to think about externalizing their worry and facing fears in treatment: https://www.youtube.com/watch?v=MOxRFVTekRM https://www.youtube.com/watch?v=hIPMZGPF64c

Caring for a child with anxiety is a big job. It’s okay to ask for help, and it’s good for your child to learn that they can also ask others for help when they need it. https://www.youtube.com/watch?v=c5ASysmOH_I Blame the diagnosis. Your child might do things that don’t make sense, worry about things that seem unrealistic, or disrupt your daily routines with their thoughts and feelings. It’s easy to get frustrated at your child and it’s important for both you and your child to remember that it’s the anxiety talking, not them. Separate the good things about your child from the scary thoughts and difficult behaviors, and remember the child you love is still there – and you’re fighting the diagnosis together. Be realistic about what you can do. It’s important not to structure your family’s life too much around your child’s thoughts and behaviors, but it’s also important to be realistic about your capacity to handle strong emotions and behaviors when your child is struggling most. Take a look at your day and see where the most stressful and difficult parts are. Does your child have big emotions and struggle with drop off at school? Plan ahead to allow some extra time in your morning routine so you’re not frustrated with how long it takes to get them into their classroom. Does your child struggle more with anxious thoughts when they’re out in public? Make sure you have a backup plan for a quiet place you can go to take a break if they need it. Having a realistic plan based on your child’s needs and capacity helps set you up for success. Lean on your support system and take breaks when you can. It makes a big difference when you can be consistent in responding calmly to your child’s thoughts and behaviors, but you don’t have to do it alone. The good news is – while it can be challenging at first to start dealing with anxious thoughts, your child will learn how to practice these skills on their own and you’ll find it will make things easier in the long run. Manage your own anxiety. Anxious kids often have anxious parents and caregivers, too. If this is you, now is a great opportunity for you to learn how to manage your own anxiety alongside your child! Many of the same strategies we recommend for kids apply for adults too – so find your own therapist if you need one, learn some cognitive restructuring and mindfulness techniques, and join a support group in your community. Showing your child that you’re on this journey together is one of the best things you can do as a caregiver to empower your child and build your relationship with them!

• What to Expect From a Good Therapist(https://www.bh360connected.com/copy-of-depression-1) • Getting the Right Treatment(https://www.bh360connected.com/copy-of-what-makes-a-good-therapist) • How to Find the Right Therapist(https://www.bh360connected.com/_files/ugd/e0dad3_3149581d976e4d9788ec4b59dc1f3752.pdf?index=true) • Providers in My Area(https://www.bh360connected.com/resources-map)

Supporting a child with an anxiety disorder takes patience, creativity, and a strong set of tools. This section offers practical strategies you can use at home—like building routines, improving communication, and finding your child’s strengths. You’ll also find tips for coaching your child as they build new skills, promoting healthy habits, and taking care of yourself along the way. You don’t have to do it perfectly—you just have to keep showing up. This toolkit is here to help make the journey a little easier, one step at a time.

What will I notice in my child?

What causes anxiety disorders?

Who is affected by anxiety disorders?

Treatments that work for anxiety disorders?

How to get help

If my child has anxiety or panic, what treatment components should I ask my provider about?

My child has a diagnosis, now what?

My child is getting worse, what can I do?

Talking with my child’s school

Daily Habits That Help

Caregiver Self-Care

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