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Symptoms of Anxiety in Children
– Emotional Signs of Anxiety
– Is extremely sensitive
– Irritable
– Is afraid of making even minor mistakes including test anxiety
– Panic attacks
– Worries about things that are far in the future
– Has frequent nightmares
– Gets distracted from playing by his worries
– Has compulsive, repetitive behaviors
Symptoms of Anxiety in Children
– Behavioral Signs of Anxiety
– Starts having meltdowns or tantrums.
– Asks “what if-” constantly.
– Avoids participating in group activities.
– Remains silent or preoccupied during group work
– Refuses to go to school.
– Avoids social situations with peers after school or on weekends
– Becomes emotional or angry when separated from parents
– Constantly seeks approval
– Low self-esteem and efficacy
– Overly concerned about negative evaluations
Symptoms of Anxiety in Children
– Physical Signs of Anxiety
– Frequently complains of head or stomachaches
– Refuses to eat snacks or lunch at school
– Can become restless, fidgety, hyperactive
– Difficulty concentrating
– Starts to shake or sweat in intimidating situations.
– Dizziness

– Frequent urge to urinate
– Constantly tenses muscles
– Exaggerated startle response
– Has trouble falling or staying asleep
– Falls asleep in school
– Repetitive activities (tapping, leg shaking…)
– Nail biting / skin picking
– Rigid routines
Not Little Adults
– How do children think differently
– 0-2: Object permanence; personal agency (crying, “Uh Oh,” Ask for drinks)
– When you are overtired, startled, too hot/cold, or have low blood sugar, the HPA-Axis is activated – Threat Response (Anxiety)
– 2-7: Egocentric, personalized, concrete/dichotomous, mystical
– Daddy yelled at me. Daddy left. Daddy hates me. It is my fault.
– I told Mommy I hated her. She got sick. It is my fault.
– I didn’t say my prayers last night. We got into a car accident because God is mad at me.
– The neighbor’s dog always charges the fence and wants to bite me. This makes me scared. Dogs are dangerous.
Not Little Adults
– How do children think differently
– 7-11: Inductive (Start making global attributions from specifics)
– I didn’t make the team. I got a C on my spelling test. I must be a failure
– 11+: More advanced reasoning but little life experience and often have not questioned prior faulty schema
What is Anxiety
– Anxiety is fear which is the flee part of the fight or flight (stress) response
– What do we/children fear
– Death (Biological Needs/Safety(self & others))
– Rejection/Isolation/Abandonment (Biological Needs, Safety, Love and Belonging)
– The Unknown (Biological Needs, Safety, Love)
– Loss of Control (Parental, older children)

What is Causing the Anxiety
– Cognitive
– Unhelpful thoughts
– Lack of knowledge
– Physical
– Lack of sleep
– Poor nutrition or hunger
– Hormones (sex, thyroid)
– Emotional
– Highly sensitive child

– Environmental/social
– Bullies
– Teacher pressure
– Parental enmeshment or disengagement
– Chaotic home environment (mental health, addiction and/or abuse or neglect)
– Social learning

Differential Diagnosis
– Anxiety Disorders (multiple)
– Depression
– Autism
– Oppositional Defiant Disorder

– Infants-2years old
– Be responsive

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