Anxiety in kids and teens is on the rise. Here’s how to best support them.
Parents don’t have to solve anxiety, but there are things they can do so that it doesn’t interfere with their children's lives. Anxiety is becoming more prevalent in children and teens, often misunderstood by both parents and schools. Meredith Elkins, a licensed clinical psychologist and co-program director of the McLean Anxiety Mastery Program at McLean Hospital in Belmont, states that anxiety is a universal human emotion and exists regardless of culture or socialization. It can trigger physiological arousal, leading to dizziness, stomach distress, headaches, muscle aches, and sleep disruption. Some children with anxiety internalize their behavior by appearing to check out, daydreaming a lot, or sleeping. Others externalize their anxiety by not sitting still or interrupting. However, when anxiety prevents a child from engaging in a routine, intervention may be needed.
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Anxiety, though increasingly common in children and teens, is often misunderstood by both parents and schools.
Editor’s note: If your child is in need of immediate psychiatric care, call or text the Massachusetts Behavioral Health Help Line at 833-773-2445.
Anxiety is a universal human emotion, said Meredith Elkins, a licensed clinical psychologist and co-program director of the McLean Anxiety Mastery Program at McLean Hospital in Belmont.
“It exists in all humans, regardless of culture or socialization,” Elkins said. “It’s associated with the perception of some sort of a threat to life or well-being, which automatically triggers physiological arousal.”
Though all humans have anxiety at some point, “it doesn’t necessarily go on and on. And is doesn’t necessarily keep us from doing the things that are most important to us,” said Kate Sheehan, managing director for the UCLA Child Anxiety Resilience Education Center.
When anxiety does prevent a child from engaging in a typical routine, intervention may be needed. But parents shouldn’t fall into the trap of trying to figure out the “why” behind their child’s anxiety, Sheehan said.
“Because (anxiety) is not always logical. It’s not rational,” Sheehan said.
Anxiety can initiate the body’s “fight, flight, or freeze” response, experts said, increasing one’s heart rate and respiration, or symptoms including being cold and clammy or sweaty.
“You may have feelings of dizziness or feeling like you can’t see clearly. The increase in blood flow is going to lead to tremors and shakiness,” Elkins said. The anxiety can also trigger nausea or other stomach distress, headaches, muscle aches, and sleep disruption, she said.
“So anxiety creates a physiological response that is both deeply uncomfortable and also exhausting,” she added.
Some children with anxiety cope by internalizing their behavior by “seeming to check out, daydreaming a lot, or just sleeping,” Sheehan said.
“That could be seen by a teacher or a parent as laziness, disinterest, lack of motivation,” she said.
Others externalize their behavior, such as by not sitting still or interrupting. The anxiety fires up the nervous system, resulting in such “physical agitation,” Sheehan said.
Kevin Simon, Boston’s chief behavioral health officer and a pediatric psychiatrist at Boston Children’s Hospital, said he’s seen patients with neurodevelopmental disorders, such as autism, struggle more post-pandemic than their peers.
“If you were kind of isolated on your own, maybe you’re in the world of social media, you’re in the world of video games, and now you’re asked to be engaged with people, and let’s just say you happen to be a neuro-atypical — that really can be distressing,” Simon said.
Avoidance is a natural reaction to anxiety, said Elkins, and became the “go-to copy strategy for kids” during the pandemic.
“Then when the world opened back up, there are all these developmental milestones, and these opportunities for building resilience, that have been missed,” she said. “And it’s just become a lot harder to face one’s fears.”
Research, though, shows children with anxiety should be encouraged to build their “distress tolerance,” said Elkins.
“When we avoid a situation that causes us anxiety, in the short term, that gives us profound relief,” she said. “But in the long term, it makes it harder for us to do the thing we avoided.”
Exposure to stressors should be incremental, Elkins said. For a child with anxiety-related school refusal, a first step may be sitting in their parent’s car in the school parking lot for a short period. Then, they could try going to the school building’s front steps, and, then, the nurse’s office, she said.
Exposure therapy may not be best suited for children with other disabilities in addition to their anxiety, such as autism or a trauma history, experts noted.
Ask for help
Parents don’t have to solve anxiety, said Sheehan. Some kids will always be more anxious than others, but there are things they can do so that it doesn’t interfere with their entire life, she said.
“We can learn to live with a lot of ways we are,” she said. “You know, I have to wear glasses every day to be able to move through my home without breaking my nose on the door. Do I wish I had 20/20 vision from birth? Yes. And yet, I manage.”
There are many resources in the state for parents to access, and they shouldn’t be afraid to ask for help, Simon said.
“If you feel like the anxiousness is to the degree where it is impacting (your child’s) ability to go to school, or they continuously say ‘no’ to any number of extracurricular activities that you’re trying to get them engaged in, it may be very well worthwhile to bring that up to your pediatrician as a concern,” he said.
• None The Baker Center for Children and Families
Mandy McLaren can be reached at [email protected]. Follow her @mandy_mclaren.