Anxiety Management in Children

Anxiety – Is it or Isn’t it?

The Diagnostic and Statistical Manual of Mental Disorders (5th Ed; DSM-V) is the book used to guide psychologists to make a diagnosis of anxiety. Guidelines to diagnosis include assessing presence of a number of symptoms as noted below.

A. At least 6 months of “excessive anxiety and worry” about a variety of events and situations. Generally, “excessive” can be interpreted as more than would be expected for a particular situation or event. Most people become anxious over certain things, but the intensity of the anxiety typically
corresponds to the situation.

B. There is significant difficulty in controlling the anxiety and worry. If someone has a very difficult struggle to regain control, relax, or cope with the anxiety and worry, then this requirement is met.

C. The presence for most days over the previous six months of 3 or more (only 1 for children) of the following symptoms:

  1. Feeling wound-up, tense, or restless
  2. Easily becoming fatigued or worn-out
  3. Concentration problems
  4. Irritability
  5. Significant tension in muscles
  6. Difficulty with sleep

D. The symptoms are not part of another mental disorder.

E. The symptoms cause “clinically significant distress” or problems functioning in daily life. “Clinically significant” is the part that relies on the perspective of the treatment provider. Some people can have many of the aforementioned symptoms and cope with them well enough to maintain a high level of functioning.

F. The condition is not due to a substance or medical issue.

There are a number of clinical presentations of anxiety including: Generalized Anxiety Disorder, Specific Phobia, Separation Disorder, Panic Disorder, Selective Mutism, Obsessive Compulsive Disorder.

It is critical to identify if your child has an anxiety disorder that falls within the clinical realm; that is, it exceeds what would be considered typical for your child’s age and/or gender.

It is critical to differentiate between anxiety versus poor coping to one or more situations.

It is critical to determine [if its anxiety] the type of anxiety you child is experiencing and target treatment accordingly.

Efficacious Models of Treatment for Children

  • Cognitive Behaviour Therapy (CBT)
  • Relaxation training including Visualization Training and Progressive Muscle Relaxation (PMR), Distraction Techniques
  • Modelling
  • Reinforced practice

The Goal of CBT: identify “worried” thinking and replace it with realistic thinking – thinking that helps children see things clearly and more fairly. Teach them to find the evidence for their worry; this is sometimes called Detective Thinking.

Teach your child about thoughts or self-talk:
Thoughts are the words we say to ourselves without speaking out loud (self-talk). We can have many thoughts each hour of the day.  Also, people can think about the same thing differently.  What we think affects how we feel. When we expect bad things to happen, we feel anxious. Feelings and Actions depend on your Thoughts.

Help your child identify thoughts [their self-talk]that leads to feelings of anxiety. This is REALLY hard to do as we usually are not aware of what we are thinking and it can take some time to learn to identify our specific thoughts.

Ask them specific questions:
What is making you feel scared?
What do you think will happen?
What do you think is going to happen?

Battling the negative thinking or worries – teach your child how to do this through direct teaching, modeling, and repeated practice.

CBT is important but there are other strategies that are necessary to do as a part of CBT and anxiety management

Eating Healthy

Physical Exercise – Being physically active and exercising is key in managing anxiety and stress. The Pediatric Society recommends a minimum of 1 hour per day of physical activity for children. Production of endorphins (neurotransmitters) happens naturally in our brain in response to stress and pain, and there is some evidence that physical activity contributes to the production of endorphins (for example, “the Runner’s High”). It’s a necessary adjunct to CBT, relaxation training, etc.

Progressive Muscle Relaxation (PMR):
(adapted from

This type of exercise will help your child learn how to relax when he or she is feeling anxious or stressed. It can also help reduce physical problems such as stomachaches and headaches, as well as improve sleep. The technique involves tensing and then relaxing different muscles in the body. This can help your child learn the difference between being tense and feeling relaxed. At our clinic we have a number of PMR scripts we use with a child.

Parent treatment for their own anxiety. At our clinic, we work with the child and his/her family. For us, it is really important to help parents identify their own anxieties and to evaluate how they may be perpetuating their child’s anxiety. In some cases, parents may wish to seek their own psychological services to help manage their symptoms. We have a number of colleagues who we trust and to whom we frequently refer. We are always happy to provide their contact information to you.

Developing Effective Parenting Strategies – Knowing how to manage your child’s anxiety responses and general behavioural issues is essential. Being able to provide clear expectations for behavior, boundaries, and consistent consequences (positive and negative) helps your child have some control over their environment, and inadvertently helps to reduce anxiety.

To help your child manage anxiety, a psychologist can systematically teach them how to:

  • Identify their thinking patterns.
  • Teach them to “refute”, “challenge”, their thinking patterns in a way that is more fair or accurate to a given situation.
  • Teach them to label their feelings and make a link between FEELINGS and THOUGHTS and BEHAVIOURS
  • Practice Breathing Techniques regularly so they become habits.
  • Teach Visualization Techniques and Utilize Strategies like the “Interruption Task.”
  • Ensure they are eating healthy and engaging in regular physical activity.
  • Practice PMR

Together these techniques will help them develop ways to better cope with their anxieties.  At Dr. Pure and Associates, all our psychologists are experts in treating anxiety issues in children and adolescents.