Understanding Anxiety Through a Child’s Eyes
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs Counselor Education

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Host: Counselor Toolbox Podcast
~ Identify symptoms of anxiety in children
~ Review common misdiagnoses
~ Explain how children’s developmental stage impacts their fears
~ Propose interventions to help children deal with anxiety
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
~ Has phobias (about bees, dogs, etc.) and exaggerated fears (about things like natural disasters, etc.)
~ 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
~ “Before six months, you're just extinguishing,” explains Chilton matter-of-factly. “Eventually, the baby just gives up.” Loss of parental contact is a serious danger signal for young babies, and they're designed to cry until it's restored. But beyond a certain point, even a hysterical baby will stop crying. This is because, in an evolutionary sense, an unprotected crying baby is broadcasting its whereabouts to predators. Instinct tells it that its parents have vanished, and that the tiger that killed them is close. It falls silent in order to survive. Dr. Howard Chilton
~ Infants-2years old
~ Talk it out
~ Start teaching emotional vocabulary and needs identification (hungry, scared, sleepy, overstimulated)
~ “The dog scares you. The is loud is loud. Loud sounds can be scary for you.”
~ Toddlers struggle with being able to correctly identify their emotions and find the right word to describe that emotion.
~ Use feeling faces
~ Identify feelings in videos. Ask questions about how characters feel.
~ Play games to help with fears
~ Hide and seek (start small)
~ Mommy and Me classes or play dates

~ 2-7 year olds
~ Provide structure and consistency
~ Let children know the plans for the day and what is happening next—Daily schedule chart
~ Give plenty of warning before transitioning– verbal, bell, chant
~ The clock on the wall says it’s time to stop, time to stop, time to stop! The clock on the wall says it’s time to stop. It’s time to go to lunch/bed/outside
~ (Twinkle, Twinkle) Stop, look and listen. Hands by your side. Listen close and I’ll tell you why.
~ Everybody buckle up to ride in the car. Were going to the [park/school] /Billy’s house it’s not very far.

~ 2-7 year olds
~ Provide structure and consistency
~ Ensure children know what is expected
~ Rules chart and/or coloring pages. Review ahead of time
~ Be patient when children test rules
~ Teach mindful awareness
~ Physical sensations, urges, thoughts associated with emotions
~ Teach distress tolerance
~ Deep breathing
~ Positive self talk
~ Getting support

~ 2-7 year olds
~ Join them in their reality
~ Reassure them that there is no danger.
~ Talk about anxiety monkey that likes to play tricks on them. Then deal with the monkey mind. (Monkey stuffed animal) Sometimes Reginald isn’t ready to sleep… Use guided imagery with the monkey.
~ Sometimes Reginald doesn’t know what is going to happen so he makes you think about the worst possible thing that could happen. What can you tell Reginald?

~ 2-7 year olds
~ Address distortions to reassure kids they are safe and loved
~ All or none
~ I can be mad at your behavior and still love you
~ Address global attributions by looking at the facts, provide info
~ Discourage the use of extreme words like everyone, always
~ Magnification
~ Keep a frequency chart (leaving, trying, going to school) to see the likelihood
~ Minimize exposure to the news (or discussions about the news)

~ 2-7 year olds
~ Address distortions to reassure kids they are safe and loved
~ Personalization
~ Identify your emotions (generally) why you feel that way
~ Have you ever [felt] but it wasn’t Sally’s fault?
~ Sometimes bad things happen and it is nobody’s fault. [Give an example]

~ 7+ Year Olds
~ Remember the small size of their world and relative lack of experience makes everything seem much bigger
~ They are constantly growing and changing so some days they may feel more tired, may have difficulty feeling like they fit in may feel more awkward and less capable
General Anxiety Management Skills
~ Keep blood sugar stable
~ Get enough sleep
~ Practice positive self-talk
~ Check the facts
~ Use visualizations
~ Deep breathing
~ Mindfulness to nip anxiety in the bud
~ Get support from people who care about you unconditionally
~ Find mentors who have gone through the same thing
~ Spend 5 minutes focusing on the positives each day
~ Remember that just because you have a thought that something is scary or feel anxious doesn’t mean it is fearsome (rollercoasters, wasps)
~ Children’s cognitive, physical and experiential differences make their anxiety different than that of adults
~ Children’s symptoms of anxiety also often manifest differently with more irritability, defiance and somatic complaints.
~ Anxiety disorders are frequently misdiagnosed as ADD, autism, ODD and PTSD
~ Children’s fears often focus around Maslow’s lower three needs: Biological, Safety, Love and Belonging
~ Addressing anxiety means helping the child understand, in a developmentally appropriate way, that they will have what they need, they are safe and they will always belong and be loved.