The document discusses understanding anxiety through a child's eyes. It identifies symptoms of anxiety in children, common misdiagnoses, how a child's developmental stage impacts fears, and interventions to help children deal with anxiety. Symptoms are presented for infants through older children and include emotional, behavioral, and physical signs. Effective interventions match a child's cognitive abilities and include establishing structure, addressing cognitive distortions, teaching coping skills, and ensuring children feel safe, secure and supported.

1. Understanding Anxiety
Through a Child’s Eyes
Dr. Dawn-Elise Snipes PhD, LPC-MHSP, LMHC
Executive Director, AllCEUs Counselor Education
Host: Counselor Toolbox Podcast
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2. Objectives
 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
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3. 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
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4. 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
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5. 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
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6. 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.
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7. 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
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8. 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)
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9. 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
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10. Differential Diagnosis
 Anxiety Disorders (multiple)
 Depression
 ADD
 Autism
 PTSD / ASD
 Oppositional Defiant Disorder
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11. Interventions
 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
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12. Interventions
 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
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14. Interventions
 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.
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15. Interventions
 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
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16. Interventions
 2-7 year olds
 Systematic desensitization
 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?
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17. Interventions
 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)
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18. Interventions
 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]
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19. Interventions
 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
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20. 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)
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21. Summary
 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.
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