Treating Anxiety in Children

Like adults, many children face emotional difficulties. Anxiety is one of the most common mental health concerns experienced by children. Oftentimes, children with anxiety may not receive treated, as there are many obstacles to accessing mental health treatment.   However, early intervention is key to preventing problems later in life, so it is important to take childhood symptoms seriously and address them appropriately.

What does Anxiety look like in Children?

Just as in adults, childhood anxiety can take many forms with varied symptoms. Children can experience Phobias, Social Anxiety, Panic Disorder, and Generalized Anxiety (which is often marked by excessive worry). Children may also experience Separation Anxiety with difficulty going to school and other activities that involve being away from their caregivers. Children can also develop Obsessive-Compulsive Disorder (OCD), which is distinct from but similar to anxiety.

When children experience anxiety, it may appear different than it would in adults. This is due, in part, to their different language abilities. Anxious children may appear agitated, irritable or hyperactive. They may report physical complaints, or refuse to participate in their regular activities. These symptoms can affect a child’s functioning at school and home. When anxiety is affecting a child’s self-esteem, mood, academic functioning, or relationships with friends and family, is important to consider having an evaluation with a child psychologist or a child psychiatrist.

How can I Help My Child with Anxiety?

If your child has Anxiety, there are some steps you can take at home to help. Most children benefit from structure and routine. Children also need support and validation when upset and you can help them to learn ways to manage their emotions, including anxiety by naming their emotions and helping them talk through why they are worried or upset. Other techniques, to try at home, include redirecting the child away from their anxiety to a new activity. This works best after some initial listening and validation.

When faced with an anxious child, it can be challenging to figure out how to address your child’s anxiety, while not reinforcing the it. Parents can support their children with additional relaxation and distraction strategies. When the anxiety is severe, it is helpful to seek out psychotherapy support with a licensed psychologist or psychiatrist. A professional can provide caregivers with an assessment, treatment plan, techniques to practice at home, and interventions to help the whole family.

What are the Typical Treatment Options?

The first line treatment for children with anxiety is psychotherapy and lifestyle interventions, and a second line treatment, when psychotherapy is not sufficient, then medication treatment can be considered.  The most commonly used medications for anxiety are Selective Serotonin Re-Uptake Inhibitors (or SSRI’s). Many caregivers are reluctant to give mediations to their children, due to concerns about exposing children to medications and medication side effects. So, psychotherapy is the better first option.

What does Therapy Look Like for Children?

Children are often not as verbal as adults, so psychotherapy needs to be adjusted to meet their needs. Psychotherapy with younger children involves guided play, games and activities that allow for expressing emotions and talking about thoughts and feelings.  Many children can engage in a modified version of Cognitive Behavioral Therapy (CBT) such as Coping Cat.  Adolescents may be ready for a conventional form of CBT.

Why is CBT a Good Choice for Childhood Anxiety?

Cognitive Behavioral Therapy is an evidence-based treatment for anxiety. Research studies show that CBT reduces the symptoms of anxiety in children, typically with better results than medication alone. In particular, studies show that CBT has lower rates of treatment drop-out than medication, which means people are more likely to stick with CBT treatment than with medication treatment.

These favorable results make CBT the first-choice approach for psychotherapy treatment for anxiety for both adults and children. Generally, CBT targets the thought patterns and behaviors associated with Anxiety, for lasting results. It is typically structured, which works well for children. Keep reading to learn more about the specific techniques that are especially helpful for particular types of Anxiety.

What does CBT typically involve?

CBT is a structured “talk therapy.” When children have phobias or separation anxiety, CBT techniques of exposure and systematic desensitization are used. Exposure techniques involve having the child sit with an anxiety-inducing situation so they can increase their tolerance for it and see that over time the anxiety decreases.  Developing the ability to monitor and evaluate thoughts is also very helpful to children.  Systematic desensitization involves gradual exposure to the feared situation or thought while engaging in a relaxation practice.  Mindfulness and acceptance practices are useful when incorporated into treatment of anxiety.  Through practicing CBT techniques, the child’s problematic thinking and anxiety-based behaviors can be reduced. Research results show that CBT is effective for many types of anxiety in children.

Exposure and Response Prevention (ERP) for OCD

CBT methods are also helpful for treating Obsessive-Compulsive Disorder (OCD). In OCD, there are two key symptoms to treat—the obsessions and the compulsions. Typically, children engage in compulsions, in their own attempts to manage the anxiety triggered by obsessions. Systematic desensitization helps children to adjust to anxiety triggers and feeling of anxiety that are normal in daily life. Exposures involve gradually learning to face the things that the child is avoiding, starting with the least anxiety provoking triggers.  Over time children discover that the anxiety diminishes when they do not avoid.  Exposures help with eliminating avoidance and reengaging in typical childhood activities such as school and playing with peers.  Response prevention involves not engaging in compulsions, for example not washing hands or checking if the door is locked.  While ERP is challenging, it is also effective in addressing OCD symptoms in both children and adults.

Addressing Anxiety at Home and in School

CBT can also be adapted for use in family therapy and school-based interventions. For best outcomes, parents, caregivers, and teachers should all be involved in anxiety treatment and aware of the treatment plan and interventions being used. This helps the child dealing with anxiety to have consistent support and expectations at both home and school with all caregivers encouraging the child to implement what he or she is learning in psychotherapy.

Anxiety Treatment for Young Children

Very young children or children with poorly developed language skills can benefit from an approach where CBT is combined with play therapy. Typically, play therapy involves purposeful play to help explore the child’s thinking and behavior, while also teaching them new skills. Books, films, and other means can be used to structure the play at an age-appropriate level.


You may have been drawn to this article because you have a child or know a child struggling with Anxiety. If you want to take steps towards early intervention, seek out a child psychologist or child psychiatrists that specializes in working with anxiety in children. A provider who takes an integrative approach will work to develop a treatment plan that addresses the whole lifestyle and your child’s unique needs, while also helping the whole family.

Psychologists, psychotherapists and psychiatrists who specialize in seeing children will know how to use age-appropriate therapy techniques, such as Play Therapy and/or CBT. Integrative and functional medicine psychiatrists may also be able to recommend other research-based approaches to help your child. For example, they can help with nutritional assessment and recommendations, supplements and mind body approaches that can improve Anxiety.