“Q: My Son Has ADHD and Anxiety. How Do I Know Whether I Should Seek Treatment?”

Anxiety affects ADHD children more frequently than their neurotypical peers, leading to a greater risk for depression and social isolation. This expert guide will help you address childhood anxiety at home — and know when it’s time to seek professional help.

Childhood Anxiety - Parent hugging child
Childhood Anxiety - Parent hugging child with ADHD

Q: “My son has ADHD and anxiety — and living through a pandemic hasn’t helped. It seems his anxiety is getting worse. How do I know whether I should seek treatment for him?”

Anxiety is a normal part of life — it’s related to fear, and fear is a natural response to something that’s threatening. If I’m hiking through the woods and stumble upon a snake, that’s a real threat, and I respond by running away. Anxiety produces the same fear response but in the absence of a real threat — for example, someone with anxiety may worry about snakes even if none are nearby.

Individuals with childhood anxiety overestimate danger and anticipate bad outcomes to a greater extent than do non-anxious people. Sometimes, it’s hard to tell the difference between stress, anxiety, and fear because they feel similar in our bodies: our hearts pound, our thoughts race, and we’re short of breath.

Helping Your Anxious Child: Strategies for Parents

You may want to try strategies for addressing anxiety at home before seeking professional help. To help an anxious child, employ positive strategies that build self-confidence and resilience.

  • Don’t accommodate the anxiety by letting your child off the hook for school responsibilities.
  • Never get angry at your child for being anxious or wanting to avoid school, family gatherings, or social events. Talk to her about what is making her anxious. Be empathetic.
  • Use relaxation and mindfulness strategies to manage anxiety together, particularly to help children over a certain age to sleep in their own rooms.
  • Approach anxiety as a family issue so the child doesn’t feel singled out.
  • Reinforce your child’s brave behaviors with praise, and ignore whining, tantrums, or other unwanted behaviors.

[Self-Test: Does My Child Have Generalized Anxiety Disorder?]

Childhood Anxiety: Distress Signals

Despite our best efforts, sometimes anxiety cannot be treated at home. To diagnose a clinical level of pediatric anxiety that may require intervention, we look for signs of fear that interfere with a child’s daily living, such as:

  • Crying, tantrums, or overreactions to a situation or event
  • Missing school and/or refusing to engage in sports or social activities
  • Being upset for no reason or acting out angrily
  • Complaining of frequent stomach and headaches
  • Seeking constant reassurance from parents
  • Having panic attacks

Childhood Anxiety: Treatments and Interventions

Cognitive behavioral therapy (CBT) is the preferred treatment for child anxiety, and it can be quite effective. CBT aims to help children see that the situations they fear are unlikely to happen and that “anxiety is just making me think this way.” CBT teaches us to differentiate real from excessive worries, and it teaches skills for tolerating worries without having to act on them. Over time, these worries lessen in frequency and intensity and no longer interfere with life.

The key ingredient in CBT is behavioral exposure. By facing a feared situation in a gradual fashion, children see that the dreaded outcomes didn’t happen. For a child with separation anxiety, a parent may start exposure therapy by going into another room for two minutes every day for a week. Over time, the separation may increase (Mom walks to the curb, then down the block, and so on).

Similarly, a child who fears speaking in front of his class may start by reading a few sentences to a therapist and working up to longer and more difficult presentations. He may then practice with a teacher, and then a friend, before finally speaking to the class.

[Read Next: Anxiety in Children With ADHD]

The Effects of Untreated Childhood Anxiety

It’s important to keep in mind that anxiety will persist if kids avoid what they fear. When you give in to the child’s anxiety — she’s afraid of doing a book report, has a tantrum, and is excused from doing it — her escape behavior is rewarded.

Childhood is the time for developing social skills and managing different situations. If a child has managed to avoid challenging situations, then he has missed valuable opportunities to learn how to get along with other kids. This becomes more problematic as kids get older. Their 12-year-old peers have developed age-appropriate social skills and the child with untreated anxiety is working with the toolkit of an eight-year-old. In severe cases, untreated anxiety in childhood can lead to increased risk of depression, substance use, and even suicidal behavior.

We want to protect our children, but we also want them to face some adversity. If they don’t develop coping skills at an early age or think for themselves and learn to problem-solve challenging situations in childhood, they’re not going to pick up such skills as adults. A lot of kids who have been sheltered may not have the critical-thinking or self-regulatory skills they need to get by in a world that’s not always positive.

Childhood Anxiety: Next Steps

John Piacentini, Ph.D., is a professor of psychiatry and biobehavioral sciences at UCLA. He is director of the UCLA Center for Child Anxiety Resilience Education and Support (CARES).

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