A common theme across anxiety disorders is avoidance of the feared object or situation, and distress when it cannot be avoided. When a child anticipates that they are going to have to face a feared situation, such as getting a shot at their medical appointment, they may engage in a wide variety of behaviors to avoid that situation, including hiding, crying, yelling, running away, and acting out aggressively. It may seem like the child has “lost control,” and in reality, they have. In these situations, the child’s sympathetic nervous system has been activated (commonly referred to fight, flight, or freeze), meaning they are reacting to this situation as though it is life threatening, and do not have the ability to logically reason about their behavior during the episode.

Avoidance can take many forms, and especially in children, is easily mistaken for oppositional behavior. Think about a child with generalized anxiety and perfectionistic tendencies who is presented with an assignment that does not make sense to them. Because of anxiety, this child may respond by refusing to begin the assignment, hiding under their desk, crying, tearing up the page, or engaging in aggression. These behaviors are likely to occur automatically, without malicious intent, though an observer may think the child is simply trying to avoid the work because they do not wish to do it. Likewise, a child with social anxiety may suddenly feel ill and ask to go to the bathroom or nurse’s office just before their turn to give a speech in front of the class. The experience of feeling ill is real. Adults observing the behavior may think the child is just trying to avoid the situation, and they are, though the avoidance behaviors may not be fully within the child’s control at this time.

Avoidance is a tricky cycle to break. We are all driven to avoid situations that our amygdala (the emotion center of our brains) perceives as dangerous or life threatening, even if our prefrontal cortex (the logical part of our brains) knows there is no real danger. When we avoid a feared object or situation, we immediately feel better. In other words, our brains are rewarded (or reinforced) for avoiding our fears. As a result, the next time we are presented with the feared situation, the drive to avoid it is even stronger. This becomes a vicious loop that can be hard to break, particularly if a person is not aware that it is happening and/or does not possess the coping skills to tolerate the level of distress they feel when confronted by their fears.

The good news is that childhood anxiety is treatable, and with the right support, children and adolescents can learn skills that help them feel more confident, capable, and in control over time.

Anxiety Treatment for Children and Teens 

So, how do we help anxious children break this loop? We have to stop the pattern of avoiding the feared object or situation; in other words, the solution is to face our fears. Unfortunately, this is more complicated than it seems. When our fear system is overwhelmed, there is potential for the exposure to be experienced as trauma, which can result in increased anxiety and other undesirable consequences. Therefore, it is critical that exposure be done thoughtfully and with support, ideally under the direction of a mental health provider.

Evidence-based mental health treatment for anxiety involves exposure. Most interventions are based in Cognitive-Behavioral Therapy practices and may include interventions like graduated exposure (or systematic desensitization) and exposure and response prevention (E/RP).

When children experience anxiety, it is also important to look at how their caregivers respond and the patterns of interactions between the child and caregiver that develop. Oftentimes, caregivers react by accommodating the anxiety to help the child avoid the feared situation (e.g., taking the child to school 30 minutes early to accommodate a fear of being late). Alternatively, some caregivers respond with a “tough love” approach and may unintentionally reduce a child’s confidence and create shame through belittling or showing lack of support (e.g., “You are way too old to still be afraid of the dark. Stop being a baby!”). If either (or both) of these responses sound like you, don’t feel bad. You are in the majority! These are very common caregiver responses to child anxiety, and typically come from a place of caring.

There is an intervention for parents called Supportive Parenting for Anxious Childhood Emotions (SPACE), developed by Dr. Eli Lebowitz at the Yale Child Study Center. This is an excellent intervention for parents who wish to better understand the anxiety cycle in their family, and to develop effective strategies for supporting and reducing their child’s anxiety by changing their own behavior.

Strategies for Supporting Anxious Children and Teens 

In addition to seeking anxiety treatment, there are some practical strategies that can help support anxious youth. Because children spend so much of their time at school, educators and school staff play a critical role in supporting anxious students. Consistency, predictable expectations, and calm, supportive responses to anxiety-driven behaviors can significantly reduce distress and help students feel safe and capable.

• Build predictability and a sense of safety. For example, establish consistent routines at home and in the classroom, and display a daily schedule.

• Teach coping skills. Basic coping and mindfulness skills, such as deep breathing and grounding techniques, can be practiced at home and reinforced at school to help students tolerate distress.

• Provide emotional support. Adults at home and school can avoid minimizing a child’s fears and instead validate the child’s feelings while communicating confidence in the child’s ability to cope. This is a key component of Dr. Lebowitz’s SPACE treatment. You can respond to a child’s anxiety by saying something like, “I know this feels really scary right now, and I am confident that you can handle it.”

• Support gradual increases in independence. It is critical to consider a child’s current skill level (e.g., are they currently staying home rather than attending school all day due to their separation anxiety, do they cry and protest leaving the car at drop off but are willing to be walked into school by their parent, or are they irritable while getting ready for school in the morning), and then encourage them to take the next small step toward the ultimate goal (e.g., easily separating from the parent to go to school). Collaboration between caregivers and school staff can help ensure expectations are aligned and that students are encouraged to take manageable, achievable steps toward independence.

• Home and school collaboration. Good communication between home and school is essential when supporting students with anxiety. Short-term accommodations may be helpful in allowing a student to manage their anxiety and remain engaged in learning while gradually building their tolerance for distress. Identifying a safe, supportive adult at school whom the student can go to when feeling anxious or overwhelmed can also help reduce school avoidance and absences related to anxiety. 

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