Understanding Accommodation in Child Anxiety: A Guide for Parents

Is all the comforting you’re doing backfiring? Learn about the role accommodation plays in a child’s anxiety.

As a parent, you’d probably do anything to help your child when they’re in distress. It’s kind of our main job as parents: we’re here to provide comfort, offer reassurance, and keep our kids safe. One of the trickiest things about child anxiety is that well-intentioned actions aimed at providing comfort and reassurance often backfire, making anxiety worse in the long run.

If your child has anxiety, you may have already sensed this: the more reassurance you give your child, the more reassurance they seem to need. The more you avoid feared situations, the more their anxiety seems to grow. You’ve unintentionally become the narrator of If You Give a Mouse a Cookie and your child’s anxiety is the insatiably hungry creature who somehow always craves more.

Anxiety therapists have a term for this phenomenon: accommodation. In this guide, we'll explore what accommodation entails, why it's important to address in therapy, and practical strategies for navigating accommodation as parents.

What is Accommodation in Anxiety?

In anxiety therapy, an accommodation refers to any way that you or your family alters your behavior in order to avoid triggering anxiety in your child. This might mean offering extra reassurance, changing your routines, or accompanying your child to activities they used to do alone.

If you’re like me, you are probably used to hearing the word “accomodation” used in a more positive way. Academic accommodations can be a huge help to kids in schools: a child with dyslexia might benefit from getting extra time to complete tests, for example. ADA accommodations make sure that people with disabilities are given equal opportunities in the workplace. These types of accommodations are objectively great!

In the therapy world, unfortunately, accommodation is not so great. While it might provide temporary relief for your child, it tends to make anxiety worse over time. Kids don’t get a chance to learn how to cope with their anxiety, which reinforces their belief that it’s something they can’t manage or control.

Basically, when we accommodate a child’s anxiety, we’re really just enabling the anxiety.

If you’re reading this and kicking yourself for being an anxiety enabler, please don’t. It’s human nature to want to keep someone else from feeling bad. The truth is, we all accommodate our kids sometimes. It’s usually harmless, but for kids with anxiety disorders, it can lead to larger issues.

What are the Risks of Accommodating a Child’s Anxiety?

Accommodation risks making anxiety worse over time, leading to more stress for the whole family.

When you accommodate a child’s anxiety, you risk entering a vicious cycle. By giving in to anxiety’s demands, your child misses out on a chance to test whether or not their worries are accurate. Instead, they avoid the situation entirely, which sends the message that maybe this scary thing really is worth staying away from.

This means your child is likely to be even more anxious the next time this scary situation comes up. They’ll need even more accommodation in order to cope. Before you know it, you’re bending over backwards to try to avoid anxious feelings.

An occasional accommodation here and there is a part of life. But repeated accommodation can come with the following risks for anxious kids:

• Worsening anxiety

• Lack of effective coping skills

• Increased reliance on parents to manage anxiety

• Disruption to daily routines due to avoidance of triggers

• Poor sense of self-efficacy (ability to solve problems independently)

• Increased family stress

These risks are much greater if your child suffers from an anxiety disorder, like social anxiety, generalized anxiety, or OCD. These kids’ super-sensitive brains are always looking out for danger, and they’re much more likely to fall into the trap of avoiding scary things.

Examples of Parental Accommodation

Excessive texting is a common and subtle example of accommodation.

So we know accommodation is not great. How can we tell if we’re doing it? While some accommodations are obvious, others are sneaky and subtle. It can be easy to fall into the routine of accommodating anxiety in small ways without even noticing you’re doing it.

Here are some common examples of anxiety accommodation, based on my experience as a children’s therapist:

• Allowing a child to skip activities that could trigger separation anxiety, such as field trips.

• Driving a child to school to avoid having to ride on the bus or carpool with a friend.

• Responding to text messages from the child all day (or all night!) to offer reassurance.

• Making sure to always tell you’re child where you are going or what you are doing.

• Repeatedly answering anxiety-driven questions, such as “Do you think I’m going to get sick?”

• Accompanying a child to activities that peers would attend alone.

• Helping a child stay away from triggers, such as crossing the street to avoid a barking dog.

• Participating in overly long or rigid bedtime routines.

• Changing family routines to help a child remain calm.

• Sleeping in a child’s room to avoid bedtime fears.

• Keeping special items on hand, such as Purell for a child afraid of germs or a barf bag for a child afraid of vomiting.

If any of these examples of accommodation seem familiar to you, don’t panic! As bothersome as accommodation can be, it’s also incredibly common.

Pretty much every family with an anxious child has some amount of accommodation going on. Therapy can help you scale it back, and empower your child to tackle their fears more directly.

Strategies to Reduce Anxiety Accommodation

Like gradually stepping in to a pool, reducing accommodation is a slow and steady process.

Even if the accommodating is making everyone fairly miserable, you don’t want to needlessly torture your kid. Like it or not, they’re relying on these defense mechanisms to cope. Removing them all at once would be hard on you and even harder on them. Instead, we can gradually reduce our accommodation, which gives kids a chance to adjust, face their fears, and develop healthier coping skills to manage anxiety.

If you want to start gradually reducing anxiety accommodation at home, you can try:

• Setting a limit on how many times you’ll reassure your child each day.

• Answering anxiety-driven questions only once.

• Limiting texting and communication during school hours or after bedtime.

• Encouraging your child to try new and challenging things rather than offering a way out.

• Making a plan with your child to go to scary places or try scary activities on purpose.

We want anxious kids to learn that they can do things even when they feel scared. Anxiety isn’t something to be avoided: it’s a part of life! Most of the time, their anxiety is just a false alarm, and not an indicator that a situation is really dangerous.

When kids develop this mindset, they can start facing their fears head-on, anxious or not. And, weirdly, the more this happens, the less anxious kids tend to feel. They’ve broken the anxiety-avoidance cycle and taught their brains there’s nothing to be afraid of.

Exposure Therapy for Anxious Kids and Families

Seems simple enough, right? Just…slowly stop doing the stuff you’re doing. But if you’re already way far down the accommodation rabbithole, this is easier said than done. It can feel nearly impossible to course correct if you’ve been answering a million texts a day or sleeping on the floor of your child’s bedroom for six months.

If you find you’re doing tons of accommodating, or your child’s anxiety symptoms are severe, therapy can help. A therapist can help you find creative ways to support your child in gradually facing their fears—without you doing the work for them. If things don’t go as planned, your therapist will help you problem-solve and keep you on track. Their job is to keep everyone feeling challenged, but not burned out.

This kind of therapy is called exposure therapy. In OCD treatment, you’ll also hear it called Exposure and Response Prevention. The goal is to help your child take back the parts of her life that anxiety has held hostage, whether that’s sleepovers or field trips or staying home alone. Facing your fears is hard, but a whole childhood without these kinds of activities is even harder.

Therapy for Anxiety Accommodation in North Carolina

Therapy can help anxious kids and teens learn to face their fears and live more confident, independent lives. Photo by Kindel Media via Pexels.

Wondering what could have possibly compelled me to write over 1300 fully original, non-AI-generated words about anxiety accommodation? I’m a children’s therapist specializing in anxiety and OCD. I am lucky enough to help families through exposure therapy on a regular basis, and honestly, I could talk about its benefits all day.

Exposure isn’t right for every family. But if you think it could be the answer to ending accommodation for you and your child, I would love to help! My office is in Davidson, North Carolina (North of Charlotte) but I can practice online therapy throughout the state, and in New York and Florida, as well.

If you don’t live in one of these states, you can search therapist databases for local therapists who practice CBT, exposure therapy, or ERP. These folks will be specifically trained in helping families reduce their accommodation to overcome anxiety.

To summarize, reducing anxiety acommodations helps kids build the skills they need to overcome fears, build resilience, and generally lead more confident lives. If you’re interested in taking the next step, you can contact me here.

Fear of Throwing Up: A Parent’s Guide to Emetophobia in Children

Fear of throwing up, also called emetophobia, is a common and challenging problem for kids and teens.

Nobody likes throwing up. It’s only natural to want to avoid being sick. But what do you do if you’re the parent of a child who really, really, really does not want to throw up: not now, not ever? Unlike many other common childhood fears (ghosts, clowns, monsters under the bed), anxiety about vomiting can seem pretty logical—at least on the surface. But for some kids, anxiety about throwing up grows past what’s typical and starts to get in the way of daily life.

This extreme fear of vomiting is called emetophobia, and it’s one of the most common phobias experienced by young children. Frustratingly for parents, it can also be one of the trickiest to diagnose and treat!

If it feels like your life is being consumed by your child’s increasing worries about getting sick, there is good news. There are therapy techniques that are proven to help kids with emetophobia get back to living happier, less anxious lives. In this guide, we’ll cover the signs and symptoms of emetophobia that set it apart from a passing childhood phase. We’ll also discuss how it develops, what you can do to support your child, and how therapy can help.

How Do I Know if My Child Has Emetophobia?

Children with emetophobia have a fear of vomiting that goes above and beyond the discomfort a person would typically feel about throwing up. It’s common to be nervous about throwing up during an illness, but kids with emetophobia are preoccupied by their worries all the time, even when they’re healthy.

If your child has emetophobia, you may notice them going to great lengths to avoid places, activities, or things that they associate with throwing up. You might also observe your child repeatedly saying or doing things that they think will make it less likely that they’ll get sick.

Most people with emetophobia start developing their fear in early childhood: the average age of diagnosis is around 9 years old. While kids of any gender can have emetophobia, it’s more commonly diagnosed in girls than in boys.

All kids go through phases, and if a child’s worries are just a passing phase they will likely resolve on their own after a few days or weeks. Emetophobia is different. It grows and worsens over time. You may notice that your child’s list of avoidances gets longer and more generalized. For example, rather than staying off one specific rollercoaster where she once threw up, now she avoids all rollercoasters, as well as any vehicle she worries will be too bumpy.

Signs and Symptoms of Emetophobia in Children

Excessively avoiding people, places or activities that could cause illness is a common symptom of emetophobia in children.

Kids with emetophobia experience anxiety symptoms when they start thinking about the possibility of throwing up. To cope with their fear, they may avoid things that they believe could put them at risk of throwing up—even if it doesn’t logically make sense to do this. They might also repeatedly ask for reassurance or repeat behaviors that reduce their anxiety and make them feel more safe from the risk of throwing up. Here are some examples of anxiety, avoidance, and repeated behaviors to look out for:

Anxiety Symptoms:

• Overwhelming worries that are hard to control

• Panic symptoms, like sweaty palms, racing heartbeat, or shaking

• Dread before entering a situation that your child associates with throwing up

• Feeling sick to your stomach (anxiety can cause nausea, which sets off a vicious cycle!)

Avoidance Symptoms:

• Refusing to eat certain foods, either because your child once threw up after eating them or because your child fears they could cause nausea (too rich, too close to expiration date, etc.)

• Staying away from places where your child has previously thrown up or seen someone else throw up

• Avoiding activities that could cause nausea, like rollercoasters

• Keeping away from sick people, doctor’s offices, or hospitals due to a fear of catching germs

• Refusing to take medications that list stomach upset as a possible side effect

• Difficulty saying words like “vomit” or “threw up”

Repeated behaviors:

• Repeatedly asking for reassurance that they will not throw up

• Excessively washing hands

• Compulsively checking expiration dates on food or medications

• Repeatedly checking for bodily sensations like a gag reflex or stomach pain

• Staying close to a trash can or barf bag

• Eating slowly, cutting food into small pieces, or otherwise changing eating habits to avoid nausea

If you’re noticing several of these signs or symptoms of emetophobia in your child, check in with your pediatrician or a children’s therapist.

What Triggers Emetophobia?

Like most anxiety disorders, emetophobia is probably triggered by a combination of genetics and stress. There’s no one singular thing that causes emetophobia to occur, and it’s nobody’s fault: there’s nothing you could’ve done as a parent to prevent it.

Anxiety has a strong genetic component and tends to run in families. If your child has biological relatives who struggle with anxiety, there’s an increased chance your child will naturally have a heightened anxiety response, too. Even if nobody else in the family has emetophobia, simply having other anxiety disorders in the family tree can put a child at increased risk.

Even with a genetic predisposition for anxiety, there’s usually some kind of trigger or event that sets a child’s emetophobia into motion. Many children start showing symptoms after getting sick and throwing up. However, it’s also possible for emetophobia to be triggered by seeing someone else throw up, or even just having the sensation of choking or gagging.

These kinds of stressful events could have any child feeling worried or stressed for a little while. But kids who are already anxiety-prone may have a harder time brushing the event off and moving on. Instead, their experience with vomiting sticks with them and triggers recurring worries and attempts to avoid throwing up again.

While unlikely to cause emetophobia, parents may also notice that their child’s symptoms get worse after any stressful life change, like a move, the birth of a new sibling, or starting at a new school.

Do Children Grow Out of Emetophobia?

Symptoms can get much better with treatment, but it’s unlikely that a child will outgrow their emetophobia without help from an adult.

If you’re in the thick of it with emetophobia, you may be wondering if your child—and you—will have to cope with this debilitating fear of vomiting for life. The thought of a lifelong diagnosis can be a scary prospect: how can you enjoy a happy childhood when you’re struggling this much?

Generally speaking, kids won’t grow out of emetophobia on their own. One a child’s anxiety symptoms are this severe, they need help from parents and professionals to get back on track. In fact, research suggests that kids with emetophobia who don’t receive treatment tend to struggle with emetophobia into adulthood.

There also isn’t great data available (at least that I’ve found) about how many kids with emetophobia are 100% cured of their worries. This is probably because kids with a fear of vomiting often have other forms of anxiety they deal with, as well, like generalized anxiety or OCD.

I realize this all sounds a little hopeless. It isn’t! There’s good news: while emetophobia can be tricky to treat, especially without help, it can get better. Therapy can help kids and their parents gradually face the situations that trigger fears of vomiting, without needing reasssurance or special treatment.

Kids can become more confident in their ability to handle their anxiety on their own. When this happens, worries may not disappear entirely, but they become a passing annoyance instead of a debilitating fear.

How Can I Help My Child With Fear of Vomiting?

Kids with a fear of vomiting absolutely benefit from therapy with a professional. However, if you’re just starting out on this path and still searching for a therapist, there’s a lot you can do on your own to help your child. Parents play a huge role in their child’s recovery from emetophobia. Changing how you respond to anxiety can help your child cope better with their worries and prevent symptoms from snowballing.

The most important thing you can do to help your child with their fear of vomiting is to be mindful of how you are changing or adapting the way you do things to keep your child from experiencing fear. Nobody wants to see their child suffering, and it’s only natural to want to reassure a worried kid or take them away from an anxiety-provoking situation. However, when a child has an anxiety disorder like emetophobia, preventing a child from facing their fear head-on makes symptoms worse over time.

In therapy, we call this accommodation: families learn to change their ways over time to accommodate and “make room” for a child’s anxiety. While this might appear to help in the short term, over time you’ll find the anxiety takes up more and more space. Its list of demands grows: instead of one reassurance, your child may need many. Throwing out expired crackers once may lead to repeated requests to check expiration dates on everything in the fridge.

You may realize that you’re already doing a good deal to accommodate anxiety, and that’s okay. You don’t need to suddenly remove all the supports you’re offering your child. A therapist can help you gradually pull back on accommodation so your child feels empowered to face their fears, rather than overwhelmed by them.

Here’s some other quick tips to support your emetophobic child at home:

• Educate your child about their diagnosis: knowing that there’s a word to describe this problem and that many others have experienced it can help a child feel less alone.

• Practice daily relaxation skills with your child during calm moments. This can help them better manage overall stress, and will better equip them to use skills the next time they’re anxious.

• Listen to and validate your child’s fears, rather than rushing to reassure them that nothing’s wrong. Phrases like “I’d really scared, too, if I thought I was going to throw up in front of all my friends” can go a long way in helping your child feel heard.

• Once you’ve validated the feeling, ask your child questions to help them think logically about their fear. For example, how many times have they thrown up at school? Have they felt this anxiety before, and has it correctly predicted that they would throw up? Even if they did vomit, would it really be the end of the world?

• Keep an eye on how you’re accommodating anxiety, and be careful not to give in to any more of the anxiety’s demands. You can even try to gradually reduce your accommodating over time by setting gentle limits on how much support you provide your child: for example, offering only 3 reassurances per day.

Is Fear of Vomiting Related to OCD?

Excessive cleaning due to a fear of germs can be a symptom of both OCD and emetophobia in kids and teens.

There’s a lot of overlap between emetophobia (fear of vomiting) and OCD. For some kids, fear of vomiting may be a standalone phobia. For others, however, it can be part of a bigger picture that includes other symptoms of obsessive-compulsive disorder.

Children who have emetophobia without OCD may have a more straightforward fear of vomiting. While they’re likely to avoid situations that could prompt them to throw up, they’re less prone to associating things with throwing up in a superstitious or illogical way. As an example, a child without OCD might avoid hanging upside down or riding a tilt-a-whirl, but they probably wouldn’t think twice about wearing the same outfit they wore the last time they got sick.

On the other hand, kids who fear throwing up due to OCD are more likely to make these kinds of mental connections, and avoid anything that feels somehow linked to a time that they or someone else threw up. You may also notice more compulsive behavior from your child, such as repeatedly checking labels, frequent handwashing, or needing to keep a trash can or bucket nearby.

If you look at your child’s overall history, you may notice that their fear of vomiting is part of a larger trend: maybe they’ve had other intense, recurrent fears in the past that have also resulted in needing to repeatedly say or do things in a certain way. This is also a good sign that OCD could be a better, more helpful diagnosis for a child’s struggles.

Either way, OCD and emetophobia have a lot in common: they both involve recurring, uncontrollable worries as well as repeated behaviors to manage the anxiety. Because of this, the same therapy techniques that work well for OCD can help kids with emetophobia feel better, too.

How Do You Treat Emetophobia in Children?

Some common child therapy approaches, like play therapy and traditional talk therapy, may not work particularly well to help kids with emetophobia—at least not on their own. Kids with emetophobia need more than just a listening ear to help them express their feelings. They also need someone who can help them gradually face their fears, so that they can prove to themselves (and their anxiously wired brains) that things are rarely as bad as they seem.

Exposure and Response Prevention, also called ERP, is a special form of therapy that was designed to help kids with obsessive compulsive disorder tame their recurrent worries and break the cycle of compulsive behaviors that go with them. It’s a version of cognitive behavioral therapy (CBT), which teaches anxious people to use specific coping skills in the present, rather than spending a lot of time understanding the past.

In ERP therapy, you and your family might learn the following skills:

• An understanding of how anxiety works in the brain

• Relaxation techniques to physically calm down your body

• How to notice and “talk back” to anxiety when it gives you exaggerated or illogical worries

• How to support your anxious child without giving into their anxiety’s demands

• Strategies to gradually face fears, starting small and working your way up, without avoiding or trying to “fix” the anxiety

• How to prevent anxiety from spiraling out of control in the future

While treatment won’t solve your child’s emetophobia problems overnight, it can absolutely help in the short-to-medium term. Families who attend therapy regularly and follow up with at-home practice often notice significant improvement in a matter of weeks or months. Importantly, therapy also helps kids to maintain their progress over the long-term, making it less likely they’ll need to return to counseling in the future.

Therapy in Charlotte, NC for Kids with a Fear of Throwing Up

Treatment with ERP therapy can help Charlotte-area kids recover from emetophobia and live life without fear of vomiting. Photo courtesy of Skylar Ewing via Pexels.

If you’re in the Charlotte, North Carolina area and looking for therapy for emetophobia, I may be able to help. I’m a children’s therapist who specializes in helping tweens and teens navigate life with anxiety. As you’ve probably guessed by the length of this blog post, I spend a lot of time thinking about anxious kids and what we can do to make their lives easier.

I got trained in ERP and CBT therapy for anxiety and obsessive-compulsive disorder due in part to my own experiences with childhood OCD. These are the therapy approaches I wish I’d had access to growing up, and I hope they can help kids like yours feel better faster.

My child therapy office is located in Davidson, convenient to families in the Lake Norman area or North Charlotte. If you can’t manage the commute, I also see children for online therapy and find this format works really well for many middle and high schoolers. If you’re even further afield, I can work with families throughout the states of North Carolina, New York, and Florida. I also have an online coping skills course available for download wherever you live.

Ready to get started? Contact me here.

The Most Common Types of Childhood Anxiety: Forms, Prevalence, and Symptoms

Childhood anxiety is increasingly common, but often overlooked. Learn the 5 most prevalent types of anxiety in this post.

Anxiety isn’t exclusive to adults: children can experience it, too. Childhood anxiety, while often underestimated, is a very real and prevalent concern. Research suggests that 1 in 8 American kids suffers from some form of anxiety, and that 25% of kids will have symptoms at some point during their teen years. We also know that childhood anxiety is on the rise: some studies show that anxiety rates have doubled over the last few years, possibly due to a combination of pandemic stress, social media exposure, and world events.

As a therapist, what concerns me most is that many of these children—40%—are not getting treatment for their anxiety. And as a parent, I imagine you want to make sure you’re not missing any symptoms! It’s perfectly normal for kids to experience stress and worries in the course of day to day life, and it’s not always easy to tell when those more typical worries are evolving into something more.

In this guide, I’ll cover the 5 most common anxiety disorders experienced by children. You’ll learn the basics of each anxiety type, including its prevalence, common symptoms, and examples of how these symptoms might look in kids. We’ll wrap up by talking about how you can make sure your child gets effective help if they’re struggling with anxiety.

1. Specific Phobia: Most Common Overall (and Rarely Discussed)

How Common Is It? Hands down, this is the most common anxiety disorder that affects children and teens—and yet I rarely see content about it online! Around 7-9% of children have a diagnosable phobia, and the National Institute of Mental Health says that 19.1% of teens will have a phobia at some point in their lives!

What Are the Symptoms? Children with this disorder have an overwhelming fear of a particular thing or situation—hence the “specific” part of the name. Their fear is out of proportion to the trigger: often, the thing or scenario they’re afraid of is not actually dangerous at all. Children with phobias will go out of their way to avoid being around or even thinking about the thing that scares them.

Examples of Phobias in Kids: Animals, blood, needles, clowns, and bugs are all very common phobias in kids and teens. However, any object, animal, or situation can become the source of a phobia. Here are a few examples:

• Sofia and her mother are in a standoff about scheduling her annual physical. Sofia is terrified of needles and doesn’t want to get vaccines or a blood draw during her doctor visit. Last year she was only able to cope by holding her mother’s hand, but since then she’s avoided even talking about getting a shot.

• Even though he’s never been bitten by one, Jackson is terrified of dogs. He won’t visit the houses of friends who have dogs unless they are kept outside while he’s there. If he encounters a dog while walking in the neighborhood, he makes the family turn around and take a different route.

• Cecilia has asked to stay home from an upcoming family vacation because she dreads flying on airplanes. She often has panic attacks while on the plane, and needs a lot of support from both her parents in order to get through. The trip is still weeks away, but Cecilia is already getting anxious about the flight.

Good to Know: It’s common for kids to experience temporary fears after watching a scary movie, having a negative or traumatic experience, or even after participating in Halloween events. These fears tend to resolve on their own in days or weeks, whereas phobias stick around and may even worsen over time.

2. Generalized Anxiety Disorder (GAD): Prevalent in Tweens and Teens

A child or teenager who is overwhelmed by frequent and excessive worries may be suffering from Generalized Anxiety Disorder, which is prevalent in older kids. Photo by Leah Kelley via Pexels.

How Common Is It? Generalized Anxiety Disorder (also called GAD) is one of the most common forms of childhood anxiety, especially for older kids. Estimates vary, but approximately 2.9-4.6 percent of American kids would qualify for this diagnosis.

What Are the Symptoms? Kids with GAD experience overwhelming, frequent worries about a variety of subjects, like school, health, safety, and family. The worrying occurs most days and gets in the way of a child’s life, potentially making it harder to focus at school or go to bed at night. Kids with GAD often complain of bodily symptoms like muscle tension, headaches, and stomach aches, and may feel irritable, as well.

Examples of GAD in Kids: If your child or teen is dealing with Generalized Anxiety, these examples may feel familiar to you:

• Julian has a hard time unwinding at night because he can’t seem to turn off his worried mind: each night, he vents about a variety of subjects to his mom including school shootings, homework stress, and letting down his team in basketball. He knows he worries a lot, but he’s still not sleeping well.

• Maya often stops by the school nurse’s office complaining of headaches or tummy aches, but doctors haven’t found anything wrong. At home she often seems tense—physically and emotionally—and often snaps at her mom. Things are calm in Maya’s life, but she often asks “what if” questions about worst-case scenarios.

• Lulu has always been a worrier: the topics change, but the habit of worrying remains the same. Recently, though, things have taken a turn: Lulu is worrying so much that her attention drifts from her work at school. She’s having a hard time focusing, and her grades have dropped a bit.

Good to Know: Kids with GAD often have other mental health diagnoses, too. GAD is common in children with ADHD, depression, and other types of anxiety like Separation Anxiety.

3. Separation Anxiety Disorder: Common in Young Children

How Common Is It? Separation anxiety is the most common form of anxiety in young children. About 2-5% of kids under the age of 12 experience it. Older kids can have separation anxiety, too, but it’s not quite as common.

What Are the Symptoms? Kids with separation anxiety are fearful of being away from their parent or primary caregiver. They often worry that something bad will happen to themselves or their loved one while they are apart. It’s common for kids to miss their parents, but for children with this disorder, the fear is so intense that it can cause physical symptoms or prevent them from participating in age-appropriate activities.

Examples of Separation Anxiety Disorder in Kids: The main symptom of separation anxiety is pretty clear—kids are nervous to be away from Mom or Dad! Even so, this disorder can look quite different from kid to kid. Here are a few examples:

• 12-year-old Bella is the only one of her friends who has never been on a sleepover. She hates feeling left out, but the idea of being away from her mom overnight is just too frightening. Every time she considers going, she imagines having an emergency while she’s gone, without her mom there to help.

• Oliver started preschool this year but hasn’t attended very many times. He often tells his mom he has a stomach ache in the morning, and asks to stay home. His mom has noticed these tummy aches only appear on school mornings, and never on the weekend. Oliver has a harder time at drop off than most of his friends, and takes longer to recover from his upset.

• Jaci’s mom has worked from home for years, and just started going back to the office a few days a week. Jaci has an epic tantrum every time her mom has to leave the house. When asked, Jaci said she worries her mom will get into a car accident on the way to work and won’t come back.

Good to Know: Some separation anxiety is a normal —and even healthy—part of child development. To qualify for a diagnosis of Separation Anxiety Disorder, a child’s symptoms need to be long-lasting (more than a month) and be more intense than what is expected given a child’s age.

4. Social Anxiety Disorder: Not Just Shyness

Public speaking is a comon trigger for Social Anxiety Disorder, one of the most common forms of anxiety affecting children and teens. Photo by Rica Naypa via Pexels.

How Common Is It? Most estimates agree that between 3 and 6% of kids have Social Anxiety Disorder, making it one of the most common forms of childhood anxiety. It tends to affect teens more than younger children, and may be more common in girls than in boys.

What Are the Symptoms? Children with Social Anxiety Disorder aren’t really afraid of socializing: they have an intense fear of being embarrassed, humiliated, or judged by others. They may avoid activities where they could be observed or judged, refuse to participate in class, or worry excessively about offending other people. Physical symptoms include blushing, trembling, and an increased heart rate.

Examples of Social Anxiety in Kids: A kid can be friendly and outgoing and still experience severe social anxiety in certain situations. Here are some examples of social anxiety signs to look out for:

• Jeremiah arrives home from school starving every day because he refuses to eat in the cafeteria with his peers. The idea of people watching him eat makes him anxious. Although he enjoys sports, he’s started to hang back in gym class due to concerns that his classmates will be watching him there, too.

• Natalia’s biggest worry in life is that other people are judging her or talking about her behind her back. She describes feeling like she’s being watched when she’s riding the bus or walking in the halls at school. Her worries have gotten so bad that she dreads the ride to school in the morning and class changes during the day.

• Although he’s an excellent student, Hugo asks to stay home whenever he’s due to present a project in class. As soon as he gets to the front of the room his hands become sweaty, his body shakes, and he feels so lightheaded he worries he could faint.

Good to Know: A history of being bullied, trouble with social skills, and general shyness can all contribute to developing social anxiety. However, plenty of kids with Social Anxiety Disorder don’t have any of these risk factors.

5. Obsessive-Compulsive Disorder: Frequently Overlooked

How Common Is It? Less common than others on this list, OCD is estimated to affect around 1-3 percent of children. Technically, it’s also not quite an anxiety disorder: it gets its very own category in the DSM-5, the manual therapists use to diagnose mental health conditions. Due to its sneaky symptoms, however, OCD is commonly overlooked or mistaken for other forms of anxiety.

What Are the Symptoms? OCD involves the presence of unwanted and upsetting thoughts, called obsessions, as well as repetitive behaviors, called compulsions. Kids with OCD get stuck in a vicious cycle of obsessive thoughts or worries, which they try to manage through their compulsive behavior. Common obsessions include fears of contamination, harm, or moral wrongdoing, while compulsions may manifest as repetitive hand washing, checking, or counting.

Examples of OCD in Children: OCD in real life doesn’t always look the way it does in the media. Kids and teens with OCD are no more likely to be clean or organized than anybody else! To add to the confusion, some compulsive behaviors are invisible: mental rituals like counting, checking, and praying aren’t always noticeable to others. A child with OCD may experience difficulties like these examples:

• Nina is very concerned about locking the front door whenever her family leaves the house, for fear that a robber could break in while they are away. Nina meticulously locks the door and checks it several times before heading out. Within a few minutes, though, she doubts whether she really locked the door, and often returns home to double check.

• Sasha learned about germs and handwashing during Covid, and got very worried about possibly having germs on his hands during that time. Since then, his handwashing habits have gotten more frequent and more extreme. Sasha often leaves class to wash his hands, and his skin is chapped and dry from frequent washing.

• Gracie has repeated worries that she might have said or done something during the day to offend or upset her friends. In order to help herself feel better, she confesses anything she fears might have gone wrong to her mom. Gracie’s mom wants to be supportive, but the confessing is happening more and more often, even though Gracie knows she didn’t really do anything wrong.

Good to Know: Kids with OCD are often aware that the thoughts they’re having are “weird” or unusual. This causes a lot of distress, and sometimes prompts children to avoid sharing worries or try to disguise their compulsions.

Treatment for Children and Teens with Anxiety Disorders

Treatment is readily avialable for all of the most common forms of childhood anxiety—and it can really help kids get back to enjoying their lives without worry. Photo by Jonas Mohamadi via Pexels.

The statistics around childhood anxiety are intimidating: so many kids are suffering, and relatively few are getting help! Knowledge is power, however, and being able to identify when a child’s symptoms go above and beyond “normal” worries is a great first step toward supporting an anxious child. There are many treatment options available to help kids manage anxiety and get back to living a healthier, happier life.

Cognitive Behavioral Therapy is often considered the “gold standard” for childhood anxiety treatment because it has loads of research to back up its effectiveness. CBT therapy tends to be skills focused, with an emphasis on solving problems as they exist now rather than delving into the past to figure out their origins. Kids in CBT therapy can expect to learn coping skills to relax their bodies, deal with unhelpful worries, and face the fears they may be avoiding in day-to-day life.

Play therapy is another popular treatment option, especially for younger kids who may not feel comfortable sitting still and talking to a strange adult about their problems. Young children naturally use play to work through their feelings and understand the world around them. Play therapy allows children to tap into this innate ability, rather than putting all the emphasis on verbalizing thoughts and feelings. In play therapy, you can expect your child to use make-believe, art, and imaginative play to express themeslves and work through their feelings over time, with support from a counselor who knows how to interpret their activities from a psychological perspective.

I offer both play and CBT therapy in my Davidson, NC office, and also meet virtually with clients throughout North Carolina, Florida, and New York. If you’re looking to get your child started in anxiety therapy, you can reach out to me here.

Navigating Transitions: How to Move from Elementary to Middle School (Without Losing Your Mind)

Need to help your child through the dreaded middle school transition? You’ve come to the right place.

Shifting from the safety of elementary school into the uncharted territory of middle school can be a bumpy ride for kids and parents alike. If you’re about to make this leap with your child and find yourself feeling anxious, you are not alone! So many kid clients in my practice start therapy around this transitional time, and even more opt to hold off on ending therapy until they feel settled into sixth grade. Even for kids without significant anxiety, beginning middle school can be a source of stress.

You don’t even have to take my word for it: we have reserarch to back up the idea that the middle school tranistion is hard on kids. A study from my home state of North Carolina found that sixth graders who move to a middle school building are more likely to be disciplined for behavior problems than their peers who remain in their elementary school for sixth grade. Other studies have found that students’ academic achievement drops between fifth and sixth grade, possibly due to the stress of tranisitioning to middle school. In both of these cases, the negative effects can be seen for years, even as the students enter 8th and 9th grade.

That data is a bummer, but the silver lining to all of this is that it’s not just you: the struggle for kids entering middle school is very real. In this guide, we'll explore why this transition is so nerve-wracking and share practical strategies to make the journey a little smoother.

What Makes the Shift to Middle School So Hard?

We know that the tranistion is hard, but why? For American kids, middle school is a nearly universal experience. If you’re a child of the 90s like me, you may have less-than-fond memories of your own junior high years, but ultimately, we all survived. Here are a few dynamics that make moving from elementary to middle school particularly challenging:

Small Fish in a Big Pond:

As a fifth grader, your child ruled the school. It was their home base for years—maybe as far back as Kindergarten—and they might not even remember life without it. By fifth grade, you know every nook and cranny of that school building, and it’s filled with familiar faces. Plus, your child enjoyed high status at the top of the social food chain. Fifth graders are the biggest, smartest, strongest, fastest kids in school. A Kindergartener practically looks like an infant in comparison! E ven if your child is not the competitive type, wielding this kind of power over your surroundings brings a sense of security.

Then you get to sixth grade and the whole ecosystem changes. You’re the youngest kid in the building, surrounded by teenagers who are way more physically and mentally developed than you. You’re no longer the big fish in a small pond: you’re a little fish, and the pond just got a whole lot bigger.

Unfamiliar Territory:

I’ve spoken to roughly a bajillion middle schoolers about their anxiety. Of all the fears I’ve heard about junior high, one reigns supreme: all kids worry about getting lost in their new building. In public school systems, multiple elementary schools typically feed into one middle school, so students tend to be dealing with a bigger school building.

What’s more, students face the new challenge of traveling from class to class between periods. Gone are the days of spending 7 hours in one cozy classroom: it’s not your job to get yourself to your teacher’s room on time. In most schools, you’ve got about 5 minutes between class periods, which goes by pretty quickly if you need to stop by your locker or the restroom. If I was racing against a timer 6-8 times a day, I’d be stressed out, too.

Students often worry that they’ll show up late for class and embarrass themselves in front of their new teacher and classmates. They imagine having to slink into class and sit down in their seat, humiliated, while everyone’s eyes are on them. And, honestly? Lots of kids will get turned around and end up late to a class, especially during the first week of school. It’s common, not a big deal, and definitely won’t ruin anyone’s social life. Whcih brings us to our next issue…

Fear of the Unknown

The process of starting middle school is shrouded in mystery. Most kids have not spent any meaningful time in the building. Their understanding of what middle school will be like is based on rumors passed down from older kids, as well as representations of middle school in the media. And let’s be honest, the media representations of middle school are not awesome.

With so little information to go on, kids are more likely to imagine worst case scenarios or cling to rumors that may not be rooted in fact. A child who hasn’t received their schedule yet may worry about being placed in classes without their friends or getting saddled with the teacher nobody likes. A student who hasn’t toured the building may worry about getting a locker in a bad location, or struggling to manage their combination lock. And virtually every student feels at least a little worried about the increased homework and friend drama they’ve heard comes along with life as a middle schooler.

In Middle School, School and Social Life Become More Complex

From more homework to cliques to passive aggressive bullying, there’s a lot for preteens to navigate starting aroudn sixth grade.

Middle school students are expected to do almost as much schoolwork as high schoolers, but with few of the perks. Most can expect nightly homework, more advanced subject matter, and more pressure in general to do well on tests and earn good grades.

Although they’re expected to behave like “big kids” academically, in most other respects they’re still receiving “little kid” treatment: no lunches away from campus, limited control over their class schedule, and micromanaged behavior. If I was given a heavy workload and then told by my boss that I was expected to sign out in order to use the bathroom, I’d quit immediately. Sadly, middle schoolers don’t have that option!

Things get trickier on the social front, too: friends become a primary source of support over these years. In middle school and beyond, friends are way more than just a companion on a play date: they’re confidantes, amateur therapists, and your family away from home. The older a tween or teen gets, the more central these friendships become in life.

As important as they are, we all know that navigating middle school friendships can also be fraught with drama. Everyone is figuring out their identity, and the influx of new classmates means that friend groups are frequently shaken up. Kids are dealing with issues like jealousy, gossiping, and cliques for the first time. It’s not surprising that so many kids make less-than-ideal social decisions that result in bullying or hanging out with the wrong crowd.

Create a Supportive Environment for Your Middle Schooler

Ideally, home and family life is a safe haven from the stresses we experience all day at work and school. But we don’t live in an ideal world! It’s easy for work and school stress to “bleed” into home life, or for resentment to build between parents and kids—especially during this increasingly hormonal and volatile age. Doing your best to create a supportive, consistent home environment is one of the best ways to help your middle schooler deal with the chaos of school.

Here are a few ways to emotionally support your middle schooler at home:

Take their perspective: Fumbling with a combination lock or arriving 2 minutes late to class may feel trivial to us as adults. But put yourself in your child’s shoes for a minute: in the microcosm of their middle school world, these are make-or-break issues. Keeping this in mind makes it easier to empathize with their worries, rather than brushing them off as insignificant.

Avoid toxic positivity: When a child comes to you with a worry, it’s so tempting to say something like “You’re going to have an awesome day!”, “Try to think positive,” or “You’re the best kid ever—who wouldn’t like you?!” While some kids appreciate this kind of pep talk, others find it makes them feel even more anxious, because it’s not acknowledging their concerns. Instead, try validating their fears while also focusing on their ability to overcome obstacles: “I can totally see why that would be embarrassing. I would be nervous too! But I’ve seen you handle so many awkward situations well, and I know you’d figure out this one, too.”

Normalize the struggle: Your middle schooler may feel as though they’re the only one who is having a hard time with this transition. As a parent, you can remind them that this is not the case! Let your child know that their worries are totally common and normal, and that they’re not alone.

Practice open-mindedness: If they haven’t started yet, the difficult parent-child conversations are just around the corner. You can set the stage for future conversations about hard subjects like drugs and dating by being mindful of your reactions now. Middle schoolers are highly aware of cause and effect, and if they see you’re flying off the handle about minor misbehaviors, they’ll be much less likely to approach you with the big stuff.

Avoid overscheduling: If your child is currently enrolled in 3 travel sports teams, now may be the time to consider cutting back. I’ve personally seen several anxious middle schoolers whose symptoms improved once they streamlined their after school activities. Prioritizing unstructured downtime can help ease the adjustment to the higher workload and demands of middle school.

Strategies for Middle School Anxiety Management

Anxiety about starting middle school is totally normal. There’s a lot you can do to help your kid cope.

In addition to creating a supportive home environment, there’s a lot you can do to proactively help your child navigate their middle school transition. Many of the same coping skills we use for other forms of anxiety work great for back to school anxiety, too—with a few tweaks.

Here’s how you can help your child manage their stress as they adjust to junior high life:

Be prepared: We talked earlier about how fear of the unknown can fuel worries about the middle school transition. Visiting the school, meeting teachers, exploring the school website, and speaking to rising seventh and eighth graders are all ways you can help your child prepare for their first day. This prep serves two purposes for your child: you’re helping make a strange environment feel more familiar, while also helping your child face their fears one little step at a time.

Question unhelpful assumptions: If you notice your child starting to get worked up over worst case scenarios, don’t let it slide—you can gently call out these thoughts and help your child adjust their thinking. We call this kind of worrying “catastrophizing”, and kids can expend a lot of time and energy thinking about horrible situations that are very unlikely to ever happen in real life (“I’ll arrive to class late, everyone will laugh, and the teacher will think I’m an idiot!”) You can ask your child questions like these to nudge them towards a more realistic perspective:

• Do you have any evidence this is going to happen?

• How likely do you think this is to happen?

• Can you think of some other ways that situation could go?

• Is this worry predicting something in the future that hasn’t happened yet?

• If your friend was worried about this, what would you tell them?

• Have you handled anything like this before in your life? If this happened, could you cope?

Support study skills: Executive functioning skills allow us to prioritize tasks, set and reach goals, folllow multi-step directions, and generally manage our impulses in order to get work done. It takes time to build these abilities, and a middle school workload asks a lot of kids from an executive functioning standpoint. If you suspect your child is struggling in this area, step in to support. Ask your school what they offer for kids needing study skills help, and check out the many resources available for parents of ADHDers on YouTube. Even if your child doesn’t have this diagnosis, you’ll find many helpful tips for strengthening executive functioning at home.

Don’t avoid: If your child is dreading getting to school every day, it can be tempting to let them stay home for a mental health day…and then another…and another. While everyone deserves the occasional day off, avoiding your anxiety trigger is an easy way to make anxiety grow. The more we avoid something that scares us, the bigger our fear will be when we try to return. In extreme cases, kids who frequently avoid school may become so anxious they’re unable to enter the building at all. I don’t want that for you or your kid!

It’s Not All Bad News: Make the Most of School Resources

Admittedly, this blog post has painted a pretty grim picture of middle school life so far. But it’s not all doom and gloom! I mentioned earlier that many of my preteen clients begin or continue therapy due to their nerves about starting middle school. However, once middle school actually starts, many of them return to tell me that it isn’t so bad after all.

As challenging as middle school can be, it has its upsides. Middle schoolers are some of the funniest people I know. Their imagination knows no bounds, and they’re independent enough to try out ideas on their own. This generation is so aware of social issues that, despite the usual peer drama, I find they tend to have a strong sense of morality. In short, they’re awesome.

Middle school kicks off a new developmental stage for kids. They’ve spent much of elementary school seeking praise from grownups in order to feel capable and confident. In the tween and teen years, kids are less reliant on that feedback from adults and more able to trust their own gut. Issues of identity come to the forefront: kids are figuring out who they are and what they stand for. They’re beginning to figure out what kind of adult they might like to be someday.

You can tap into this positive side of the middle school experience by making the most of what your school has to offer. Here are a few common resources that can support kids emotionally as they develop their sense of self:

• Extracurriculars: Many kids find their identity—and a group of kindred spirits—in after school clubs. Moving to middle school typically means gaining access to a much wider range of extracurriculars. Every kid needs a chance to shine and feel appreciated, and if their academics or social life are struggling, these groups can be a real safe haven.

• School counselors: These people know your particular school better than anyone! They’ve seen it all, heard it all, and probably tried it all. If you’re having a specific school-related issue, like anxiety at drop-off or loneliness at lunch time, they can likely offer strategies that have worked for others in the past. While most school counselors aren’t able to provide ongoing weekly therapy, they’re your best bet if an emergency comes up in the middle of a school day. Think of your counselor as a sort of Urgent Care for your mental health.

• Lunch Bunches and Social Skills Groups: Increasing numbers of schools offer extra support for kids looking to make friends. Lunch Bunches pull a small group of like-minded kids together during their break to get to know each other better in a structured environment, with support from a teacher. Your school’s guidance office may also run social skills groups for kids looking for more specific help. These services aren’t always widely advertised, so it doesn’t hurt to ask about them.

• Psychological and Learning Assessments: If your child is truly struggling emotionally or academically, you can request an evaluation from your school district at any time to see if they may qualify for a 504 or IEP plan. These two plans help kids with learning differences or disabilities get the support they need at school, either through changes to the learning environment or through special education. Your school district may not agree with your request, but if they do, your child can be screened for vision and hearing difficulties, autism and ADHD, learning and emotional difficulties, and sensory processing differences. These kinds of evaluations are pricy and hard to get from private psychologists, but are provided at no cost in schools.

When to Seek Extra Help

If you’ve tried to help your child through the middle school transition on your own, consider adding some extra help in the form of a counselor.

By fostering open communication, offering support, and being proactive in addressing anxiety, you can help your child navigate the transition to middle school without (we hope) losing your mind. Know that you’re not alone, and that the challenges of middle school can yield a lot of growth and personal development despite all the angst.

If you find that the stressors of middle school are becoming overwhelming for your child, or if you simply want extra guidance on supporting their emotional well-being during this time, consider reaching out to a professional therapist like me. My counseling practice specializes in helping tween clients learn effective coping skills to deal with anxiety and OCD.

For those who prefer to take a self-guided approach, I also offer an online coping skills course designed to equip middle schoolers with the tools they need to manage stress, anxiety, and the challenges of growing up.

Good luck out there, parents—I salute you.

Signs of Panic Disorder in Children (And How You Can Help)

Learn how to help your child cope with Panic Disorder in this handy guide for parents and caregivers. Photo by Ron Lach via Pexels.

“The only thing we have to fear is fear itself.” We’ve all heard this famous quote from Franklin Roosevelt before. And it’s a great message, right? Often, our fear holds us back from doing things that really wouldn’t be so scary, if only we faced our anxiety head on. But when a child is dealing with Panic Disorder, the “fear itself” is pretty terrifying! Sweaty palms, a racing heartbeat, rapid breathing, and lightheadedness can make kids feel like the world is about to end.

Fear not! This post will take a deep dive into panic disorder, so you can feel confident navigating your child through their next wave of panic. We’ll talk about how panic disorder works, review common signs and symptoms, and discuss what parents (and professionals) can do to help.

What is Panic Disorder?

Panic Disorder is a type of anxiety disorder that can affect both kids and adults. It’s much more common in teens than in younger kids, but can strike at any age. People who have panic disorder have experienced panic attacks (also called anxiety attacks), and struggle with the fear of having another one.

Panic attacks come on suddenly, and may or may not have a clear trigger. A child may have a panic attack because they’re extremely anxious about boarding an airplane: in this case, the trigger is clear! But a child could also have a panic attack come on seemingly out of the blue, while relaxing at home or hanging out with friends. Sometimes, panic attacks can even wake a child up in the night!

Panic attacks are frightening, and it’s common for kids (and even adults) to worry they mean something’s seriously wrong. The physical symptoms can feel like you’re losing control of your body and mind. Children may worry they’re having a problem with their heart or lungs, or might even fear that they’re dying or going crazy.

Understandably, kids who’ve had a few panic attacks can get really worried about having another one. Sometimes this leads to desperate attempts to avoid things they think might trigger a panic attack, or to stay away from places where they think nobody will be able to help them. When this starts getting in the way of life, we call it Panic Disorder.

How is Panic Disorder Different Than a Regular Panic Attack?

Many people have panic attacks: up to 35% of people will have one at some point in life. They can happen as a part of other anxiety disorders, like social anxiety, generalized anxiety, phobias, or even OCD. They can also happen by themselves, without any other mental health problems.

Panic disorder, on the other hand, is much less common. It affects about 4.7% of U.S. adults and about 1-3% of kids and teens. For kids with Panic Disorder, the panic attacks are the source of anxiety. Kids are worried about having more attacks, of something bad happening during an attack, or of having a panic attack in a place where they’re not able to get help.

If a child is worried about something else—dogs, germs, other kids judging them—and they’re having panic attacks as a result, that’s not Panic Disorder. If a child is worried about the panic attacks themselves, and is trying to avoid them in unhelpful ways, that’s Panic Disorder.

What Are the Symptoms of Panic Disorder?

The symptoms of Panic Disorder include multiple bouts of extreme anxiety, as well as worries about having more attacks in the future. Photo by Shvets via Pexels.

To get a diagnosis of panic disorder, kids need to have had more than one panic attack. A panic attack is a sudden, unexpected burst of extreme anxiety or fear that only lasts a short time, usually 10-30 minutes.

They don’t always have a clear cause and may seem totally out of the blue. During a panic attack, a child may notice 4 or more of the following symptoms:

• Sweating

• Shaking

• Rapid or pounding heartbeat, or feeling like the heart is skipping a beat

• Chest pain or pressure

• Upset stomach

• Feeling short of breath or like you can’t breathe

• Strange sensations, like heat, tingling, or numbness

• Feeling dizzy or lightheaded

• Feeling detached from reality

• Feeling as though something really bad is about to happen (impending doom)

Essentially, a panic attack sends your body into full on fight-or-flight mode with no warning, which causes these intense physical symptoms. Kids with panic disorder become so afraid of these attacks that they go to great lengths to try to prevent them from happening. This means you’ll also see the following:

• Worries about having another attack

• Concern about the meaning of the panic attacks or negative consequences they could cause

• Trying to avoid or prevent attacks in ways that lead to significant behavior changes

Once these symptoms have happened for at least a month, a child can be diagnosed with Panic Disorder.

Signs of Panic Disorder in Kids

Panic attacks might be easier to spot than some other forms of anxiety, but Panic Disorder can still look different for each individual kid. If you’re beginning to suspect panic may be to blame for your child’s difficulties, here are three examples to consider.

1. Maya has had a handful of panic attacks over the past few months: her hands start to sweat, then she starts hyperventilating and crying. She was sitting in Biology class one day when she noticed her palms getting sweaty, and asked her teacher if she could leave class. Her teacher asked her to wait for another student to return from the bathroom, and Maya had a panic attack. Maya’s teacher has apologized and reassured her that this won’t happen again. However, Maya doesn’t want to go back to class for fear that she’ll have another attack.

2. Mateo has heart palpitations with his panic attacks, and gets a terrible feeling like something bad is going to happen. He’s gone to the doctor for a checkup and has a clean bill of health, but he can’t shake the feeling that his panic attack could turn into a heart attack. He worries about this possibility all the time, and asks his mom for reassurance that there’s nothing wrong with his heart. Every time he feels the slightest twinge in his body, he worries it means another panic attack is coming.

3. Ash has only had a couple panic attacks, but they really left an impression on her. Each one felt like an emergency, and luckily her mom was close by to help. Even though she hasn’t had one in a little while, Ash is really nervous about going to summer camp or sleepovers with her friends, because she’s anxious about having a panic attack away from home. She worries what her friends would think, and who would help her to calm down. Ash friends have noticed she’s turning down their invitations, but Ash is too embarrassed to tell them why.

Even though their symptoms are different, all these kids are struggling with repeated, unexpected panic attacks. As if that wasn’t enough, their anxiety about the attacks is so big that it’s getting in the way of important parts of life.

What Do I Do If I Think My Child Has Panic Disorder?

It’s important to rule out any medical problems or lifestyle issues before settling on a diagnosis of Panic Disorder for a child or teen. Photo by Liza Summer via Pexels.

If you’re concerned your child is having repeated panic attacks, it’s a good idea to check in with their pediatrician first to make sure what you’re dealing with is really anxiety-related. There are some medical conditions that can mimic panic attacks, and you’d hate to brush something off as “just anxiety” that could be made better with medical care.

Conditions like tachycardia and POTS can affect your heart rate and blood pressure, causing palpitations and dizziness. A child complaining of shortness of breath should be checked out for asthma, just in case. The cause could even be as simple as having too much caffeine: it’s hiding in all kinds of sports drinks and energy bars these days, and it’s so effective at triggering panic attacks that scientists use it when they want to research panic.

Once you’ve ruled out any underlying medical stuff, you can rest assured that as scary as your child’s panic attacks may be, they’re totally safe. Many children worry that panic attacks will cause serious harm or lasting damage. Knowing this isn’t the case can be a relief.

Next, take a look at some of the strategies below to help your child cope with panic and get back to enjoying life.

Helping a Child with Panic Disorder

You've learned the symptoms, you’ve ruled out any medical causes…now that you’re sure this is Panic Disorder, how can you help your child cope? It’s painful to watch your child go through debilitating anxiety, and emotionally exhausting for everyone involved.

Fortunately, Panic Disorder is very treatable! We have ways to help kids and teens who are dealing with panic, and we know they work. Here’s how a parent or caregiver can help a child through panic:

1. Educate Your Child About Panic Attacks

   Part of what makes panic attacks so scary is how mysterious they are. They seem to come out of nowhere, with little to no warning. Even if they aren’t dangerous, they feel like they are. It’s important for kids to know that panic attacks are not dangerous, and that they’re the result of their body doing the right thing at the wrong time. The symptoms kids feel during a panic attack are the result of their fight-or-flight response kicking in, which exists to help us escape life-threatening situations. We want to be able to feel that adrenaline rush when we really need it—just not on the school bus.

2. Practice Regular Relaxation

   It never hurts to learn new ways to calm down your body and mind, especially when you’re dealing with any form of anxiety disorder. Coping skills like deep breathing, muscle relaxation, and guided visualization really can help a lot of kids—but they work better when you practice them regularly, instead of trying them only when you’re panicked. Just like with any exercise, regular practice helps your child’s nervous system get better at coming out of fight-or-flight mode and returning to calm. Download my free guide for more ideas!

3. Use Grounding Skills When Panic Strikes

   Many kids find that typical relaxation skills don’t work super well in the midst of a panic attack: it’s hard to get all noodly when there’s adrenaline coursing through your body. Your child may find they have better luck with grounding skills. These skills give your child something to focus on outside of themselves, so they’re not just fixating on their body sensations and anxiety. Any kind of strong sensory input, like holding an ice cube, tasting a sour candy, or splashing your face with cold water can be helpful for grounding.

4. Accept That Panic Happens

   You may be surprised to learn that our goal when treating Panic Disorder is not to eliminate panic attacks from a child’s life. That’s like trying to keep yourself from ever sneezing again: it’s a bodily function that’s mostly outside of your control. The more time we spend stressing about panic attacks, the more anxious we become. Interestingly, the more kids accept that panic sometimes happens, the fewer attacks they tend to have. You can remind your child that although panic attacks stink, they’re manageable, they’re not dangerous, and they always end.

5. Approach, Don’t Avoid

   Kids with Panic Disorder are so fearful of having another attack that they change their behavior and routines to try to protect themselves. This can look like avoiding places where they’ve previously had an attack, repeatedly checking in with parents about their worries, monitoring their body for signs of panic, or saying no to activities that feel too risky. The more kids avoid these places and activities, the worse their anxiety is likely to become. Over time, the list of “dangerous” places can get longer. We can help kids overcome their anxiety by gently helping them return to these off limits places, so they can prove to themselves that they’re not so dangerous after all.

Panic Disorder Therapy for Kids

Cognitive Behavioral Therapy gives kids and parents the tools they need to deal with panic when it strikes. Photo by Any Lane via Pexels.

You don’t have to keep living in fear of your child’s next panic attack. In addition to the tips above, meeting with an anxiety therapist can help your child recover from Panic Disorder and learn skills they can use to manage anxiety as they grow. Cognitive Behavioral Therapy is often called the “gold standard” for anxious kids because we have lots of research to show how effective it is. It’s my first recommendation for families looking for help with panic.

Many “find a therapist” directories allow you to search for therapists who use specific forms of therapy, so you can specifically seek out counselors who practice CBT. This kind of therapy is very focused on education and skills. You can expect to get “homework” to practice with your child between sessions, and to be involved in your child’s therapy process. Happily, kids who learn CBT skills often move through therapy a little more quickly than kids who do not.

I love using CBT to help kids with anxiety, both in my therapy office and online. This kind of skills based counseling works great over telehealth, especially with kids ages 8 and up. If you’re located in the Charlotte area, I’d be happy to meet at my Davidson office. If you’re somewhere else in North Carolina, New York, or Florida, I offer virtual sessions using a secure platform that works just like Zoom.

Ready to get started? Send me a message. You can also download my free anxiety guide to learn more coping skills you can start using right away.

Can a Child Have Mild OCD?

It’s bedtime, and your child’s goodnight routine is a little longer than usual. Over the past few weeks, it seems like things have gotten a little more elaborate, and the steps have to be done just right. Or, maybe you’ve noticed your child repeatdly asking if things are okay—even when they know the answer is yes.

You know kids can have quirky habits sometimes, and your child has always been prone to worrying. Is this just a passing phase, or could your child possibly have mild OCD? Is “mild OCD” even a thing?

When we see OCD portrayed on TV, it’s often easy to spot. Characters with OCD usually have easily noticeable symptoms, and they’re often pretty severe. In real life, OCD is much better at hiding: symptoms can be really subtle. What’s more, kids with OCD sometimes feel they need to hide their compulsive behavior. Children are often aware that not everybody has these “weird” thoughts and urges, and so they try not to advertise what’s going on.

The short answer is: yes, it’s very possible to have mild OCD. For the longer answer, keep reading! We’ll take a look at the different, sneaky ways that OCD can show up for kids.

First, Let’s Clarify What OCD Is

If your child’s problems are mild, it might be harder to distinguish whether or not OCD is really what you’re dealing with. Anxiety and OCD have a lot in common. And some personality traits and quirks can resemble OCD too, like perfectionism, superstitiousness, and orderliness.

People with OCD share 2 big symptoms in common:

• They have recurring unwanted thoughts, urges, or mental images. These are unwanted, tough to control, and cause the person anxiety or distress.

• The person tries to push away or “neutralize” these thoughts, usually with some kind of special thought or action.

That’s where we get the name “Obsessive Compulsive Disorder” from. The unwanted thought that shows up again and again is the obsession. The thing a person feels they have to do in order to make the uncomfortable thought go away is the compulsion. The trick is that, while compulsions make a person feel better in the short term, they actually make the thoughts and anxiety worse over time.

A child who holds herself to a high standard at school, prefers a clean room, or likes to carry a lucky charm on important days is unlikely to have OCD. However, a child whose worries seem to be stuck in a loop, or who repeatedly performs the same action might be showing OCD symptoms.

OCD Has a Range of Severities

Just like most other mental health problems, OCD can be mild, moderate, or severe. Some children might experience OCD as a minor inconvenience, while for others it can be completely debilitating. The media tends to show mental illness in its most severe forms because that’s what’s most dramatic and interesting. However, this isn’t the reality for all kids with OCD.

Many kids are able to fly under the radar for a while, without their symptoms being apparent to others. Even parents may not notice anything unusual, especially at first. By the time a child comes to treatment, they may have had OCD symptoms for quite a while.

Therapists look at a few areas to see if a child’s symptoms are mild, moderate, or severe:

• Frequency: A child whose worry shows up once a day may be on the midler end of the OCD spectrum. A child whose thought pops up many times throughout the day may have more severe OCD.

• Intensity: If a child can sometimes brush off the thought or it causes only mild anxiety, their symptoms are more mild. If a child can’t let go of a thought and it causes extreme stress, that’s severe.

• Duration: Kids with mild OCD symptoms may spend a few minutes a day doing something compulsively. Children struggling with severe OCD may spend hours.

• Functioning: Mild OCD may not really get in the way of things like school, friendships, or other everyday activities. On the other hand, severe OCD can affect relationships and keep kids from doing the things they want or need to do.

If you take your child to a therapist, they can use a special assessment to confirm an OCD diagnosis, and to see if your child’s symptoms fall into the mild, moderate, or severe range. This can be helpful to know because therapy recommendations will be different depending on where your child falls in that range.

You May Have Caught Your Child’s Symptoms Early

If you are noticing mild OCD symptoms in your child, it’s possible you’ve caught your child’s condition pretty early, while it’s still developing. As worrying as it can be to learn that a child is having these kinds of problems, discovering them early is great news.

Even though OCD is common, it can be hard to catch: one study found that it took the average OCD patient over 12 years to get a correct diagnosis! Younger people in the study had an easier time than older people when it came to getting diagnosed, but this is still a pretty long time to wait for the right help.

Research also tell us that kids who participate OCD therapy early often have better results than adults do. OCD symptoms tend to start in childhood or adolescence, so kids who are in therapy generally haven’t lived with their symptoms for as long as adults have. Quick treatment seems to make a difference: on average, they had more improvement in their symptoms than the adults in the study.

One final reason that it’s great to catch OCD symptoms early: mild OCD doesn’t always stay mild. When left untreated, kids may develop more complex and time-consuming rituals, and have more frequent and severe worries. As OCD grows, it can have more and more of an impact on a child’s quality of life. Kids who start therapy when their OCD is still mild can avoid a lot of this difficulty, and get their lives back on track sooner.

Sometimes, OCD Symptoms Are Invisible

There may be more to your child’s OCD than meets the eye. OCD involves obsessinos and compulsions that aren’t always easy to see. When we imagine a child performing OCD rituals, we might think of physical actions like handwashing or flipping light switches repeatedly. However, kids can have mental rituals as well, that don’t involve physically doing anything. Some examples are:

• Thinking a special word or thought in order to “undo” their worry.

• Praying compulsively

• Making mental lists

• Counting in their head

• Reviewing certain events over and over to double check them

Other times, compulsions involve saying something rather than doing something. These can also be a little more difficult to notice, at first. Pay attention for behaviors like:

• Asking for reassurance over and over

• Saying “I love you,” “I’m sorry”, or another phrase excessively

• Repeated confessions about things the child fears they have done wrong, such as having a bad thought, or possibly saying something unkind to someone

When parents begin to take stock of compulsions like these, what initially looked like mild OCD may look more complicated. There can be a lot happening beneath the surface, and these kinds of mental thoughts and rituals can be difficult for kids to talk about, or even put into words.

Do Kids with Mild OCD Still Need Therapy?

Even if your child’s symptoms seem mild, it’s a good idea to consult with a therapist to see if counseling could help. A therapist who specializes in OCD can complete a full assessment to see if any sneaky symptoms are going unnoticed. They can teach you and your child skills to deal with OCD worries without giving in to them all the time. Sometimes, it can be reassuring for a child just to hear from an adult who isn’t their parent that OCD worries are common, harmless, and not a sign of “going crazy.”

Occasionally, OCD symptoms may resolve on their own without therapy. Often, however, therapy is needed in order to overcome them. We know that mild symptoms tend to grow worse over time, and that younger kids do better in OCD therapy than adults. Because of all this, it’s worth talking to a counselor and considering therapy, even if your child’s symptoms aren’t getting in the way of life too much right now.

There are some great self-help resources out there for children with OCD. My favorite book for kids, What to Do When Your Brain Gets Stuck, is a great place to start. Up and Down The Worry Hill is another popular option. These books can give your family some helpful background information on OCD and how it works. You’ll also find tools you can use to take action right away.

How Can I Help My Child With Mild OCD?

There’s a lot you can do as a parent to help your child with OCD. In fact, parents are an important part of OCD therapy. A child’s symptoms tend to affect the whole family. Whether you’re waiting around for a child to complete a ritual or answering a question for the 100th time, parents ofen notice that they are changing the way they do things in order to keep the peace at home.

Unfortunately, OCD is never satisfied with what you give it. The more you give in to OCD, the bigger it grows. That’s why mild OCD often morphs over time into more moderate or severe illness.

OCD therapy helps both kids and parents to break this cycle. Using a form of therapy called Exposure and Response Prevention, a therapist can help your family learn new ways to stand up to OCD without giving in to compulsions and rituals. Kids can learn that they don’t have to listen to the thoughts and worries OCD gives them. Parents can learn how to support children without giving in to OCD’s demands.

If you’re noticing mild symptoms of OCD in your child, you can help right away by letting your child know that OCD thoughts are just random noise. The thoughts don’t mean anything, can’t hurt anyone, and everybody—even non-OCD sufferers—gets weird thoughts sometimes.

If you’re looking for help to deal with thoughts and worries right now, my free coping skills guide might help. You can download 5 Coping Skills for Anxious Tweens (That Aren’t Just Deep Breathing) right now, wherever you are.

If you’re hoping to begin therapy for OCD and you live in the states of North Carolina, New York, or FLorida, I may be able to help! I’m certified in Exposure and Response Prevention, the therapy that’s been proven most effective for OCD. As someone with a childhood OCD diagnosis, I remember how scary and overwhelming these symptoms can be. And I know that ERP therapy can really make a difference in the lives of children, whether their symptoms are mild or not.

You can learn more about ERP here, or contact me to inquire about starting therapy.

5 Common Types of Intrusive Thoughts Your Child Might Have

Intrusive thoughts are freaky. Like an uninvited guest, they pop up and bother us with ideas or images we wouldn’t want to think about on our own. They can be frightening for kids to experience, because it feels like you’re losing control of your own mind. But they’re also unsettling to hear about as a parent, especially if a child’s thoughts are about something taboo, like death or violence.

The truth is, many intrusive thoughts are about taboo subjects. The more upsetting or off-limits something is to think about, the more likely it is to push back into our consciousness as an intrusive thought. It’s sort of an “opposite day” situation, where the things we find the most unpleasant—things we’d never actually want to do—pop up as thoughts or mental pictures.

Just knowing that other people have these types of thoughts can be reassuring, and a first step toward learning to manage them better. So, in this post, we’re going to go over 5 types of intrusive thoughts children commonly experience.

Content Warning: We’ll discuss specific examples of intrusive thougths in this article, which are often about upsetting or shocking subjects.

What Exactly Are Intrusive Thoughts?

An intrusive thought is any kind of idea, urge, image, or impulse that comes to mind when you don’t want it to be there. They can be about anything, but tend to be about subjects that a person finds upsetting, gross, or wrong. They usually happen repeatedly, and they can cause a lot of distress.

Intrusive thoughts are “ego dystonic”, which is a therapy jargon way of saying that they go against a person’s beliefs or don’t sync up with their personality. They can feel foreign or weird. People who have intrusive thoughts are aware that the thoughts are unusual, but can’t stop them from happening.

Intrusive thoughts are a really common symptom of OCD, which often starts in childhood. They can also happen in kids with anxiety or a history of trauma. However, that doesn’t mean every kid who has an intrusive thought has OCD! Pretty much everybody experiences a thought like this at some point. However, less-anxious people are more able to shrug them off as a weird, random event that doesn’t really mean anything. People with anxiety and OCD are more likely to hold on to these thoughts and worry that they mean something is seriously wrong.

What Are Some Characteristics of Intrusive Thoughts?

Intrusive thoughts stand out from the usual noise our brains make all day. If you’re trying to figure out whether your child is dealing with intrusive thoughts, consider the following list. Intrusive thoughts are unique because they tend to be:

• Involuntary: a person doesn’t want to have the intrusive thought, but it happens anyway.

• Repetitive: these thoughts tend to come back again and again.

• Anxiety-triggering: the thoughts can be annoying at best, and scary at worst.

• Out of character: the subject matter is something a person wouldn’t usually think about.

• Inappropriate: often, intrusive thoughts have to do with taboo subjects like sex, death, illness, violence, or bad behavior.

• Unwanted: the person has no desire to act on the thought, which is part of why it’s so upsetting. However, kids with anxiety or OCD may worry that having the thought means that someday they’ll lose control and act on it anyway—that’s not how these thoughts work.

Once you know what to look for, it gets easier to spot intrusive thoughts when they happen.

What Sorts of Intrusive Thoughts Do Kids Have?

Kids tend to have intrusive thoughts about subjects that society thinks are wrong or impolite to talk about—actually, this is true of adults with intrusive thoughts, too! Themes related to religion, sex, death, illness, or immoral behavior are all common when it comes to intrusive thoughts. Children may imagine themselves doing something they don’t really want to do, or see a mental picture of something they don’t like.

Younger children are still in the process of understanding adult concepts like sex, death, and violence, and their intrusive thoughts can reflect this. Even though the subject matter is the same, a child’s intrusive thoughts may not be the same as an adult’s. You might notice that your child’s thoughts are not realistic or logical. This can help set intrusive thougths casued by anxiety or OCD apart from the flashbacks caused by trauma or PTSD.

Next, let’s take a deeper look at 5 of the most common types of intrusive thoughts kids experience.

Type 1: “What If” Thoughts

OCD loves to make people doubt themselves. These “what if” thoughts often happen as a part of OCD, but they’re also one of the more common types of intrusive thoughts in general. A “what if” thought prompts you to question something you thought you knew for certain.

“What if” thoughts can affect people’s perceptions of their relationships, tasks they’ve completed, or even their own identity. Even if you have a clear memory of yourself doing something, the thought injects the possibility that maybe you actually forgot—and something bad might happen as a result.

Some examples of “what if” thoughts children might have include:

• A usually responsible child worrying that they somehow forgot to lock the door, and their dog will run away.

• A teenager who is secure in their sexual identity wondering if they might unknowingly be gay.

• A child who is bothered by thoughts of someone possibly hiding in their bedroom, even after checking under the bed and in the closet.

The hard thing about “what if” thoughts is that reassurance or double-checking only helps for a little while. Eventually, the doubt creeps in again and the cycle starts over.

Type 2: Thoughts About Hurting Self or Others

It can be alarming to hear your child is having repeated thoughts about hurting themselves or somebody else. Just like all other intrusive thoughts, these harm-related thoughts are unwanted and go against the personality of the child. Often, children who have these kinds of intrusive thoughts are described as being particularly kind, empathetic, and gentle.

Of course, any time you hear a child talking about harm, you can’t automatically assume it’s an intrusive thought. You need to rule out other possibilities, like suicidal ideation, which always need to be taken seriously. An intrusive thought—rather than an actual urge—might look something like:

• A child who has images pop into mind of pushing a sibling down the stairs, even though they’d never do something like that in real life.

• A usually kind child has thoughts about stabbing people that are so frightening they avoid being around knives or sharp objects.

• A teenager complains of fleeting thoughts about jumping in front of a train or running into traffic that bother him, because he really doesn’t want to die.

In all these examples, the thoughts are causing a lot of distress. Kids with this kind of intrusive thought don’t want to be thinking about violence, and may take great lengths to avoid being in situations they worry could be unsafe.

Type 3: Thoughts About Doing Something Embarrassing, Unkind or Illegal

Similar to thoughts about harm, this variety of intrusive thought is based on a fear that a child might somehow “lose control” and do something that’s socially unacceptable. Many people experience a stray thought like this, and shrug it off knowing they’d never act on it.

When children have these thoughts, they may not be so easy to shrug off. These taboo behaviors flash into a child’s mind, which makes them worry that some part of them really wants to do that bad thing. They put a lot of meaning into the experience, which leads to more anxiety.

Examples of this type of intrusive thought include:

• A child having thoughts about saying something inappropriate in a public place, like yelling “fire” in a movie theater or “bomb” in an airport.

• A student having bothersome thoughts while at school of saying insulting things to a classmate.

• A child who worries that their thoughts about shoplifting mean that they actually want to steal something.

When a child is truly having an intrusive thought, it’s extremely unlikely that they’ll ever act on it. Thinking and doing are very different things! However, the fear of possibly losing control can be very powerful, and get in the way of a child’s day-to-day life.

Type 4: Sexual Intrusive Thoughts

Even though they are common, this category of intrusive thought can cause a lot of shame and distress for kids. It can be hard enough to talk about the birds and the bees under normal circumstances, and even harder when you’re having your day interrupted by thoughts or images of upsetting sexual situations.

Because they are so taboo, children experiencing these types of thoughts may choose to keep them a secret. Even if children are open about most worries, they may fear that hearing about sexual thoughts will change a parent or therapist’s opinion of them. It can be a relief for children to know they’re not alone with these thoughts and to hear about examples of common intrusive thoughts. Some common worries in this category are:

• Worries about losing control and groping or sexually abusing someone.

• Unwanted thoughts that include family members, animals, or children.

• Fears related to unintentionally getting pregnant or getting someone else pregnant, even when this may not be logical.

There’s nothing pleasurable about these kinds of thoughts. Instead, kids experience feelings of shock, disgust, shame, and fear. Just like kids who have thoughts about harm, children with sexual intrusive thoughts may worry that having the thought means some part of them must want to act on it, and may avoid certain people, places, or activities as a result.

In reality, kids suffering from these types of intrusive thoughts are not violent or bad people: they’re just normal kids experiencing a bothersome mental heath symptom. It isn’t a reflection on their personality or character.

Type 5: Thoughts About Illness, Contamination, or Germs

Most of us have been worried about getting sick at one time or another. Health anxiety is really common, especially in the wake of the recent pandemic. Kids who struggle with intrusive thoughts may worry about sickness, too. They may worry about catching a disease, picking up germs, or spreading illness to other people. But there are some differences between their intrusive thoughts and regular health anxiety.

The thoughts children have about illness, contamination, and germs may be illogical or extreme. They may worry about catching germs from things that aren’t usually considered dirty, or about getting sick with a disease they’re highly unlikely to get. They may also worry about touching, breathing, or eating something that has somehow been contaminated. Some common fears for children with this type of intrusive thought are:

• Repeated fears that their food, drink, or utensils have been poisoned or contaminated by a chemical or cleaning supply.

• Fears that common objects or surfaces may have had germs on them.

• Thoughts about getting sick and dying from a disease such as cancer or AIDS.

• Worries about unintentionally spreading germs or serious disease to loved ones.

Children with these thoughts may avoid touching items with their bare hands, only eat “safe” foods or use “safe” utensils, or repeatedly wash their hands in an effort to avoid transmitting disease. These behaviors go above and beyond the hygiene we’d expect to see in a Covid-conscious kid, and interfere with day-to-day life.

Get Help for Kids with Intrusive Thoughts

As upsetting as they may be, intrusive thoughts are normal and common. Kids dealing with these types of worries are not alone! Sometimes, just knowing this can help soothe children’s anxiety about intrusive thoughts. When children accept these thoughts for what they are—random brain hiccups—it’s easier to just let them pass by without trying to push them down. Over time, this can help the thoughts to happen less and less often.

Other kids will need more support in dealing with their thoughts. This is especially true if the thoughts are accompanied by an urgent need to do something again and again, like washing hands or asking a parent if everything is okay. Kids whose intrusive thoughts begin after a traumatic event should also get support to help them recover.

Exposure and Response Prevention is the most effective tool therapists have to help children with compulsive thoughts and behaviors get their lives back. TF-CBT can help kids and their parents learn skills to cope with trauma symptoms and move forward in life without feeling overwhelmed by flashbacks or memories.

I offer both these therapies in my child counseling practice. I’m based in the Charlotte, NC area, but also work with kids online throughout the states of North Carolina, New York, and Florida. If you’re interested in starting therapy for intrusive thoughts, contact me here.

If you’d like to learn more about intrusive thoughts, check out my other blog posts on the subject:

Intrusive Thoughts in Children, Explained
How to Help a Child with Intrusive Thoughts
Signs of OCD in Children: What Parents Can Look For

What Triggers Anxiety in a Child?

Sometimes, a child’s anxiety seems to come out of nowhere. One day, everything seems okay, and the next day, boom! You’re begging them to leave the car to go to school. Other kids may have seemed anxiety-prone since toddlerhood: they were just always more sensitive than their peers. You may even have been told that their worries were just a phase. But here you are, years later, still dealing with the same fears.

When you’re trying to tackle anxiety, it can help to know the root cause. Whether you’re dealing with an all-of-a-sudden attack or an always-been-there anxious temperament, knowing what’s triggered your child’s anxiety lets you better help them to manage it.

Genetics + Life Experiences = Your Child’s Anxiety Risk

Stress affects all of us differently. It’s not always clear why one child may struggle with anxiety after a tough experience, when another gets through the same situation seemingly no worse for wear. It’s likely that our genes and life experiences combine to give each of us a unique way of coping with anxiety and stress.

We know that anxiety runs in families. Kids who have relatives with anxiety disorders are more likely to develop one themselves. This is true even if the types of anxiety are different within the family; for example, a chid who has many family members with generalized anxiety may have a slightly higher risk of developing OCD. Depending on the genes your child inherits, they may be more or less anxiety-prone from the start.

Even if your child has inherited some anxious traits, anxiety still needs an outside event to trigger symptoms. Big events, like moves and divorces, can do this. However, more day-to-day stress plays a part, too. In general, a child who has a strong family history won’t need as big of a stress to set off anxiety. On the other hand, a child with very little family history could still become anxious after a big enough trigger.

There are plenty of things parents and families can do to support a kid with anxiety—and sometimes best intentions can accidentally cause anxiety to grow. But there are so many factors that contribute to childhood anxiety that it’s never one person’s fault.

What’s a Trigger, Exactly?

“Trigger” has become a household word…and sometimes a word used to tease people who are deemed overly sensitive. So let’s clarify what exactly we mean when we talk about anxiety triggers.

A trigger is a catchall term for anything that sets off anxiety. Triggers can be physiological, like drinking too much caffeine if you’re sensitive to it. They may be sensory, like the sound of a fire alarm going off if your child has a sensitivity to loud noises. They can also be situational, like taking a test if you struggle with perfectionism. The pandemic has served as an anxiety trigger for many kids in recent years.

Triggers are unique to an individual. What triggers one person might not be an issue for another. Sometimes it can be hard to figure out what exactly is setting off anxiety for a child. It’s helpful to discover your child’s triggers so you can figure out how to prepare for potentially difficult situations in advance. The goal isn’t to avoid triggers forever, but to find ways to gradually learn to deal with them.

Sometimes, people talk about triggers as being the thing that set off a child’s anxiety in the first place. Other times, “trigger” is used to describe the day-to-day events that cause anxiety to flare up again. We’ll talk about both types in this post.

Any Big Life Change Can Trigger Worries

Predictabilty and routine help children feel safe. Knowing what’s about to happen next gives kids a sense of control in a world that often feels big and unpredictable. Anything—good or bad—that upends routines in a major way can lead to increased anxiety for kids.

This is one reason why so many kids are struggling with anxiety after covid, even if their loved ones haven’t been seriously affected. Even without major illness, the stress of household routines collapsing in on themselves during quarantine was a lot to cope with. It’s also why starting at a new school or moving to new town can set of anxiety, even if your child is excited about the change.

Here are some big changes that can set off anxiety for kids:

• Moving to a new place

• Divorce or remarriage of a parent

• The birth of a new baby

• The death or loss of a loved one

On a more day-to-day basis, these changes in routine can cause anxiety to flare up, too:

• Unexpected changes in plans

• Changes in a parent’s work schedule that affect their time spent at home

• Vacations or travel

• New babysitters or caregivers

Family Stress Increases Anxiety Risk

Kids are really good at picking up on family stress. Sometimes, a chlid’s anxiety is almost like a release valve for pressure that’s been building up at home. If a child starts showing new symptoms of anxiety, it’s never a bad idea to do a quick assessment of how you and the rest of the family are doing managing your own stress.

If children sense that things are a little tense at home, they may respond by clinging or getting more anxious when they have to be away from a parent. Kids instinctively want to be close to a parent during uncertain times, to make sure they stay safe.

Any major stress in a family will affect children too, such as:

• Intense, frequent fights between parents

• A family member’s chronic or serious illness

• Job loss or trouble with finances

• A parent or caregiver’s own mental health struggles

• Struggles with racism or other systemic oppression

If your child is sensitive to family stress, you may notice that their anxiety gets set off by everyday scenarios such as:

• Changes in family routines or plans

• Parents leaving the house for work or date nights

• Having to separate from the family, such as for school or a sleepover

• Seemingly minor arguments, disagreements, or discipline

Friend and School Drama Are Often Triggers

The older kids get, the more important friendships become in their lives. And these friendships can be pretty turbulent! On one hand, most kids are desperate to be accepted as part of a group. On the other, they’re still figuring out the social skills they need to manage conflict without escalating disagreements into full-on drama.

Kids have to juggle all this social stuff while also dealing with academic pressure that can feel overwhelming. Homework, college admissions, and even just getting to class on time can be stressors for kids.

School and peer issues like these can contribute to the development of anxiety troubles:

• Returning to in-person school after being online during Covid

• Bullying or social isolation

• Transitioning fo a new school building, such as the move from elementary to middle shcool

• Learning difficulties, low grades, or other academic problems

Kids may notice that smaller triggers like these set off everyday anxiety at school:

• Projects that require public speaking

• Testing, especially standardized testing

• Feeling judged for their appearance, clothes, or interests

• Having to navigate a large or complicated school building

• Not sharing many classes with familiar friends

Grief: A Surprisingly Common Source of Anxiety

Grief is often associated with sadness, anger, denial, and a whole host of other feelings. But when we think of grieving children, anxiety might not be top of mind. Losing a loved one often means a loss of stability for kids. Their routines are upended, a safe person is gone, and suddenly, they’re aware of the many unexpected dangers that can happen in life.

It’s normal for grieving children to experience separation anxiety while grieving, because keeping loved ones in sight feels more safe. Health anxiety is also common, since children may worry about whether or not they or a loved one could get sick or die, too. The stress of grief can also lead to more generalized worries, trouble sleeping, and body aches and pains due to anxiety, too.

Some types of grief that can trigger anxiety include:

• The death of a family member or close friend

• Losing a loved one due to estrangement, a move, or imprisonment

• The death of a pet

• The loss of a pregnancy in the family

Triggers related to grief, death, and loss can trigger kids on a more day-to-day basis, too. Grieving kids may notice their anxiety heighten when faced with situations such as:

• Scenes of violence, illness, or death on TV or in movies

• Mentions of suicide in health class

• Assigned school readings with themes of grief and loss

• Anniversaries and holidays that remind a child of their loved one

• Being away from caregivers

Illness, Accidents, and Trauma Can Lead to Anxiety

Highly stressful and traumatic events can also shake up a child’s sense of safety. Even if nobody gets seriously hurt, the experience of an accident or a dangerous situation can leave a child with lasting worries.

At the beginning, you may notice your child is only anxious in situations that are closely linked to their stressful event. Over time, however, that anxiety can generalize. This means the anxiety pops up more often in situations that are only loosely connected to the original event. As time passes it can be harder to connect anxiety symptoms to the underlying trauma or stress that triggered them in the first place.

Traumatic or stressful events that can lead to anxiety include:

• Car accidents

• Attacks or bites from dogs or other pets

• A loved one experiencing a major illness

• Natural disasters such as fires, floods, and tornadoes

• Repeatedly hearing about crime, disasters, or other emergencies affecting people on the news

Children dealing with trauma may notice they feel nervous or overly aware of their surroundings even when there isn’t a clear trigger. They might also notice anxiety caused by:

• Sudden noises

• Sensory experiences (like sounds and smells) that remind them of their trauma

• People, places or things that are associated with the stressful event

Help Your Child Learn and Cope With Their Anxiety Triggers

Learning what triggers anxiety is the first step toward helping your child cope with worries in a healthier way. Once children know what sets their anxiety off, they can learn strategies to help them in difficult situations. They can even practice noticing their thoughts, and questioning whether the worries that bother them so much are even accurate.

These skills may seem small, but over time they add up. Coping skills can change a child’s perspective on anxiety and other big feelings. They can empower children by giving them some control when things feel totally out of hand. We can’t always change a stressful situation, but giving kids coping skills can help them deal with hard moments, both now and as they grow up.

I teach coping skills so much in my therapy practice that I’ve created an entire coping skills course for tweens on the subject. Kids ages 8-13 can learn anxiety management tools they can use right away. There’s content for parents, too, so you can learn why the skills work and how to support your child in practicing them. You’ll also learn what isn’t as helpful for anxiety, so you don’t unintentionally make worries worse.

You can learn more about the course, preview the lessons, and enroll your child here.

Do Coping Skills Work, or Are They Just a Band-Aid?

At first glance, you wouldn’t think coping skills were a controversial subject. What’s not to like about deep belly breathing or guided relaxation? We’ve all been talking about these kinds of skills for ages. Maybe that’s why we’re seeing a bit of a coping skills backlash these days. Coping skills have become such a popular concept that it’s tempting to think they’re the answer to every mental health problem.

It’s true. When they’re used incorrectly, coping skills can be a little like putting a band-aid on a major wound. But most of us still use band-aids, right? They give us quick help and make our lives more comfortable. We’re not going to outlaw band-aids just because they’re not the right choice in every situation.

The truth is, many parents and kid clients come into my therapy office asking for coping skills to deal with anxiety, stress, and even trauma. I think they’re right to ask! Coping skills may not be The Answer to Everything, but they do work. Let’s talk about what makes coping skills effective for kids.

No, Deep Breathing Isn’t Going to Magically Solve All Your Problems.

If a child is dealing with anxiety so severe that they have stopped attending school, they’re going to need more than coping skills to get back to living their normal life. Similarly, a child can learn all the coping skills on earth and it won’t be sufficient if parents are constantly fighting at home. Big, long-term, or complicated problems need more than just a few coping skills to resolve. They need to be looked at holistically.

Sometimes we put a little too much responsibility on kids to solve issues that are much bigger than themselves. For kids dealing with mild anxiety or a sensitive, deeply feeling temperament, coping skills may be all they need to course correct. For bigger issues, coping skills may just be the first step in a longer therapy process that involves parents or caregivers, too.

But When Coping Skills Work, They Can Change a Child’s Life.

Yeah, this is kind of a big statement, but I stand by it! I believe coping skills can change a child’s life. I wish I’d had access to more coping skills back when I was an anxious kid.

When we give children coping skills, we give them a sense of control over their own lives. We provide the emotional first aid they need to get through the day, which buys us some time to address the root cause of theri anxiety. And often, coping skills open the door to deeper learning. By changing their behavior, children make new discoveries about their feelings and relationships.

Anxious Kids Need Help Right Away

Imagine you’re a kid who has been dealing with debilitating anxiety for a long time. You can’t sleep at night, and you spend the whole bus ride to school feeling sick to your stomach. You haven’t gone on a sleepover in ages because it’s too scary to be away from home, and you’re pretty sure you won’t be going on any of the big field trips coming up, either.

Your parents have been begging you to try therapy, and you finally work up the courage to give it a try. You sit in a strange lady’s office, who tells you that she can absolutely help you with your anxiety…in 3 to 6 months.

How would that feel? 3 to 6 months is eternity for a kid. But that’s often how long it takes for a child to complete therapy, and during that time they’ll probably need to put in some hard work and try some things that scare them.

Coping skills give kids some “quick wins” that help them feel better right away. It may not cure their anxiety, but it can make it a whole lot easier to tolerate. Experiencing this fast relief—and discovering the control they have over their emotional responses—can help motivate children to go the distance in therapy.

Coping Skills Help Kids Stabilize, So They Can Do the Deep Work

Not only do coping skills motivate kids to go deeper in therapy, they’re often a necessary first step. Kids dealing with severe anxiety or trauma spend a lot of their time in fight-or-flight mode. When you’ve got all that adrenaline coursing through your body, you’re focused on survival, not learning.

It’s really hard to effect big, lasting change when a child is too worked up to learn. Effective coping skills soothe the nervous system, so kids can calm themselves more easily and spend less time in fight-or-flight.

If your child is participating in trauma therapy, learning to self-soothe is critical. As children tell deeper and more difficult parts of their story, they may find their symptoms get worse before they get better. Revisiting their coping skills helps kids care for themselves and prevent overwhelm.

Effective Coping Skills Help Kids Discover Their Own Power

Many kids (and adults) enter therapy feeling powerless in the face of their anxiety. It’s bigger than them, it’s frightening, and it’s seemingly impossible to control. Anxiety feels like something that happens to them, and since they’re powerless to change it, they might as well just give in to its demands.

Coping skills show children that they have agency when it comes to their feelings. Sure, painful emotions are going to happen sometimes, that’s just life. But we get to decide how to respond to anxious thoughts, and there are ways to calm anxiety so it doesn’t take over your whole day. Returning that sense of control to children can change their whole outlook on how they handle anxiety and challenging situations in life.

Coping Skills Work by Healing From the Outside In

Before I went to therapy school, I went to theater school. I took a bunch of acting classes. There are two big schools of thought in acting: “inside out” and “outside in.”

If you imagine a stereotypical, old school actor asking “what’s my motivation?” you’ve got a basic sense of what inside out acting is all about. In this approach, actors create an inner emotional life for their character that helps them decide what to do onstage: how to talk, how to move, how to behave.

Outside in actors do things in reverse order. They might figure out their character’s walk, first. Maybe they figure out an interesting voice to use. Going through the physical motions helps them understand how the character might be feeling, and why.

Neither approach is wrong! Both actors are going to get to the same place in the end.

I promise there’s a reason I’ve devoted several paragraphs to this. Therapy is the same way. Coping skills may seem shallow at first, compared to “deep” work like understanding the origins of anxiety or changing family dynamics. But they work from the outside in. They help kids get to that deep work.

I’ve had many a kid client figure out solid coping skills and return to therapy in a couple weeks with important new insights about their lives. They come into session and make a connection between their worries and a specific family situation, or share something they’d like to change about how they relate to their friends. Changing your behavior disrupts old patterns and gives you space to discover something new.

When Are Coping Skills a Bad Idea?

Before you think I’m some shill who has been paid off by Big Coping Skills or whatever, let’s talk about some of the drawbacks. There’s no one size fits all in therapy. Coping skills aren’t going to work for everyone or serve kids well in every situation. Here are some examples of times that coping skills will not be effective:

• When coping skills are used to avoid anxious situations forever, rather than gradually facing your fear

• When a child uses coping skills to push down or deny “bad” feelings in an attempt to “stay positive”

• When coping skills are used as a substitute for support from parents, caregivers, or other adults

• When a child doesn’t see anyone else modeling how to cope with feelings effectively

Coping skills aren’t a substitute for feeling your feelings. They don’t work very well in isolation, either: kids still need support from the adults in their lives to overcome worries and change family patterns that might accidentally contribute to anxiety. If they’re not used thoughtfully, coping skills can easily morph into an unhelpful form of toxic positivity.

Effective Coping Skills for Tweens

Coping skills work for kids of all ages. However, in my therapy practice I mostly work with tween-aged kids, roughly ages 8-13. Since these are the kids I see day in and day out, they’re the ones I feel most equipped to help when it comes to coping skills.

You couldn’t pay me enough to go back to middle school. The tween years can be really rough. Studies show that when kids tranistion to 6th grade, their grades dip and don’t fully rebound until they begin high school. Friend drama, relationship woes, academic pressure, and puberty all start during middle school, but most of the privileges and freedoms that come with growing up don’t arrive until later. Tweens get all of the angst, and not much of the fun.

The good news is tweens are at the perfect age for coping skills. Cognitively, they’re leaps and bounds ahead of where they were in elementary school. They’re ready for challenging stuff. But socially, they’re right at the beginning of the “big kid” years. There’s still so much in front of them. Learning coping skills in middle school sets kids up for success as they manage stress and drama in the years to come.

If you have a tween who would like to learn coping skills, you’ve come to the right place! My course, Worry-Free Tweens, was created just for them. It’s available online and on demand, so your child can complete the lessons at their own pace. Since we know coping skills work best when parents are involved, you’ll find plenty of information for yourself, too.

You can check out the course here.

5 Coping Skills for Kids with OCD

If your child is struggling with OCD symptoms, feel at a loss for how to help. Maybe you’ve tried using logic to help your child see how unlikely their worries are. Or, maybe you’ve been working really hard on relaxation and deep breathing techniques, but you aren’t seeing a lot of change. This is totally normal! The usual coping skills that help kids deal with anxiety and stress aren’t as helpful for OCD.

While many children with OCD benefit from counseling, there are still things you can try at home to help your child cope. You can help your child learn to understand what OCD is and how it works, and equip them with tools they can use to “fight back” against recurrent worries and rituals. Children with strong coping skills feel less alone, can manage their symptoms better, and they will likely progress through therapy more quickly, too. Let’s take a look at 5 coping skills you and your child can practice together.

Learn About How OCD Works

Obsessive-compulsive disorder, also known as OCD, is a mental health problem that is similar to anxiety, but with its own unique characteristics. It causes people to have unwanted worries or thoughts over and over again. To deal with these thoughts, people with OCD feel like they have to repeatedly do an action in order to relieve their anxiety or prevent something bad from happening. The repeated thoughts are called obsessions, and the repeated actions are called compulsions.

OCD often begins in childhood, and it can be confusing and frustrating for kids and parents alike. Kids really do not want to be thinking about the terrible things their OCD prompts them to think about. They may feel as though they’re going crazy, or worry that having bad thoughts means they are a bad person. Parents may be shocked by the seemingly out-of-the blue appearance of OCD worries. It can be tough to understand why a child is suddenly so afraid, especially when their worries do not seem logical or realistic.

The first step to coping with OCD is understanding what you’re dealing with. Books like Up and Down the Worry Hill and What to Do When Your Brain Gets Stuck teach kids that OCD is caused by a harmless “brain glitch” that keeps the brain from sorting out unhelpful thoughts. Books like these help children feel less alone, and can reduce feelings of shame and guilt that make it hard to get help. They also give kids helpful language to describe their experiences with OCD.

Cope by Focusing on Strengths, Not Worries

When your child comes to you with a problem, you naturally want to talk about it. We all want to be understanding, responsive parents, and heart-to-heart chats with our kids are part of the deal. This is a great approach for lots of childhood worries and struggles, but it doesn’t always work well for OCD.

The repeated worries that come with OCD aren’t logical. Kids with OCD often worry about events that are highly unlikely to happen, like a plane crashing into your home or contracting a rare disease. Sometimes, the worries don’t make much sense, such as being concerned that stepping on a sidewalk crack will cause something bad to happen.

Most kids know their fears aren’t realistic, but they still can’t stop thinking about them. Talking about the worries in detail and reassuring your child that nothing bad will happen is unlikely to make the worries stop. In fact, the more time we spend talking about and paying attention to OCD worries, the more likely they are to happen again.

You can help your child shift their focus away from the worry and towards something more productive: their own ability to cope. We can’t make anxiety go away, but we can help kids deal with their anxious feelings. Instead of asking lots of questions or giving lots of reassurance, praise your child for their effort to do hard things in spite of their worries. Remind them that they’re brave, strong, and capable of facing their fears…and that it will feel so amazing when they do.

Make an OCD “Worry Monster”

Parents may find themselves bending over backwards to try to soothe their child’s worries, or using tough love to try to muscle through activities that cause anxiety to flare. It’s exhausting, and can start to feel like a battle between parent and child. This leaves kids feeling frustrated or ashamed that they can’t just “get over” their symptoms.

Instead of fighting each other, parents and kids need to team up against the real enemy—OCD. We can help kids cope with their symptoms by externalizing OCD, meaning we imagine it as a force that isn’t a part of them and isn’t their fault. This helps to cut down on the shame kids feel, and can increase a child’s motivation to fight back.

A fun way to externalize OCD is by imagining it as an annoying pest, like a bug, creature, or monster. Ask your child to draw a picture that represents how they imagine their OCD. You might even give the creature a funny name. When you talk about your child’s struggles, blame them on this creature instead: “It sounds like Jim Bob is really giving you a hard time today.” It can inject some humor into a tough situation, and remind your child that they can choose whether or not to listen to what OCD is telling them to do.

Spot Unhelpful or Tricky Thoughts

Most of us go through life without questioning our own thoughts too much. We might misinterpret things at times, but it’s usually not a big deal. People with anxiety and OCD are much more prone to having overly negative, unhelpful thoughts. In particular, kids with OCD have a tough time dismissing thoughts that are upsetting or strange. Instead, these thoughts linger, and kids have to deal with the nagging, “what if?” feeling that comes with recurrent worries.

Kids with OCD can learn to notice when their thoughts are playing tricks on them. We call this skill metacognition, which means learning to think about your own thinking. Instead of just taking their thoughts at face value, kids can examine their worries like a detective. Over time, children can start to notice patterns in their own worries, which helps them not take the worries so seriously.

The book Tiger-Tiger, Is It True? is great for teaching this skill to younger children, and we cover it in depth in my online course for kids and tweens.

Practice “Talking Back” to OCD

So maybe your child has gotten very skilled at spotting their own unhelpful thoughts. What’s next? Kids with OCD have a couple options for coping with these unwanted worries: they can talk back to them, or simply ignore what OCD is telling them to do.

”Talking back” to a worry means finding something you can say to yourself instead that is more accurate or helpful. This could mean taking a huge worry and shrinking it down to a more realistic size, or reminding yourself that even when bad things happen, you can figure them out and move on. Talking back can also mean reminding yourself that you’re in charge of your thoughts, and don’t have to listen to the unhelpful ones. Here are a few examples of thoughts kids with OCD can use to “talk back:”

• “I don’t have any proof that this worry will happen.”

• “I’ve gone to school for 6 whole years, and I’ve never thrown up in class.”

• “Even if something bad does happen, I can handle it.”

• “This is just my OCD talking and I don’t have to listen.”

• “I’ve had this worry a million times and it’s never come true.”

Learning and practicing this coping skill empowers children to stop taking their worries and urges so seriously. Eventually, children may feel ready to ignore their OCD by not following through with compulsive behavior when anxiety arises. Facing scary situations and dealing with the anxiety without rituals or compulsions is the core of Exposure and Response Prevention, the most common and effective therapy treatment for OCD.

More Coping Skills for Kids with Anxiety and OCD

If you’re looking for more ways to help a child with anxiety or OCD, consider checking out my online coping skills course, Worry-Free Tweens. In the course, you’ll find child-friendly, in-depth lessons on how anxiety works, how to deal with it, and why anxiety can actually be a superpower.

You and your child will learn how to notice unhelpful thinking patterns and shift into a more realistic mindset when worries occur. Together, you can learn how and when to use coping skills most effectively. You’ll also find advice for parents on how to support and encourage an anxious child while avoiding the traps that can accidentally worsen anxiety over time.

If the course sounds like what you’re looking for, you can access Worry-Free Tweens here.

Counseling for Kids with OCD in Davidson, North Carolina

Coping skills are a great place to start when you suspect OCD. However, many kids will need the support of a mental health professional in order to overcome their symptoms. OCD often impacts the whole family: everyone has to change the way they do things in order to keep a child’s “worry monster” happy. Counseling can help both you and your child learn new ways to deal with repeated worries and urges, so you can get back to having fun together.

I’m licensed to help kids with anxiety and OCD in North Carolina, New York, and Florida. I offer face-to-face therapy in Davidson, NC, just outside of Charlotte. For families who live farther away, we meet for online therapy using a secure platform similar to Zoom. Both kinds of therapy can be effective (and sometimes even fun) for kids and tweens.

If you’re curious about therapy for OCD, check out my post on ERP. You can also check out my FAQ to learn more about what therapy with me is like. To ask other questions or inquire about setting up an appointment, send me an email. I am always happy to help.

What Are the 4 Types of OCD?

Pop culture is getting better about representing people with mental health conditions on TV, in movies, and in books. It’s allowed many people to get familiar with mental health conditions that aren’t always talked about, but affect millions of people. At this point, you’ve probably encountered a character that has OCD. In all likelihood, this character was super clean, hyper-organized, and maybe a little nitpicky or eccentric.

Although more representation for mental health issues is a good thing, for OCD it’s come with a small downside. Most portrayals of OCD only focus on one or two types of the disorder. As a result, most of us have an overly narrow idea of what OCD looks like. While it’s true that some people with OCD are very neat and tidy, many aren’t.

If you are wondering whether your child may have OCD, it helps to learn about all 4 types. This way, you’ll be prepared to spot all of the signs and symptoms of OCD, not just the ones we see on TV. Let’s take a closer look at each of the 4 main types and how it commonly manifests in kids.

OCD Type #1: Contamination and Cleaning

Many people associate OCD with germs and germaphobia. But this type of OCD is more than just practicing good hygiene or keeping a spotless home. People with contamination OCD worry about coming into contact with things that could get them dirty, sick, or even just feeling unclean. They may worry about their belongings becoming contaminated as well, or that they might spread their contamination to other people.

Sometimes, people with contamination OCD are concerned with germs or dirt. However, lots of other things can trigger it, too. Some kids with contamination OCD might be triggered by bodily fluids, certain strong smells, or even just by people or things that feel wrong to them.

Feeling contaminated causes anxiety to spike, so kids with this OCD type will do whatever they can to avoid the feeling or make it go away. This often means compulsively cleaning, avoiding “dirty” places and things, having difficulty sharing belongings, or completing rituals that help make something feel clean again.

What Contamination OCD Looks Like in Kids

I’ve met more children with contamination OCD in the wake of the Covid-19 pandemic. This makes sense: we’ve spent over a year talking about washing and avoiding germs, which I imagine makes it an easy subject for OCD to grab on to. Here are a few common ways contamination OCD may show up for kids:

• Repeatedly washing hands or taking multiple showers a day

• Not wanting to touch or use objects that have come in contact with something “dirty”

• Difficulty sharing toys or allowing others to use their things

• Overwhelming worries about getting sick or making others sick

• Cleaning belongings (like toys or school supplies) more often or thoroughly than is normal

• Bathroom difficulties due to worries about urine or feces contaminating clothing

OCD Type #2: Checking and Rechecking

Ever walked out of the house, only to stop and wonder if you locked the door on your way out? We all get that nagging “did I forget” feeling occasionally, but for people with this type of OCD it’s a daily occurrence. It’s harder for them to brush these thoughts aside, because they happen so frequently and feel so intense. To calm the feeling, they check or re-do things over and over, even if they know they just did them moments ago. Unfortunately, the “did I forget” feeling doesn’t stay away for long, which leads to a need to check again. As you can imagine, this can be really aggravating and take up a lot of time.

Compulsive checking activities may be physical actions, like flipping a light switch or turning a knob on the oven. They can also be mental actions, like double-checking that the fire alarm still has batteries or that a door is closed. Sometimes, repeated worries prompt kids to repeatedly ask parents for reassurance. This is another kind of checking that might be easy for parents to miss.

What Checking OCD Looks Like in Kids

Symptoms of compulsive checking range from super subtle to very overt. How easy they are to spot depends on what your child feels compelled to check. Here are a few examples of compulsive checking that you might notice in a child with this form of OCD:

• Repeatedly doing things like locking and unlocking doors, flipping light switches, or turning faucets on and off

• Asking the same question over and over, without a decrease in anxiety—for example, repeatedly asking a parent if they are sick

• Going back to check on things more often than seems normal

• Repeatedly asking parents for reassurance that something bad is not going to happen

• Asking parents if the child has forgotten something or if their memory is accurate

OCD Type 3: Perfection and Order

This is the type many people likely imagine when they think of OCD. Along with germaphobia, this is the other common OCD form that gets a lot of representation in pop culture. People with this OCD type may worry about symmetry, organization, or doing things just right. In fact, this type is also sometimes called “just right OCD.”

While this may sound like the hyper-organized, neat freak stereotype we often associate with OCD, the reality is it’s much more complex. Some people with this OCD type may be neat and tidy, or be concerned with appearances. However, this type also includes compulsive behavior like tapping things an even number of times, arranging items to appear symmetrical, or fixing and re-fixing something that nobody else would notice was “wrong.”

This OCD type also includes people who feel compelled to do things perfectly. This might lead to a lot of anxiety when working on school assignments or participating in sports or other activities. Some people with this type might fixate on a facial feature or part of their body and worry that it is not good enough.

What Perfectionistic OCD Looks Like in Kids

Although this type is more understood, it’s helpful for parents to remember that “perfection” and “order” doesn’t necessarily mean color-coded school binders and a clutter-free bedroom. A child’s focus can be on a very specific area that we don’t usually think about as something that needs to be organized or even, which can make these signs of OCD slightly tricky to spot. Here are some ways perfectionism and “just right” OCD might show up in children:

• Extreme difficulty completing homework assignments, especially open-ended ones, due to a fear of not being able to do them well enough

• Needing to feel that things are “even” on both sides of the body

• Doing things a set number of times, for example, saying the same thing three times in a row or stepping on the “right” number of leaves outside

• Fixating on a small detail related to clothes, hair, or makeup

• Having trouble texting friends due to fear about not saying the right thing

OCD Type 4: Mental Rituals & “Bad” Thoughts

This type of OCD is a little different than the others. Most forms of OCD involve acting out some kind of repeated or ritualized behavior. The behavior may be subtle, but it’s noticeable if you know what you’re looking for. Mental ritual OCD is sneakier. Rather than doing something repeatedly, people with this type of OCD think something repeatedly. This can make it much more difficult for parents to identify. In fact, until fairly recently, mental health professionals had a hart time identifying it too!

Mental ritual OCD is relatively new. You may also hear it described as “Pure O” OCD, which is short for “purely obsessional.” It’s called this because there aren’t any compulsions for those of us on the outside to see. However, that doesn’t mean they aren’t there.

People with “Pure O” or mental rituals are often bothered by thoughts that feel inappropriate: for example, thoughts about violence or sexual behavior. Some people may also be preoccupied with thoughts about religion or worries that they’ve done something wrong. They may worry that having these bad, taboo thoughts means that they are bad people.

To counteract the “bad” thought, a person may try to replace it with a “good” one or perform some mental action to make it better. This could include thinking a special thought, saying a number or word inside their head, praying, or reassuring themselves that they are okay.

What Mental Ritual OCD Looks Like in Kids

Mental rituals are extremely difficult to spot unless the person experiencing them says something about them. Some children with this form of OCD may also repeatedly ask for reassurance as a way to cope with upsetting thoughts or mental images. That can sometimes be a tipoff that other mental rituals could be happening, too. Here are some ways mental rituals might show up for “Pure O” kids:

• Compulsively saying prayers or confessing to things inside their head

• Repeatedly going over memories to see if they really happened

• Saying special words, numbers, or thinking of a special picture to make a bad thought go away

• Checking to see if a bad thought is still there

• Repeatedly reassuring oneself that something didn’t really happen, or that they would never do that thing in real life

Are There Any Other Types of OCD?

Yes and no! The 4 types of OCD I’ve outlined here are used by both therapists and people with OCD to describe different ways that OCD can look and feel. However, you won’t find them in the DSM-5, the big book of mental health problems that therapists use to help diagnose people. So even though they are common and helpful, they aren’t super duper official.

While many people divide OCD into 4 broad categories, others may identify as many as 6, 7, or 8 different types. It all depend on how specific you want to get with your labels. Here are some other OCD types you may hear others mention:

• Hoarding

• Ruminating

• Intrusive Thoughts

• Mental Contamination

• Moral OCD

• Doubt or Incompleteness

• Thoughts of harm or self-harm

I Think My Child Has OCD…What’s Next?

If you read through these 4 types of OCD and recognized your child in one (or more) of them, you may be wondering where to go from here. I’ve written a fair amount about OCD in children and OCD treatment on this blog if you’d like to learn more.

Learning anxiety coping skills is a good first step to help your child at home. There are several educational and self-help books for kids about OCD, too. What to Do When Your Brain Gets Stuck is my favorite.

Although books and coping skills can help, many children with OCD will need more support to overcome their symptoms. Research suggests OCD is not likely to go away on its own without professional help. Fortunately, children with OCD have options when it comes to therapy. Cognitive behavioral therapy can be really helpful, and there’s even a version of it designed especially for kids with OCD called Exposure and Response Prevention.

If you’re looking for a child therapist in North Carolina, New York, or Florida, I may be able to help. I meet with kids in person (in Davidson, NC) and online (everywhere else) to work through anxiety, stress, and trauma. You can email me here to ask question or set up an appointment.

My Child is Afraid of Halloween! What Do I Do?

Maybe it’s just me, but I love a good baby Halloween costume. I started researching them long before I became a parent, and I’m excited to have at least a year or two of freedom to dress my baby up without objections from him about my style decisions. Eventually, though, all good things must come to an end.

As children grow up and begin to develop their own (strong) opinions about things, including Halloween. What if your child’s views are not so enthusiastic? What if they are downright scared of Halloween? You may be wondering if it’s okay to push them to face their fears so they don’t miss out on any fun—or keep their siblings from having a good time. On the other hand, you don’t want to overwhelm your poor kiddo by subjecting them to an evening of skeletons and eyeballs.

What’s a parent to do? Let’s take a look at a few strategies to help children who are afraid of Halloween feel secure enough to (gently) try out some spooky fun.

Is it Normal for Kids to Be Afraid of Halloween?

If everyone else’s children are eagerly jumping into their Pennywise costumes or laughing with glee at the scary chainsaw man on the haunted hayride, you may wonder if it’s normal for your child to feel so scared.

When you stop to think about it, many Halloween traditions are very weird and unlike our normal day-to-day life. It’s a day deliberately intended to scare people. On Halloween, kids get to do a lot of things they aren’t allowed to do any other night of the year, like walk around the neighborhood in the dark and take candy from strangers. No wonder some kids have a hard time adapting.

I wonder if the abundance of scary games, movies, and other content geared towards children has led to more kids fearing Halloween. I can’t tell you how many kids have come into my therapy office deathly afraid of characters like Pennywise, Annabelle, or the cast of Five Nights at Freddy’s. Even creepy memes can have a lasting effect on kids. Remember Momo? She was a major subject in my office for about 6 months in 2019.

I do think it’s worth mentioning that while mild anxiety is totally normal and understandable, extreme anxiety may be a different story. A child who is creeped out by Halloween decorations or who is hesitant to go trick or treating is experiencing pretty typical fears. On the other hand, if your child is so paralyzed by fear that they have nightmares the entire month of October, or refuse to go to public places because they might have decorations up, she may be dealing with a more severe phobia that could use some outside help.

How to Help a Child Who is Scared of Halloween

We all want to protect our children from harm and help them avoid upsetting experiences when we can. That said, please don’t wrap your child in psychological bubble wrap and avoid all things Halloween-themed. While this might help your child (and you) feel less anxious in the short term, it is likely to make your child’s fears stronger and more persistent over the long term.

Anxiety makes us want to avoid the things that scare us. We get the sense that something terrible will happen if we don’t. The problem is that every time we avoid something scary, we reinforce the idea that it is worth being afraid of. The longer a child avoids a scary situation, the harder it will be to return to it when the time comes. This is why it can be so hard to go back to school after summer vacation, and why so many kids developed separation anxiety after months of togetherness during quarantine.

To help an anxious child, we want to:

• Let them know their feelings are normal and okay

• Talk, read, and play about feelings and scary things

• Clear up any misunderstandings that might make anxiety worse

• Support them in gently and gradually facing their fears

Let’s see how we can apply those ideas to help a child who is afraid of Halloween.

Practice in Advance of the Big Day

The best time to start addressing Halloween anxiety is not October 30th. I say this knowing full well that this blog post will go up on October 30th, the night before Halloween. But, I am assuming that you are likely reading this blog post at some future time. Hopefully, Future You has decided to Google this issue in September or early October, which gives you plenty of time to prepare.

Kids learn and make sense of things around them through repetition and play. Ever seen your child act out the same game over and over for a week and then move on to something else? They’re learning! Children also thrive on routine, which helps the world feel more predictable and safe. Repeated conversations about Halloween traditions helps children learn what to expect, and takes away the element of surprise that can be so frightening.

Reading books about Halloween together is a great way to facilitate conversation. As an added bonus, books are a gentle form of exposure for anxiety. You are gently showing your child that he can handle talking and thinking about scary subjects, and you’ll be right there to support him.

Talk About the Difference Between Real and Pretend

Little kids have a hard time distinguishing between fantasy and reality. Their imaginations and ability to “make believe” can add a lot of magic to childhood. On the flip side, it can also add a lot of fear!

Older kids and adults can delight in scary movies because they know that there’s no chance of Godzilla lurking around the corner when they leave the theater. Pretend scary stories let us experience the adrenaline rush of a good scare at a time when we know that nothing bad can actually happen. Imagine how it must feel if you aren’t so sure the Godzilla won’t be there!

You can use TV shows and movies as an opportunity to show your child that the stories are pretend, and the actors are playing make-believe. Mister Rogers once invited the actress who played the Wicked Witch of the West onto his show to teach this exact concept. Onscreen, the actress showed how she put on her costume and makeup, and used a pretend scary voice to play the part. In reality, she was a really nice lady! You can talk with your child about how actors use makeup and costumes to look scary, when really they are normal people—there’s plenty of videos of actors in and out of costume to back up your point.

Use Exposure to Make Scary Items Feel Familiar

Exposure is a big part of the kind of therapy I practice for kids with anxiety, called Cognitive Behavioral Therapy. In exposure, we help a child face unhelpful fears, but we do it in a gradual way. This helps kids build up their confidence, and learn to tolerate anxious feelings without becoming totally overwhelmed.

You can practice exposure at home by giving kids a chance to look at and handle scary Halloween props in small doses. This could mean taking the scary mask from a sibling’s costume out for your younger child to handle and play with. It could also mean walking on the opposite side of the street from a Halloween display to view it from a safe distance before getting closer. It often helps to make these exposure situations funny: try talking with your child in a goofy witch voice, or encourage them to make fun of a monster that frightens them. It’s hard for things to be both funny and scary at the same time.

Involve Your Child in Halloween Prep

Helping your child participate in Halloween traditions in an age-appropriate way gives them another opportunity for exposure. It’s also another chance to highlight the difference between real and pretend by showing kids how things are made. A glowing jack-o-lantern seems a lot less intimidating when you saw the pumpkin that was scooped and carved to make it.

Giving your child a role in the Halloween festivities allows them to feel a sense of control over the situation. You can let your child pick out your decorations, play their choice of music, and decide what snacks to enjoy or what candy to give out to trick-or-treaters. Feeling in control can ease anxiety, and getting to pick out all the details might give children an added motivation to participate.

Fun is Most Important!

Okay, so I’ve gone on and on in this post about the importance of exposure and facing your fears. All of that is true! But also…Halloween is a holiday, and it’s one day a year. While I encourage you to gently help your child overcome Halloween anxieties, there’s no need to push them so far out of their comfort zone that the holiday stops being fun.

We’re looking for progress, not perfection. Maybe this isn’t the year that you go trick-or-treating in the neighborhood that goes all out for Halloween with super gory decorations. Maybe your young child would be more into a casual daytime party with friends rather than a nighttime trek with the big kids. Some aspects of Halloween may just be too intense for young or sensitive kids to handle, and that’s perfectly okay.

What’s most important is communicating to your child that having anxiety is okay, and that we don’t always have to do what it tells us to do. By staying calm and finding small opportunities for exposure, you are showing your child that you can handle their big feelings. They may be terrified of the ghost hanging on the neighbor’s house, but you aren’t!

Help for Anxious Kids in Davidson, NC

Do your child’s anxieties extend past Halloween? If you’ve got a sensitive kid who is prone to big feelings, it might feel like there’s a minefield of situations you have to tread carefully around to avoid triggering a meltdown. If anxiety is getting in the way of your child living their best life, counseling can help make things more manageable.

I am a former-anxious-kid-turned-therapist who loves working with children and tweens. I see kids in person for CBT and play therapy at my office in Davidson, North Carolina, just outside of Charlotte. If you aren’t close by, we may still be able to work together! I see kids throughout North Carolina, New York, and Florida for online therapy. If you’re not sure you’re ready to start therapy, or need some basic help right away, check out my coping skills course for anxious kids and tweens.

If you’re ready to start child anxiety therapy, drop me a line. I’m always happy to hear from you.

How to Help a Child with Intrusive Thoughts

Dark, bad, scary, negative, weird…whatever words you or your child use to describe intrusive thoughts, the effects are the same. Intrusive thoughts are like unwanted guests in our minds, barging in without being invited to spoil the party. While any child can have intrusive thoughts, they’re more common in children with anxiety, OCD, or a history of trauma. Keep reading to learn what you can do at home to help your child with the normal, common, but still very stressful phenomenon of intrusive thoughts.

Why Does My Child Have These Negative Thoughts?

If you’re curious to learn more about intrusive thought and why they happen, check out last month’s blog post. I break down what intrusive thoughts are in detail, with real-life examples. I also talk about what mental health problems might make kids more prone to experiencing them.

If you don’t have time to read the whole post, the gist is that intrusive thoughts are normal, and not always a problem. Many people—if not most people—will have intrusive thoughts at some point in their lives. They’re just one of the many weird things our brains and bodies do in an effort to keep us safe. When most of us have these seemingly random thoughts, we can shrug them off and quickly forget about them.

However, some kids are not so lucky. It can be harder for kids to distinguish between a useful thought and a useless one. This makes it more difficult to brush the thoughts aside. Instead, children may end up focusing on the thought and worrying about it. This leads to more anxiety, which increases the likelihood that these bothersome thoughts will pop up again.

An occasional intrusive thought is no problem, but kids with anxiety or OCD may get them so often that it feels debilitating. Children also sometimes experience these thoughts after a trauma as a part of PTSD.

How Can I Help My Child With Intrusive Thoughts?

There’s a lot you can do as a parent to support a child struggling with intrusive thoughts. You hold a powerful role in your child’s life. Your child looks to you as a guide to decide how she should think and feel about things, so your responses carry a lot of weight. By responding calmly and compassionately, you can help your child self-soothe and take the power away from overly dark or negative thoughts.

We’ll go over each of these in more depth in a minute, but here are 3 ways you can help:

• Normalize intrusive thoughts for your child

• Teach the difference between thinking and doing

• Help your child name and accept intrusive thoughts

These steps can go a long way toward helping kids handle disturbing thoughts with less worry and stress. Next, let’s break down each one to see why it helps and how you can practice it at home.

Let Your Child Know Her “Bad Thoughts” Are Normal (and Not So Bad)

Intrusive thoughts can be disturbing, but they’re also really, really common. So common, in fact, that one study found that 94% of people experience them. They’re just a part of being human! As common as they are, we don’t tend to bring up intrusive thoughts during polite conversation. Because nobody ever talks about them, a child may assume she’s the only one who gets intrusive thoughts. The thoughts can become a big source of shame, especially because they might be about taboo subjects.

Things always feel scarier when we don’t understand them. Teaching children about intrusive thoughts takes away some of their power. When you tell children that many people have these bad thoughts and they aren’t alone, you alleviate their shame. Reducing fear and shame not only helps your child feel better; it can also reduce her intrusive thoughts over time.

Try explaining this to your child: “Our brains are always thinking, and always looking for ways to keep us safe.” Giving us these “bad thoughts” is sort of like the brain showing us a flashing danger sign. The only problem is, the brain isn’t always right! Sometimes, the more we try to ignore these bad thoughts, the more our brain pushes the thoughts back. These thoughts can be really weird, or scary, or even be about things we’d never want to do in real life. As weird as they seem, most people have them sometimes and they are totally normal.

Explain That Thinking Isn’t The Same as Doing

Have you ever knocked on wood to keep something bad from happening? Or worn your “lucky shirt” on game day to help your team win? If so, you’ve experienced magical thinking. Magical thinking is the belief that our private thoughts and behaviors influence what happens in the outside world.

Magical thinking is really common in children, especially younger kids. It’s usually most noticeable from the toddler years through about age 7. If you think back to your own childhood, you’ll probably discover magical thinking everywhere: cootie shots, lucky charms, and “step on a crack, break your mama’s back” are all examples of magical thinking that are fun for kids.

However, there can be a dark side to magical thinking, too. Children often believe that their thoughts can cause things to happen in the world around them. If a child worries their thoughts are responsible for something bad happening, this can cause terrible fear and guilt. It’s easy to imagine how a child who gets intrusive thoughts about violence or crime could begin to worry about accidentally hurting others.

Help your child understand that having bad thoughts does not make you a bad person. It’s our actions and choices—not our thoughts and feelings—that hep us to be “good people.” Next, reassure your child that thinking angry or scary thoughts about a person can’t hurt them or cause something bad to happen. Even if they feel bad to us, thoughts are not that powerful.

Shine Some Light on Dark Thoughts By Naming and Accepting Them

When I think about kids struggling with dark intrusive thoughts, a quote from famous psychiatrist Dan Siegel comes to mind: “Name it to tame it.” Dr. Siegel came up with this phrase, and it’s since been adopted by many therapists to describe a simple process that makes strong feelings more bearable.

“Name it to tame it” is exactly what it sounds like. Often, the simple act of labeling our thoughts and feelings as we have them can make them feel better. This is because naming something requires us to take a step back and go into observing mode, rather than being totally absorbed and overwhelmed by our feelings.

Naming intrusive thoughts as they happen can be a helpful reminder that we are not our thoughts. Thoughts come and go, but it’s up to us to decide how much attention they deserve. Calling out intrusive thoughts for what they are is also a helpful reminder that they are common and harmless: after all, they’ve happened to enough people that we’ve given them a name!

You can help your child practice saying one of these phrases (or something similar) the next time an intrusive thought strikes:

• “My brain is giving me one of those garbage thoughts again.”

• “I’m having an intrusive thought right now.”

• “This seems like one of those thoughts I don’t need to listen to.”

Once the thought has been named, don’t dwell! We can just let the thought pass by. The more a child resists having intrusive thoughts, the more likely they are to pop up again. It may sound counterintuitive, but accepting intrusive thoughts can actually reduce how often they happen. By naming the dark thought and moving on, your child is teaching herself that they’re nothing to be afraid of.

Need More Help? Begin Child Therapy for Intrusive Thoughts in North Carolina

Sometimes, a child’s intrusive thoughts grow to be so big and overwhelming that at-home strategies aren’t enough to tame them. Maybe your child’s thoughts are part of a larger problem with anxiety or OCD. Sometimes, intrusive thoughts show up after a child experiences something traumatic or highly stressful. If your child’s intrusive thoughts are very frequent or very overwhelming, therapy can help sort things out.

Cognitive-behavioral therapy teaches children that they have more power than they might think over their thoughts and actions. They can learn to spot intrusive thoughts when they happen, and dismiss them rather than worrying about what they mean. Play therapy can also help younger kids work through anxiety and other feelings that are sometimes difficult to put into words. If your child survived a trauma, TF-CBT is a special, kid-friendly form of therapy designed to help children work through their symptoms in a safe way.

I’m a play and CBT therapist who specializes in helping kids with anxiety and trauma. I can work with families in three states: North Carolina, New York, and Florida. Children who live near my Davidson, NC child therapy office are welcome to stop by in person. If that’s not possible, no worries! I really enjoy online therapy and have found it to be just as helpful for many kids.

Ready to learn more? Drop me a line here. I’m always happy to hear from you.

Intrusive Thoughts in Children, Explained

Every kid worries from time to time. It’s normal (and even healthy!) to wonder about fitting in before the first day of school, or to imagine the worst-case scenario before taking a big test. Usually, these worries are easy for kids to talk about, because they know other kids have felt the same way. They also tend to be time-limited: once the test or first day of school is over, the worries are over, too.

For some kids, worries aren’t so easy to talk about. A troubling thought or mental image might pop up out of nowhere, when a child isn’t expecting it. Their worries may be repetitive and feel very difficult to control. Often, these thoughts are really scary and upsetting. They can be dark, violent, or about a taboo subject. These kinds of worries are called intrusive thoughts.

Kids don’t want to be thinking these things, and know they would never act on the thoughts they’re having. So why do they keep happening? In this post, we’ll be talking about what exactly intrusive thoughts are, why they happen, and when to seek help.

What Are Intrusive Thoughts?

Take a second and imagine an intruder. What do you think of? Someone who busts down the door, unannounced, without being invited. What a scary scenario! It’s safe to assume that most of us would be pretty freaked out to discover an intruder in our home. We’d probably dread having it happen again, and try everything we could to make sure our house was secure in the future.

Intrusive thoughts are the brain equivalent of an unwanted guest. They show up to ruin the party. Intrusive thoughts tend to:

• Pop up out of the blue

• Come back repeatedly

• Feel unlike the thoughts a child usually has

• Be upsetting to the child

Intrusive thoughts are ego dystonic. This is therapy jargon that means a person doesn’t agree with the thoughts, and it may not even feel like the thoughts really belong to them. Intrusive thoughts include imagery that is violent, sexual, or feels “wrong” to a child. Other times, worries about worst-case scenarios might come up again and again. They aren’t things that kids would choose to think about, and they’re often the opposite of what a child would do or hope for.

Kids with intrusive thoughts may feel distressed, anxious, or ashamed. They may not understand why the thoughts are happening, but can guess that not everyone is bothered by their thinking in this way. Because the thoughts feel out of control, children may dread having more and try to avoid them.

At What Age Do Kids Get Intrusive Thoughts?

There is no set age at which intrusive thoughts start. However, they may be more common or noticeable in tweens and teens. Intrusive thoughts are sometimes a symptom of OCD, which can show up as early as age 7 or 8 and as late as the teens or early twenties.

In my child therapy office, it’s usually middle or high school kids who are able to put the weird experience of having unwanted thoughts into words. They are old enough to think about their own thinking and notice their thoughts as they pass by, so they know that something doesn’t feel right.

Although they may not talk about it as much, younger kids can be bothered by these thoughts, too. Because they don’t have the vocabulary to talk about what’s going on, you might see changes in their actions, instead. For example, they may ask for reassurance about the same subject again and again.

Why Do Children Have Intrusive Thoughts?

Now that we have spent the past several paragraphs talking about how difficult and upsetting intrusive thoughts can be, you’re probably wondering why kids get them in the first place. The answer may surprise you! Many people experience intrusive thoughts, and it doesn’t necessarily mean something is wrong. They may happen when a person is going through a lot of stress, or they may just happen randomly.

Having an intrusive thought every once in a while isn’t a sign of mental illness. They can be totally normal, like the brain version of a hiccup. A child with occasional intrusive thoughts can usually brush them off without taking them too seriously.

What Mental Health Problems Cause Intrusive Thoughts?

Children who are struggling with repeated, ongoing intrusive thoughts can’t brush them off so easily. In these cases, a child may be dealing with a mental health problem that needs attention. OCD and PTSD are two common mental health conditions that can cause children to have intrusive thoughts.

Kids with OCD deal with repeated thoughts, worries, or mental pictures that upset or scare them. Kids are bothered by these worries, and feel pushed to do something to make the worry go away or prevent something bad from happening. This creates a cycle of repeated worries and repeated behaviors, called obsessions and compulsions, that take up a lot of time and add even more stress.

Children who have survived extremely frightening or dangerous events may have lingering problems after the fact. While some kids will bounce back, others may be diagnosed with PTSD. Kids with PTSD will re-experience parts of their trauma in some way, often through intrusive thoughts or flashbacks. Flashbacks are vivid memories that pop up suddenly and intensely, almost as if a child is living through the event again.

What Are Some Examples of Intrusive Thoughts in Children?

Most of the intrusive thoughts children have fall into one of three broad categories: worries, flashbacks, and “inappropriate” thoughts. If you think your child may be having intrusive thoughts, keep reading to take a closer look at each category. I’ll share some examples of each intrusive thought type. It can be helpful for both kids and parents to discover that they’re not alone, and many kids (and adults) deal with these kinds of thoughts.

Worries: Children with anxiety or OCD may have repeated, unwanted worries that they cant seem to shake. These are often “what if” worries that focus on something bad that could happen in the future. Other times, these “what if” thoughts could be about something naughty a child worries they could have done. Some children with OCD may also get a nagging sense that if they don’t do something exactly right, they could cause something bad to happen. These thoughts may not always be logical, which can make them even more confusing and bothersome for kids. Here are some examples:

• “What if I throw up in public?”

• “What if I accidentally lied to the teacher?”

• “I have to step on all the sidewalk cracks or I won’t be safe.”

Flashbacks: These are most common in kids with PTSD. Flashbacks may feel like they come out of nowhere, or they can be triggered by something that reminds a child of their trauma in some way. They can include any of the 5 senses, and often activate a child’s fight-or-flight system as if the dangerous event was happening again. Examples of flashbacks include:

• Feeling as though you’re back in the place where a trauma happened

• Having an image of the trauma pop into mind

• Hearing or smelling something you associate with the trauma

“Inappropriate” Thoughts: I put inappropriate thoughts in quotes here because there’s a big difference between thinking something and acting on it. We all have weird thoughts from time to time about things we probably wouldn’t be proud to share. Sometimes, intrusive thoughts are about the exact subjects we try to push away or not think about in our day-to-day lives: things like sex, violence, and criminal behavior. These kinds of thoughts can cause a lot of shame, guilt, and distress for children, who worry these thoughts mean they are bad or naughty. They may have thoughts like:

• Imagining hurting someone else

• Picturing themselves stealing something

• Noticing other people’s bodies or imagining them naked

Are Intrusive Thoughts Normal?

The short answer: yes. Intrusive thoughts can be weird, annoying, or disturbing, but they are totally normal. In fact, most of us will probably have intrusive thoughts at some point in our lives. One recent study found that 94% of people have them, which is a surprisingly huge number.

That number is particularly surprising when you consider that most kids with intrusive thoughts feel like the odd one out. They may worry they’re the only ones who have ever had thoughts like this, and that it means they’re bad or weird. Most adults with intrusive thoughts don’t talk about them with other people, either because they quickly disregard them or because it would feel odd to mention in casual conversation. No wonder kids feel so alone.

So, intrusive thoughts are normal—but we know that they can still cause problems for kids. Those issues aren’t caused by the thoughts themselves. Problems arise when the thoughts are very frequent or intense, or when kids have a hard time dismissing them.

Children with OCD have a tougher time disregarding stray thoughts that the rest of us would shrug off. They may take these thoughts more seriously or begin to fixate on them, which causes the thought to pop up more often. Trauma-related thoughts and flashbacks may be so upsetting that they quickly overwhelm a child.

Help for Kids with Intrusive Thoughts in Charlotte, NC

If your child is complaining of an occasional intrusive thought, a little reassurance and education may be all she needs to feel better. It’s helpful for kids to hear that their thoughts are normal, and can’t hurt them or others. Armed with that knowledge, it may be easier for kids to let intrusive thoughts pass by without taking them too seriously. This reduces anxiety which, over time, can also reduce how often the thoughts happen.

On the other hand, you may be on this page because your child’s thoughts are causing larger problems. Maybe you recognized your child in the descriptions of OCD or trauma. If these thoughts have been happening for a long time, are disrupting your daily life, or are combined with other symptoms, therapy can help.

Cognitive behavioral therapy helps anxious kids learn how to catch themselves when their thoughts aren’t doing them any favors. Being able to put a name to your worries helps you to gently shift your mindset. In CBT kids learn that they have control over their thinking, and what thoughts they choose to listen to. A specialized form of CBT called Exposure and Response Prevention helps kids with OCD break the cycle of obsessive thinking and repetitive behavior.

Play therapy helps younger children work through their complicated feelings after trauma. Kids naturally make sense of the world around them through play, and this gentle, child-led approach lets kids handle scary topics in the way that feels safest to them. For kids who are ready to tell their story more directly, TF-CBT gives children a step-by-step path toward managing strong feelings, talking about their experiences, and coping with reminders of trauma.

If you are looking for therapy in North Carolina, New York, or Florida, I’d love to help. We can meet online or in-person in my counseling and play therapy offices just North of Charlotte, North Carolina. If you’ve got questions or would like to schedule an appointment, contact me here.

Does Childhood OCD Go Away?

If your child has OCD, you may worry at times about what the future holds. It seems like such an unfair burden for a young child to deal with. Maybe you’ve wondered whether your child’s OCD symptoms will eventually fade away, so she will be free to live life without constant worry. If you have, you aren’t alone.

“Does childhood OCD ever go away?” is one of the most common questions I hear from parents, especially at the beginning of therapy. And it’s totally understandable! OCD symptoms can be debilitating and time consuming. Handwashing, repeated checking, asking for reassurance, or long rituals are exhausting not just for the child, but for the whole family. Nobody wants a child be stuck with those symptoms forever!

I can’t predict what the outcome may be for your child, but I do know that therapy can lead to big, positive changes in the lives of kids with OCD. Today, I am digging into the research to see how common it is for childhood OCD symptoms to completely resolve. I’ll also take a look at what we can do to help all kids with OCD start feeling better.

How Common is Childhood OCD?

Childhood OCD is more common than you might think. While we may talk more about forms of anxiety and depression affecting kids, OCD also often starts early in life. Most studies estimate that 1-3% of kids have OCD, although their symptoms might fly under the radar for a long time. This is because because they can be hard to spot.

OCD most often starts when a person is a child or teen. Pretty much everyone with OCD starts getting symptoms before age 25. For childhood-onset OCD, the average age of onset is around 10 years old. It is common for boys to start noticing symptoms a little earlier, while girls might not develop OCD symptoms until later.

Some people may not get treatment for OCD until they reach the late teen or adult years, but their problems often began years earlier, during childhood.

You Can’t Outgrow Childhood OCD Without Help

Looking at the research, one thing that is really clear is that OCD is not likely to go away on its own. It’s not something that a child is likely to just outgrow or forget about. Kids with OCD need specialized therapy. The right counseling can help them learn how to deal with the intrusive thoughts that cause their anxiety and push them to repeat actions over and over.

OCD symptoms tend to ebb and flow over time: sometimes they’re better, sometimes they’re worse. Stress often plays a part in how bothersome OCD symptoms are. Some studies suggest that a small number of people might be able to “outgrow” their OCD without therapy: about 1 in 5. However, it can be a little tricky to tell if someone has really gotten rid of their OCD, or if they’re just in a low-stress time of life when it isn’t noticeable. It’s possible for symptoms to go away entirely when stress is low, only to return again during a more difficult time.

There’s also a risk that a child’s OCD could get worse without treatment. This can lead to small inconveniences, like chapped skin from too much handwashing, or major life impairments, like difficulty getting out of the house. Children with OCD are at an increased risk of also having other mental health problems, like anxiety and depression. Later in life, people with untreated mental health problems sometimes turn to unhealthy coping mechanisms like drugs and alcohol if they don’t have other good ways to deal with their symptoms.

The good news is that most people with OCD feel better after therapy. About 70% of people who get specialized treatment for OCD will improve, and usually they improve by a lot. The great news is that kids often get better results from OCD therapy than adults do. Catching symptoms early and getting help quickly leads to fewer symptoms later in life. Most kids will still have some leftover symptoms after therapy, but a small number of kids might see their OCD go away.

Sometimes, OCD Goes Away Completely (But Not Always)

Different experts have different opinions on whether or not it’s possible for OCD to completely go away. I don’t think I can argue with the experts! It’s not entirely clear whether people get cured of their OCD, or if they just go into remission from OCD. “Cured” means the symptoms are gone forever, while “remission” means the symptoms go away for a while, but may come back later.

Being the nerd that I am, I’ve looked over a handful of studies looking at the likelihood of OCD symptoms going away after therapy. It seems like it is possible for some people, and there are a few factors that increase a person’s odds. Kids whose symptoms start when they are young have better chances of remission than teens or adults. So do people whose symptoms are milder, and who are able to get therapy quickly. Finally, people who do not have other mental health problems alongside their OCD fare better than people who are also dealing with anxiety or other conditions.

Depending on the study you look at, you’ll see researchers estimating that anywhere from 32% to 70% of people go into remission after therapy, meaning that their symptoms are gone for a long time, or have gotten so mild that they aren’t getting in the way of things. However, this is different than being cured: there’s no guarantee that the symptoms might come back. The number of kids who are cured is much smaller and open to debate. Some experts guess that 20% of kids with childhood OCD are cured, while others think OCD never completely goes away.

You Can’t Always Cure OCD…And That’s OK!

As we just talked about in the last section, there’s a big difference between remission and cure. With good treatment, many kids with OCD will go for long stretches without problems. However, expecting your child to never have another OCD thought ever again for the rest of her life probably isn’t realistic. While some kids may fully outgrow their OCD, many won’t. Most experts consider OCD to be a chronic condition that, once you have it, sticks around for the long term.

That may be demoralizing to hear. The words “chronic illness” can sound very hopeless, especially if your child is struggling intensely right now. But just because OCD can be a lifetime diagnosis doesn’t mean it’s a life sentence. You may remember from earlier in this post that OCD affects 1-3% of people. That’s a pretty solid number! There are lots of kids and adults out there who are thriving, enjoying life, and just so happen to have OCD.

Help is Available for Childhood OCD in Charlotte, NC

OCD doesn’t have to run your child’s life. If you are tired of repeated worries and rituals taking up your family’s time, therapy can help. In counseling, kids can learn that OCD is just a way that some people’s brains think—and they have control over which thoughts they listen to and which they don’t. A skilled therapist can help a child gradually “talk back” to their worries and face their fears. Eventually, OCD stops being such an overwhelming urge and turns into background noise.

I’m a therapist based in Davidson, NC, just outside of Charlotte. I’m also someone who had childhood OCD! Everybody’s symptoms are different, but I remember what it felt like to be spending so much time every day dealing with worries I didn’t want to have. I love helping other kids manage their OCD fears so they can get back to enjoying childhood.

Cognitive Behavioral Therapy is a great option for OCD, and younger kids often benefit from play therapy, too. Is Davidson, NC a long commute for you? We can work together online if you live anywhere in North Carolina, New York, or Florida.

Want to learn more? Email me to ask a question or request an appointment.

Is My Child Having a Panic Attack or an Anxiety Attack?

Your child’s mind is racing. Her stomach is flip-flopping. She’s having a hard time falling asleep at night, and an even harder time getting up for school in the morning. You know something is going on, but you’re not sure what to call it when you describe it to people. Is your child having a panic attack or an anxiety attack? What’s the difference? Today I’m going to break down the difference between panic and anxiety, so you know the next steps to take to help your kiddo.

Panic Attacks and Anxiety Attacks Are Basically The Same Thing

I guess I’m giving away the big reveal in this blog post right up top, huh? Kids and parents often ask me if the symptoms they’re describing sound more like an anxiety attack or a panic attack. The truth is, most people use both terms to describe the same thing, so you can pretty much use them interchangeably. Mentioning either term to a therapist will give them a good idea of what you’re going through.

“Panic attack” is the official name for a sudden bout of intense fear, bodily reactions, and a feeling of impending doom. This is the term used by the DSM-5, the phone book-sized manual therapists use to diagnose mental health problems. The phrase “anxiety attack” isn’t usually used by therapists because it doesn’t appear in the book and isn’t “official.”

Parents might use the phrase “anxiety attack” to describe another intense emotional experience, like a tantrum or extreme worrying, but that’s rarely the case. It makes sense to describe panic as an attack of anxiety, and pretty much everyone will understand what you mean if you do.

What Does Anxiety Look Like in a Child?

The big difference between anxiety and panic is that anxiety is more general and long-lasting, while panic is specific and sudden. Anxiety can be mild or severe, and it can ebb and flow over time. Some kids may only feel nervous in specific situations, such as meeting new people or sleeping in bed alone, while others may have more generalized anxiety that happens most days.

If your child has anxiety, you might see signs like:

• Frequent worries that seem like more than a phase

• Avoiding specific people, places, or things to keep from feeling afraid

• Difficulty falling asleep, or trouble sleeping alone

• Muscle tension, headaches, and stomach aches that don’t have a clear medical cause

• Clinginess and difficulty tolerating being alone

• Repeatedly asking for reassurance

• Irritability or seeming on edge

• Being easily startled by loud sounds or surprises

• Focusing on things that went wrong in the past or that might go wrong in the future

Every child is different, but these are some of the most common signs I hear about from families in therapy.

Signs Your Child Is Having Panic

Panic comes on suddenly, and it can be debilitating. It’s possible for a child to go about her day with anxiety, but a panic attack will stop her in her tracks. While anxiety gradually waxes and wanes, panic is like a light switch flipping on and off. The good news is that although panic attacks are intense, they don’t usually last very long. If your child has a panic attack, it will most likely be over in 15 minutes.

If your child is having a panic attack, you may notice things like:

• Shaking hands or full-body shivering

• Increased sweating

• Hot flashes or chills

• A racing, pounding heartbeat

• Hyperventilating, or feeling like it is hard to breathe

• Dizziness or weakness

• Tingling feelings in the fingers or hands

• A sense of losing control

• Intense terror, as if something bad is about to happen

Your child may or may not be worried about something in particular when a panic attack occurs. Sometimes, panic attacks seem to appear out of the blue, when a child isn’t thinking about anything in particular. Over time, though, your child may start feeling worried about the panic attacks themselves. If she’s already had a few, she may dread the possibility of having another one.

Can a Child Have Both Anxiety and Panic?

Yep! A child can have both anxiety and panic attacks. In fact, it’s pretty common. Being anxiety-prone or sensitive to stress may put a child at risk for experiencing panic attacks. Sometimes, panic attacks happen on their own, and this is called Panic Disorder. It’s also very common for panic attacks to go hand-in-hand with other forms of anxiety, like Social Anxiety, Generalized Anxiety, and Agoraphobia.

If a child is struggling with both anxiety and panic attacks, she probably has lower-level anxiety on an ongoing basis that gets punctuated by brief moments of intense fear. For example, a child may struggle with perfectionism and worries about not doing a good enough job on school assignments. This could lead to problems like avoiding turning in homework, stomach aches on school days, and fitful sleep. Before a test, however, this child might experience a full-blown panic attack with rapid breathing and dizziness.

Anxiety and panic are both tough. Dealing with them both is even harder. The good news is, there are great therapy options to help kids with anxiety, panic, or a mix of both. It’s possible to get worries under control and learn to soothe panic responses in the body, so your child can get back to enjoying life.

Help For Kids With Anxiety and Panic Attacks in Davidson, NC

Anxiety doesn’t have to run your child’s life and call the shots in your house. If you feel like you’re bending over backwards to avoid things that set off your child’s worries, therapy can help. Kids can learn coping skills to feel more in control of anxiety and panic, like the ones I teach in Worry-Free Tweens, my online class for kids.

Child-friendly styles of therapy like Play Therapy and Cognitive Behavioral Therapy have been proven to help anxious kids feel better in a relatively short period of time. With a little practice, your child won’t have to dread their next panic attack, because she’ll know exactly what to do if she feels one coming on.

I love helping anxious kids and tweens in my Davidson, NC child therapy office. I also provide play therapy and CBT online to kids throughout North Carolina, New York, and Florida. I use these approaches because I’ve seen them work, and I know they’re effective. Whether you work with me or another counselor, I hope your family finds therapy helpful, too.

Questions? Ready to schedule an appointment? Reach out to me here.

Signs of Social Anxiety Disorder in Children

How can you tell whether your child is just shy, or if there’s something more going on? If you’ve noticed your child lingering on the edges of the playground or appearing uncomfortable during playdates, you might wonder if social anxiety is to blame. Social anxiety affects about 7% of Americans, and it often starts during late childhood or the teen years.

This post will cover the common symptoms of social anxiety and how they show up in younger kids. You’ll learn what to keep an eye out for, and how to spot the difference between true social anxiety and run-of-the-mill shyness.

How to Tell If Your Child Is Shy…

Kids who are shy have trouble meeting new people. While their shyness may pop up with close friends and family, it’s usually the most noticeable when talking to an unfamiliar person. Shy kids may have a hard time initiating conversations, or responding when an adult says hello. However, after spending some time with a new person, many shy kids are able to warm up and interact more comfortably.

Kids who are shy may appear soft-spoken or socially awkward at times, but their troubles are usually mild or fleeting. Shyness doesn’t usually cause major problems in a child’s life, or keep them from making at least a few good friends. Over time, many children may outgrow their shyness altogether.

…And How to Tell If Your Child Has Social Anxiety

On the flip side, kids who have social anxiety fear judgment from others. They worry about embarrassing themselves or making a mistake in front of friends, teachers, and even strangers. You may hear a socially anxious child worrying aloud about doing something wrong. This fear can be paralyzing, and it doesn’t usually get better on its own.

Because socially anxious kids fear judgment, they can definitely have a hard time talking to friends or meeting new people. However, they can have a hard time with other public activities, too. The “social” in social anxiety refers not just to friendships, but any activities that involve being observed by others. This can include things like reading out loud in class, participating in gym class, or even eating in restaurants or using public restrooms.

Signs and Symptoms of Social Anxiety Disorder

Therapists use a manual called the DSM-5 to diagnose children with Social Anxiety Disorder and other mental health problems. It tells us how many symptoms a child needs to have, and gives us a handy bullet point list of what exactly those symptoms are. It also tells us how long those symptoms need to last in order to be considered social anxiety.

Here are the “official” symptoms of Social Anxiety Disorder, according to the manual:

• Intense and ongoing anxiety about social situations due to a fear of being judged or humiliated

• Avoiding situations that trigger this anxiety, or tolerating them with distress

• The fear is exaggerated or out of proportion to the actual situation

• The anxiety gets in the way of completing day-to-day activities

In order to qualify as social anxiety, the symptoms need last for at least 6 months. There also can’t be a better reason for the anxiety, such as a physical problem or the side effect of a medication.

What Social Anxiety Looks Like in Kids

Okay, now that we know the “official” symptoms of social anxiety, let’s talk about how they actually show up in children. Some kids with social anxiety might be very vocal about their worries, which makes it easier to figure out what’s going on. Others might have a harder time putting feelings into words—or they may feel too embarrassed to talk about it.

Here are a few common scenarios that illustrate what Social Anxiety Disorder may look like in children:

• Your child loves school and learning, but absolutely dreads class presentations. He gets flushed and visibly anxious when he has to read aloud, and stumbles over his words. You have noticed he avoids these projects at all costs, even in classes where he excels. In fact, he always seems to get sick on presentation days.

• You’ve noticed your child is extremely worried about what others may think of her. She feels like all eyes are on her, even in situations where most of her peers probably have other things on their minds. Her thoughts tend to jump to the worst-case scenario, and assume other people are critical of how she dresses, what she says, or how she acts.

• Your child avoids trying out for sports or the school play, even though you have a feeling he’d love to join. Being “in the spotlight” is just too overwhelming for him, and he’d rather be able to participate without anybody looking at him. You’re worried he might be missing out on a lot of fun.

• It’s hard for your kid to order food at a restaurant or answer the phone. You’ve offered a lot of encouragement, but it’s still seems like it’s way harder for her than it should be. You’ve noticed other kids the same age don’t have the same struggle.

• Your younger child throws tantrums when it’s time to go to a birthday party or other social event. It’s hard for him to articulate why, but he dreads going. He complains of headaches and stomach aches, and starts feeling on edge the night before it’s time to go.

Do any of these sound like your child? If so, chatting with a children’s therapist can help you confirm whether or not your child is dealing with Social Anxiety Disorder.

Counseling for Kids with Social Anxiety

Counseling can help your child to overcome her worries, so she can participate more fully in life without a fear of being judged. Therapy approaches like cognitive behavioral therapy can help kids learn how social anxiety affects their thoughts. It can be a big relief for socially anxious kids to realize that, most of the time, other people are focused on their own lives and not thinking negatively about us at all!

Younger children with social anxiety can benefit from play therapy, too. Even if it’s too hard (or embarrassing) to talk about worries out loud, children naturally express their anxieties through their play. A play therapist can help kids work through these feelings in a non-threatening way, and even use play and storytelling to help kids learn coping skills to manage their worries.

If coping skills sound like the way to go for your child, you can also check out my online coping skills courses. My anxiety skills course, Worry-Free Kids, is a good fit for older kids with social anxiety.

I’m a CBT and play therapist in Davidson, North Carolina. I love helping kids with anxiety to learn that they don’t always have to listen to the worries that anxiety gives them. I get to see kids build their self-confidence and face their fears every day in my office, which is part of why I love my job. Even if you don’t live in the Lake Norman area, I may be able to help: I offer throughout North Carolina, New York, and Florida.

If you are ready to take the next step with counseling for childhood social anxiety, you can reach out to me here to set up an appointment.

Does My Child Have Generalized Anxiety Disorder?

If you’ve been spending what feels like an overwhelming amount of time talking through your child’s worries, you might be wondering about Generalized Anxiety Disorder. It’s a pretty common mental health disorder, but it can sometimes be tricky to spot. Unlike other forms of anxiety, kids with generalized anxiety aren’t dealing with one specific fear. Instead, many day-to-day events can be the source of their worries. Today I’ll be writing about the signs and symptoms of Generalized Anxiety Disorder (GAD), and how you can help your child with anxiety.

When Does Worrying Become a Problem?

As uncomfortable as it feels, anxiety is a healthy emotion to have. If we never felt anxious, we’d have no inner voice letting us know when a situation is potentially dangerous. Kids are still learning about the world, so it makes sense that they’d be on high alert in new situations. It’s totally normal, age-appropriate, and even healthy for kids to worry sometimes.

Very young children usually worry about being away from their parents. By preschool, fears of animals, monsters, and the dark become more common. Grade schoolers often worry about more complex, “real world” fears like germs, serious illness, natural disasters, and kidnapping.

Kids with generalized anxiety worry about these common topics, too, but the nature of their worrying is different. While many kids might focus on a single worry for a few weeks or months and eventually move on, kids with GAD seemingly worry about everything.

They have a laundry list of worries, both big and small. Parents of kids with GAD may notice that their child’s stress level seems out of proportion to the actual situation, and it’s hard get that stress under control. The worry these kids experience is so intense that it affects their sleep, and can even lead to physical problems like tension headaches and fatigue.

Symptoms of Generalized Anxiety Disorder

Therapists use specific criteria to diagnose mental health problems like anxiety and depression. Here are the symptoms we look for when diagnosing Generalized Anxiety Disorder:

• Excessive worrying and anxiety about a variety of topics, events, or activities. The worrying has to happen most days, and last at least 6 months.

• The worries are very difficult to control—the child can’t easily shift away from them.

• The anxiety affects the child physically or mentally in at least one of the following ways:

  • Feeling on edge

  • Fatigue

  • Trouble concentrating

  • Irritability

  • Body aches, or muscle tension

  • Problems falling or staying asleep

• The anxiety (or the physical and mental problems it causes) get in the way of a child’s day-to-day life, and make it harder to participate in activities at school or home.

• There isn’t a more obvious reason for the worrying, such as a recent trauma.

Signs of Generalized Anxiety Disorder in Children

Here are a few more signs that might suggest generalized anxiety is to blame for your child’s worries. If your child is struggling with GAD, you might notice:

• A lot of time spent worrying about things that could happen in the future, whether or not they seem very likely to happen.

• Frequent complaints of headaches, tummy troubles, or other problems that don’t seem to have a medical cause.

• Your child seems to worry more often and more intensely than other kids of the same age, and has a harder time setting his worries aside.

• As soon as one worry gets resolved, another seems to rise up to take its place. The worries shift rapidly from topic to topic.

• Your child is extremely worried about bad things happening to herself or to you, even if you’ve never been in a dangerous situation before.

• Mildly stressful events at school cause major anxiety, for example, a test, big project, or a competitive game.

How Parents Can Help Kids with Generalized Anxiety

Kids who have generalized anxiety need help to relax, so they can ease their muscle tension and sleep more peacefully. Parents can help their kids develop healthy coping skills to relax the body and mind, like mindfulness, deep breathing, and progressive muscle relaxation. Trying one of these skills out one time might help a little bit, but kids with GAD will likely need daily practice in order to see results.

We know that sleep has a big impact on mental health, and sleep-deprived kids (and adults) are more prone to anxiety and depression. Kids with generalized anxiety can fall into a vicious cycle, where the anxiety causes poor sleep, and the poor sleep causes even more anxiety. Using relaxation skills at bedtime can help kids get in the right mindset to drift off—muscle relaxation and guided visualizations are especially helpful for this.

These skills will be even more helpful if they’re part of a “settling routine”: a simple ritual you and your child share each night. The repetition of the same routine sends a signal to your child’s brain that it’s time to unwind and go to bed.

Start Child Counseling in New York, North Carolina, or Florida

So, you’re noticing some signs of generalized anxiety in your child…where do you start looking for help? For some fast relief while you’re looking for a therapist or considering next steps, consider teaching your child some coping skills to deal with anxiety. My online course, Worry-Free Tweens, was designed especially for kids ages 8-12 and their parents. In it, you’ll find step-by-step directions for both you and your child on how to manage anxiety, panic, and overwhelming worries at home.

Kids who have been anxious for a long time may need more than a few coping skills to get back on track. Counseling can help kids stop the endless cycle of worry and learn to feel more in control of anxious thoughts. Younger children can work through their fears and practice coping skills through Play Therapy, while older kids can develop lifelong tools for anxiety management with Cognitive Behavioral Therapy.

I love working with anxious kids and tweens in my Davidson, NC office. Not within driving distance? I also provide online counseling services, and can see kids in New York and Florida remotely, too. If you’d like to get started, or you have any questions, feel free to reach out to me here.

Explaining CBT to a Child: 4 Topics to Talk About

Cognitive Behavioral Therapy, also known as CBT, is one of the most effective forms of therapy for children with anxiety. There’s a mountain of research behind it to prove that it helps kids with a variety of anxiety-related problems, from tantrums and acting-out behavior to worrying and sleep difficulties. Although it’s helpful for all ages, studies show it’s especially effective for kids in the 11-13 age range. Maybe that’s why I’m such a big fan of using it in my tween therapy practice!

If you’re reading this post, maybe you are intrigued by CBT, too. It’s possible it’s been recommended to you by your pediatrician, or perhaps you’ve discovered it by Googling around for anxiety treatment for kids. However you learned about it, you might be wondering how to discuss it with your child. As helpful as CBT is, it’s also full of intimidating-sounding therapy jargon. In this post, I’ll break down some of the main concepts in a child friendly way, so your child will be ready to rock their first CBT therapy appointment!

What is Cognitive Behavioral Therapy?

Cognitive Behavioral Therapy is a skill-based therapy that’s used with both kids and adults. It’s a way of dealing with anxiety that’s focused on the present, rather than the past. You probably won’t spend a ton of time in CBT talking about family history and early childhood, because uncovering the root of where anxiety comes from isn’t the main goal of this style of therapy.

Regardless of where the anxiety came from, anxious kids need strategies to deal with it. That’s the main goal of CBT: learning tools to cope with anxiety when it arises, both now and in the future. Although it sounds simple, the effects of CBT can be really deep. Research shows that 70-80% of kids respond well to CBT, and they often see lasting results from short-term therapy. In my experience, learning the right coping skills often leads to an “aha” moment for kids. They start to understand how their own anxiety works, and that they have a say in how they think and feel, which is really empowering.

Common CBT Techniques

A child in CBT therapy might learn any or all of the following techniques:

• Relaxation techniques to calm the body

• Mindfulness or grounding skills to focus attention during times of stress

• Keeping a journal or written log to track worries at home

• Practicing “cognitive restructuring”, a way of transforming unhelpful worries

• Gradually exposing themselves to things that trigger anxiety

• Using roleplay to practice skills

• Doing “experiments” in real life to test if their fears really come true

Okay! Now that you’ve got an overview of what CBT is and how it works, let’s move on to talking about how to discuss it with your child. The next 4 sections cover what I think are the most helpful concepts for children to understand about CBT.

CBT Topic #1: The Cognitive Triangle

Most children view their emotions as something that come out of the blue. They come and go, sometimes without good reason, and they’re difficult or impossible to control. Heck, many adults feel this way about their feelings, too: how many times have you heard someone say that something “made them angry” or “made them anxious”? Many of us feel pretty powerless when faced with strong emotions like anxiety and anger.

However, it’s not really true that our feelings come out of nowhere. Any time something happens to us, all day long, we have a thought about it. It’s our thoughts that tell us how we should feel about what’s going on. Most of the time, this process works great and our thoughts let us make accurate judgment calls about situations. But for anxious kids, overly negative thoughts might lead them to feel anxious when they don’t really need to be.

The cognitive triangle is a map that shows how our thoughts, feelings, and behaviors are all connected to each other. Our thoughts tell us how to feel, our feelings influence how we act, and then our actions play a big role in how we see the world and future thoughts we might have. Teaching a child about the cognitive triangle is a great first step when introducing them to CBT.

You can use the cognitive triangle to show how different people can have the same experience, but end up feeling and acting different ways based on their thoughts. For example, a child who loves animals might see a dog sitting on the sidewalk and think “Cute, I love dogs!”. This would make her feel excited and happy. She might walk up to the dog and pet him. Another child who was bitten by a puppy in the past might see the same dog and think “Oh no, he could bite me!”. That would make him feel anxious and afraid. He’d probably cross to the other side of the street to avoid getting near the dog.

Learning and practicing the cognitive triangle helps kids understand that there’s no one “right” way to respond to a situation. It can also help them to notice the vicious cycles that sometimes form when a person is anxious. For example, if the boy in the story above keeps avoiding every dog he sees, he will never get the chance to learn about all the friendly dogs that exist in the world. He may just keep on fearing dogs forever.

CBT Topic #2: Thoughts or Actions Can Change Feelings

Once a child knows about the cognitive triangle, you can move on to the next step. Our thoughts, feelings, and actions are all connected, which means that changing one of those things changes the others. It’s pretty hard to change a feeling: just telling someone to stop being anxious probably isn’t going to work! It’s easier to change our thought or change our actions, and deal with the anxiety that way.

Your child can change her thoughts by learning how to spot worries and turn them into something more useful. She can change your actions by learning coping skills to relax her body and focus on something besides her worries. Either way, she’ll be helping herself to shrink her anxiety down, or turn it into a more helpful feeling to have.

CBT Topic #3: Talking Back to Worries

In CBT, kids learn a process to change their thoughts called “cognitive restructuring.” Because this is pretty much the least child-friendly term ever, I usually just refer to it as “talking back” to thoughts. To practice this technique, kids first need to get skilled at noticing when they’re having a worry. Next, they learn how to gauge whether or not their worry is realistic or not—usually, it isn’t! Finally, they come up with something that is more helpful and realistic they can say to themselves instead.

You can tell your child that in CBT, she’ll learn she doesn’t have to believe everything her worries tell her. Therapy will help her learn how to spot worries, and decide whether or not they’re worth listening to. She’ll learn how to “talk back” to the unhelpful ones, so that they won’t boss her around anymore. Tiger-Tiger, Is It True? is a great book for introducing this concept to preschoolers and early elementary-aged kids. Older kids might benefit from giving my coping skills course a try, where I cover this subject in detail and talk about how to try “talking back” to worries at home.

CBT Topic #4: The Feelings Remote Control

I often use this “remote control” analogy when I’m talking about coping and relaxation skills with kids. Activities like deep breathing, muscle relaxation, and guided visualization are one way that we can change our behavior in order to improve our mood. It can help kids understand the reason we’re always asking them to do things like “take deep breaths.”

When we’re hit with a really intense emotion, sometimes focusing on it just makes it get worse. Kids with anxiety are prone to doing something called ruminating: going over their worries again and again, which magnifies them. Coping skills work like a remote control that helps kids to “change the channel” on their feelings by shifting them into another emotional state. They can also work to “turn the volume down” on an intense emotion, to make it more manageable.

Most kids are familiar with remotes and how they work, which makes these terms helpful shorthand when you’re trying to help your anxious child. Relaxation skills like breathing and muscle relaxing can help turn down the volume, while music, exercise, and guided visualization can help to change the channel.

OK, You’ve Explained CBT to Your Child. What’s Next?

You’ve walked your child through the basics of Cognitive Behavioral Therapy. What’s the next step? If you know this is the approach for you, you can look for a therapist that specializes in CBT on therapist directories like Psychology Today.

If you live in New York, North Carolina, or Florida, I might be able to help you at my tween therapy practice. I love helping kids learn CBT, because these skills don’t have an expiration date: they can help kids manage anxiety and worries for the rest of their lives. That is pretty cool! If you’re not located in a state where I’m licensed, you might like my CBT-inspired coping skills course. It’s a self-guided class (not therapy) for parents and children that teaches my favorite techniques for managing anxiety at home.

I could chat about CBT all day, so if you are curious, feel free to reach out! You can ask a question or request an appointment here.

Signs of Separation Anxiety in Older Kids and Teens

The term “separation anxiety” might conjure up images of a toddler crying in the window as you pull out of the driveway. While it’s true that separation anxiety is super common in preschool kids, older children and even teenagers can be affected by it, too. As I’m writing this post, we are (still) in the middle of the COVID pandemic, which has kept kids of all ages at home with their parents for most of each day. I’ve noticed more older kids and teens coming into my virtual office these days with separation anxiety struggles. In this post, I’ll share some signs to look out for if you suspect that Separation Anxiety Disorder is the cause of your older child’s worries.

How Common is Separation Anxiety in Kids and Teens?

Separation anxiety is so common in young children that it’s considered a normal part of child development. In fact, it can be seen as a positive sign: it means that a child feels attached to his caregiver, which is always a good thing.

Historically, little children have needed to stay in close proximity to their parents in order to survive. Feeling anxious about being far away from a parent makes sense! This is why we often talk about separation anxiety in little kids, but don’t usually start referring to it as Separation Anxiety Disorder until about age 6.

Separation Anxiety Disorder is pretty common among older children. It affects roughly 4-5% of American kids between the ages of 7 and 11. If your tween child is struggling to leave home and do things away from the family, she’s not alone.

The older kids get, the less common Separation Anxiety Disorder seems to be. About 3.9% of young teenagers (12-14) are dealing with separation anxiety symptoms. The numbers go down even further for older teenagers, to about 1.3% for teenagers ages 14-16. Although it used to be considered a children’s condition, some research suggests that a small percentage of adults continue to struggle with Separation Anxiety Disorder into adulthood.

What Causes Separation Anxiety In Older Kids?

There’s no single cause for separation anxiety in older kids. As is the case with many mental health problems, a combination of genetics and life events seem to make some children more vulnerable to it than others.

Some children may simply be born with more anxious temperaments than others, kids can inherit these anxious traits from their parents. Kids with Separation Anxiety Disorder are more likely to have other types of anxiety disorders as well, like Obsessive Compulsive Disorder, Agoraphobia, and panic attacks. IF a child is naturally worry-prone because of their biology, they’ll be more predisposed to all these forms of anxiety.

Children who have been through stressful situations are also more likely to develop separation anxiety. Trauma experiences—especially ones that involved a child being separated or removed from a parent—can make it much harder for a child to be away from parents in the future. The loss of a loved one can also prompt children to cling more closely to surviving family members. Sometimes, less serious changes can also trigger separation anxiety, such as a big move or switch to a new school.

Both genetics and environment are usually to blame for separation anxiety. If your child has a naturally anxious temperament, they may be able to cope just fine as long as life remains calm. However, a big disruption can really activate their anxiety, and sensitive kids may have a harder time bouncing back. These kids may try to cope with their overwhelming anxiety by staying close to a parent, which can sometimes get in the way of day-to-day life.

What Are the Symptoms of Teen Separation Anxiety?

We all know that the major symptom of separation anxiety is fear of being away from a parent, and this is true for all kids from toddler age through the teens. However, all kids are different, and separation anxiety can manifest in various ways based on age.

Older children and teens may be less likely to voice their worries about being away from parents. This might be due to embarrassment or shame about struggling with something seen as babyish. Parents may need to look to their child’s behavior for clues that Separation Anxiety Disorder is behind their teen’s struggles.

Here are the symptoms that therapists use to diagnose Separation Anxiety Disorder in kids and teens:

• Anxiety about being away from an important caregiver that is excessive and not typical for the child’s age. This can lead kids or teens to avoid separating from parents altogether.

• The anxiety or avoidance is persistent and lasts at least 4 weeks.

• The child or teen suffers negative consequences due to their anxiety, and it may interfere with school, work, or friends.

• The problems aren’t better explained by another reason or another form of anxiety.

Now that we know the symptoms to look for, let’s see how these problems might look in teenagers or older kids.

Signs of Separation Anxiety to Look Out For

Here are a few signs of teen separation anxiety to look out for:

• Refusing to go to school: this is a big one. Plenty of teenagers are reluctant to go to school for all kinds of reasons. If your child’s dread about school looks more like anxiety or sheer panic, without a clear reason, social anxiety could be an underlying cause.

• Worrying about the health or safety of family members: many kids with separation anxiety fear that something terrible will happen to their caregivers if they let them out of their sight. This can be true for teens, as well. Teens are more able to imagine worst-case scenarios than younger children. They may be especially prone to these worries if they’ve survived a trauma or experienced the serious illness or injury of a family member.

• Fears about kidnapping or getting lost: teens are very aware of stranger danger and other safety risks. If their anxiety levels are high, they may be overly worried about their safety when they are away from home. The fear is out of proportion to the situation, and might hold them back from going on outings alone.

• Body symptoms: for some people, anxiety mainly shows up as physical illness rather than emotional upset. If that’s the case for your teen, you’ll likely notice that the symptoms start shortly before a separation and resolve once the threat of being away from parents has passed. Of course, it’s always a good idea to rule out medical causes before assuming this is a sign of anxiety.

• Avoiding outings with friends: difficulty being away from home might lead teens to turn down social invites they would otherwise be interested in. It may be too anxiety-provoking to participate in activities if you aren’t there, too. This can negatively impact a teen’s social life.

• Meltdowns: you may notice your teen having meltdowns when it’s time to leave the house. They may seem unexpected for your child’s age, and even resemble the tantrum of a younger child. It’s a sign your child is so overwhelmed with anxiety that she’s moved past her ability to cope.

Begin Counseling For Teens With Separation Anxiety in North Carolina

Whether it’s due to an anxious temperament, life stress, or the pandemic, counseling can help anxious kids and teens get back on track. It’s really satisfying to watch teens master their separation anxiety through cognitive behavioral therapy. Sometimes, the process is surprisingly quick once teens feel empowered and they have the right tools!

If you are looking for therapy for a preteen or young teenager, I may be able to help at my Davidson, North Carolina counseling office. If your family lives anywhere else in North Carolina, New York, or Florida, we can meet virtually in my secure telehealth platform. If you’d like to learn more, contact me here. I’m always happy to answer questions!