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.

TF-CBT for Preschoolers: Therapy for Early Childhood Trauma

TF-CBT is designed to help preschool children as young as 3 and 4 years old after a trauma.

Preschool Trauma is Common

Trauma is one of the leading causes of mental health problems in children, and TF-CBT for preschoolers can help support the many young children who find themselves affected by trauma each year. Learning that a preschooler has experienced a trauma is terrible news for any parent. As caregivers for children, we do everything possible to shield the young people in our lives from danger. Despite our best efforts, sometimes life happens in ways we didn’t expect or hope for: accidents, violent situations, grief, and loss are not always preventable, and can affect people of any age—including preschool children. Statistically, 26% of kids in the United States will witness or experience a trauma before the age of 4.

Some common causes of childhood trauma among preschoolers are:

• Prolonged separation from a parent due to illness, incarceration, or foster care placement

• A severe accident or illness, such as a car accident or cancer

• Physical, verbal, or sexual abuse

• Witnessing physical or verbally abusive arguments between parents

It’s important to know that preschoolers can be just as affected by witnessing a parent’s trauma as they would be if the trauma happened to them directly. Very young children are so connected to their parents that their own sense of self and safety is wrapped up with their parents’ well-being. Seeing a parent in trouble can be intensely frightening and painful for a preschool-aged child, and can be just as likely to result in trauma symptoms.

How PTSD Affects Preschoolers

While some preschool children will “bounce back” fairly easily from their trauma experience, others might show lingering problems long after the initial event has passed. Trauma symptoms can impact any child’s life, but younger children may especially vulnerable to developing symptoms. Other factors that make trauma symptoms more likely include having special needs or sensory sensitivities, experiencing other life stresses, and having a previous history of trauma or loss.

How can you tell if a preschooler in your life has trauma-related symptoms? Very young kids may not be able to tell us in words what they are going through, but will communicate their trauma through tantrums or crying, difficulty sleeping, frequent nightmares, or problems paying attention or following directions. Parents often observe that their child seems to “regress” to an earlier developmental stage after a trauma, and may suddenly struggle with problems they had previously grown out of, such as potty training or sleeping through the night.

Lots of research has been done on the subject of early childhood trauma. We’re learning that even the youngest children can be just as deeply affected by trauma as older children and adults. Fortunately, we’ve also discovered that preschool-aged children can benefit greatly from age-appropriate trauma therapy tailored to their developmental level. One of the best-researched forms of therapy for preschool survivors of trauma is Trauma-Focused Cognitive Behavioral Therapy, or TF-CBT.

What is TF-CBT, and How Can it Help Preschool Children?

TF-CBT is a form of therapy designed specifically to help children ages 3-18 following a traumatic event, and it can be an especially big help for children in the preschool and early elementary age range. It is an evidence-based form of therapy, meaning that it has been proven effective by research to help children with these symptoms. Through TF-CBT, preschoolers and their parents learn skills to cope with trauma symptoms, helping the child to alleviate anxiety, manage worries, and cope with strong feelings. The parent and therapist gradually assist the child in expressing their thoughts and feelings about the traumatic event and make sense of what happened, so that it no longer feels like an overwhelming experience.

TF-CBT tailored for preschoolers puts a strong emphasis on educating both children and parents about how trauma can cause problems problems with their bodies as well as their feelings. This can be extremely helpful for young children, who may feel quite confused by their symptoms and alone in their experience. Educating children about trauma in an age-appropriate way helps children understand that they are not alone—many other young children have walked in their shoes, and have recovered from trauma to live happy and fulfilling lives.

How does TF-CBT for Preschoolers Work?

During treatment with TF-CBT, preschoolers are taught how to use relaxation and mindfulness techniques to reduce anxiety and mood swings during the day and promote restful sleep at night. While these relaxation skills are used initially to reduce symptoms of trauma, they are also a great life skill that can grow with the child, helping them to manage other stressful situations as they arise.

Since younger children may have more difficulty putting feelings into words and making connections between past and present experiences, TF-CBT for preschoolers relies more on art and play-based activities to help children identify important feelings and develop a better understanding of their experiences. Through art and play activities facilitated by a therapist, the child can work through any misconceptions about their trauma experience, alleviate feelings of guilt or self-blame, and find a sense of closure.

Helping Preschoolers Move Beyond Trauma with TF-CBT

While therapy cannot make a young child forget what has happened to him, it can take some of the power away from a traumatic experience. It can help a child move past this difficult time in their lives and toward other, more hopeful chapters. Many parents and children find that after working through a traumatic event in therapy, children develop more resilience and empathy for others. Children and parents complete the TF-CBT process together by reviewing the child’s growth and learning strategies to help the child stay safe and avoid dangerous situations in the future.

If you’d like to learn more about how to support your preschooler with trauma through TF-CBT, my door is always open. You can also learn more by visiting the official website for TF-CBT.

Therapy for Toddlers with PTSD: Child-Parent Psychotherapy

A Special Therapy for Toddlers with Trauma Symptoms

Can Toddlers Have PTSD?

Trauma has become a buzzword among people who care for children. In the past, the word “trauma” was usually reserved for experiences most common among adults, like war and violent crime. Now, mental health professionals understand that many other frightening experiences, such as abuse, medical emergencies, and witnessing accidents or violent arguments can lead to trauma in people of all ages. In this post, I’ll be discussing how therapy can help toddlers with trauma symptoms and PTSD following one of these experiences.

Doctors, teachers, counselors, and parents are becoming increasingly aware of the ways that traumatic experiences like these can affect children's physical and emotional health. Even children's television programs like Sesame Street have recognized the impact of trauma on young children, and have started to address difficult experiences like grief, foster care, and incarceration in episodes. As hard as it might be to imagine, trauma and PTSD can affect even very young children—including toddlers.

How Trauma Affects Toddlers

Studies have shown that exposure to extremely frightening or violent events impacts a child's ability to learn, form close relationships with family and friends, and can even make kids more susceptible to chronic illnesses later in life. Separation from a parent, even when it isn’t due to a violent or scary cause, can also have similar effects on a child. We also know now that these effects last for a long time: even if a toddler is too young to remember the traumatic event, he may suffer from trauma symptoms like tantrums, anxiety, difficulty bonding with parents, or problems with sleep for years to come if he does not receive the help he needs to move forward.

Therapy for Toddlers with PTSD

While there are quite a few forms of therapy to help older children cope after a trauma, it can be hard to find therapy that is a good fit for very young children. Toddlers often have a hard time putting their feelings into words, and need specialized therapy that incorporates play and nonverbal techniques to help make sense of traumatic experiences, as well as coping skills to manage strong emotions. Child-Parent Psychotherapy is one of the only forms of therapy specially designed for the youngest kids--children under the age of five--who have survived a trauma or loss.

Child-Parent Psychotherapy, or CPP, is a form of play and talk therapy for children ages 0-5 and a parent or caregiver. It is a dyadic therapy, which means that typically the child and parent participate together with support from a therapist. CPP aims to strengthen the bond between parent and child after a frightening event. Because parents are so central to young children's lives, they are especially equipped to help a child return to healthy growth and development.

How Child-Parent Psychotherapy Works

Through CPP, toddlers with PTSD symptoms rediscover how to feel safe and protected after a trauma, and make sense of what has happened to them in an age-appropriate way. Learning coping skills to help the child relax and manage emotional outbursts is another important goal of CPP. Parents can also get support for themselves through caregiver coaching sessions, where they have the opportunity to cope with their own feelings about what happened and receive tips from the therapist on how to handle behavior problems related to trauma.

CPP is an evidence-based therapy, which means that it has been proven effective by scientific research. While not every form of therapy works for every person, CPP has been used successfully with kids from many different cultural backgrounds, and to help with a variety of traumatic events including domestic violence, grief, abuse or neglect, parental separation, and serious accidents. It can be a helpful therapy for children with biological, foster, or adoptive parents, and even a caring relative can serve as a support system in CPP sessions.

Therapy for Young Children After Trauma in Davidson, NC

Coping with a trauma or loss can be an extremely challenging situation for people of any age, but parents with toddlers don't have to struggle with this alone. If you think your young child might benefit from therapy for toddlers with trauma symptoms, please don't hesitate to reach out to me and learn more about this approach. You can also learn more about the impact of trauma on children and how therapy can help here.

Help! My Child Won’t Sleep Through the Night!

It’s 9pm. The homework is done, the dishes are washed, and your kiddo is bathed and tucked into bed. Stories have been read! Cuddles have been given! You’ve made it to the end of the day! Time for a celebratory Netflix episode, or a chapter in that book you keep telling yourself you’re going to finish…and then you hear the pitter patter of little feet in the hallway, and your door creaks open.

Does this sound familiar to you? If so, you are not alone! In this post, I’ll be sharing suggestions to help a child who can’t sleep through the night.

When Your Child Can’t Sleep Alone, Bedtime Becomes a Problem

Insomnia is one of the most common concerns I hear about in my child therapy office. This can mean a child is having trouble going to bed, falling asleep, or staying asleep. Sometimes, a child is able to fall asleep with no problem—as long as a parent stays in the room all night long.

Insomnia is a frequent complaint for both kids and adults, but children’s sleep problems can be especially tough on a family. When a child isn’t sleeping well, it weighs on everybody in the household. Not only is the child not getting enough sleep to function, but parents and siblings may also be getting their rest interrupted by the child’s frequent waking,. This maked things harder for everyone the following morning.

The Insomnia Vicious Cycle

Many of us will have trouble sleeping at some point in life, especially when we’re stressed. Sometimes, a child’s sleepless nights resolve by themselves once the stress is gone. For other children, sleep problems are not so easily solved. The insomnia can go on for weeks, months, or longer.

Sleep is important to a child’s emotional well-being, children who have trouble sleeping for prolonged periods often enter a vicious cycle. The lack of sleep leads to increased anxiety and difficulty concentrating, which in turn makes it even harder to sleep the following night. With help from parents, and sometimes with extra support from a child counselor, children and families can break this cycle, and help everyone to get a better night’s sleep.

Sleeping Through The Night Helps Children’s Physical and Mental Growth

Good quality sleep is especially important children who are still growing. It has a direct impact on their ability to grow physically, mentally and emotionally. During sleep, kids release growth hormones that they need to develop and mature. Sleep is also critical for learning. It helps children to retain and store information they’ve learned, and makes them more able to focus and learn at school the next day.

Sleep is really important for kids’ emotional health, too. Sleep problems can contribute to anxiety, depression, and ADHD. In fact, poor sleep can even trigger emotional problems, and make it more difficult for people to cope. Studies have shown that disturbed sleep can lead to symptoms of depression, and that depressed people who aren’t sleeping well are less likely to respond to treatment than those who are getting a good night’s rest.

How Much Sleep Do Kids Need Each Night?

More than you might think! No two kids are exactly alike, and different kids may be able to get by with different amounts of sleep. The National Sleep Foundation has set guidelines to help make sure your child’s sleep time is in the right ballpark.

For toddlers between ages 1 and 2, the Foundation recommends 11-14 hours of sleep per day, which usually includes a daytime nap. Preschoolers (age 3 to 5) generally need 10-13 hours a day, and may still nap.

By elementary and middle school (age 6 to 13), it is recommended that children sleep between 9 and 11 hours a night. You know your child’s rhythms best. Helping him to establish a healthy sleep schedule within these guidelines will ensure that he’s getting the rest he needs to grow, both physically and emotionally.

What Causes Childhood Insomnia and Sleep Problems?

Many children have difficulty falling or staying asleep at some time in their lives—this is a really typical problem! Here are a few common reasons children can’t (or won’t) sleep through the night:

Anxiety: Many children appear nervous or downright fearful as bedtime approaches. Separation anxiety, a fear of being away from parents or loved ones, is common in younger children. It can sometimes manifest as reluctance to go to bed, a fear of being alone, or a fear that something bad will happen if the child is out of sight of the parent.

Other forms of anxiety, like generalized anxiety and OCD, can also make it harder for children to sleep. If a child seems nervous or afraid at bedtime, is bothered by lots of worries at night, or needs to complete a long or elaborate bedtime ritual in order to feel comfortable going to bed, anxiety might the source of their difficulties.

Media: Kids often have vivid imaginations, which is a great strength. Sometimes, though, a very active imagination can make children more prone to sleep problems. For children with rich fantasy lives, the lines between reality and pretend are easily blurred. These kids may be more sensitive to the effects of scary movies, violent video games, and stories shared by children at school. Their fears of scary characters may last long after the movie ends, and often intensify at bedtime.

Behavioral Causes: Sometimes, without meaning to, children and parents fall into a nightly routine that has to be repeated in order for the child to feel ready to sleep. For example, a child whose mother lies in bed each night until she falls asleep may start to link mom’s presence in bed to the idea of sleep, and soon this becomes a requirement for bedtime every night. Once the child has unconsciously connected this behavior with falling asleep, she won’t be able to drift off until it’s been done.

Physical Causes: Just like adults, some kids are naturally night owls while others are morning people, and this can impact sleep habits. According to this article from Today’s Parent, a small minority of children with sleep problems may have an underlying medical reason, such as sleep apnea or restless leg syndrome. If sleep problems persist for a long time, or you notice any physical symptoms such as difficulty breathing, it’s a good idea to schedule a checkup with your pediatrician to rule these conditions out.

Trauma: Rarely, a traumatic event can be the cause of disturbed sleep. Children who have experienced a trauma often become fearful at bedtime, have trouble falling asleep, and are bothered by night terrors or other bad dreams that may or may not have anything to do with what they’ve experienced. If the sleep problems are accompanied by other symptoms, such as bedwetting, tantrums, or anxiety, trauma should be ruled out as a possible cause. You can read more about the impact of trauma on children here.

How Can I Help My Child Sleep Better at Night?

Sleep problems take time to develop, and so they also take some time and patience to resolve. Anxious children benefit from a bedtime routine that is consistent, predictable, and includes opportunities to soothe and relax before bed. Creating a visual chart of the bedtime routine can also be a good way to help kids shift gears and get ready for sleep.

For imaginative children with fears about monsters or other “bad guys”, it can be a big help to talk about the difference between “real” and “pretend” and offer reassurance that scary events from TV will not happen in real life. Some children are also very motivated by reward charts. Children may “buy in” to the idea of sleeping alone more readily if they are able to set a goal for themselves to sleep independently for a certain number of nights in order to earn a prize.

If you have tried these tips and your child still can’t unwind at bedtime, she may need more effective coping skills. My coping skills course for kids helps kids and tweens learn how to relax their body, manage panic attacks, and learn how to deal with unrealistic worries that aren’t likely to ever happen (like that monster showing up in the night).

Begin Therapy for Kids With Insomnia in Davidson, North Carolina

Sleep problems can be exhausting for all involved, but patience and persistence can often turn even the most nocturnal of night owls into a more peaceful sleeper. However, some kids need more than a few coping skills and a consistent routine to resolve long-standing sleep issues. If you’ve been trying tips like the ones in this post for a while with no luck, counseling can help.

Therapy can help your child work through any underlying worries, and increase her sense of felt safety so she can sleep more soundly. I use cognitive behavioral therapy to help kids with bedtime anxiety at my Davidson, North Carolina child therapy office. If you aren’t local, I see kids online throughout North Carolina, as well as in New York and Florida. I also have an educational class called Worry Free Tweens, which can teach coping skills to kids regardless of where you live.

Interested in therapy? You can contact me to request an appointment or get more information.