Worrying is normal but what if your child is chronically overwhelmed or on edge? Signs like a racing heart, gastrointestinal issues, extreme nervousness and obsessive thoughts could mean your child is experiencing anxiety. Even before the pandemic, anxiety was on the rise among kids.
According to a recent study published in JAMA Pediatrics, anxiety among children ages 0-17 increased from 7.1 percent in 2016 to 9.2 percent in 2020.

What if, beyond obsessive thoughts, your child has developed compulsions, engaging in repetitive rituals? Or maybe they avoid certain situations altogether in order to cope. While these behaviors can be signs of obsessive compulsive disorder, or OCD, it can sometimes be tough for parents to distinguish OCD from anxiety. Here, experts explain how to spot the differences, plus treatment options for both.

Anxiety in children can take on many forms, says Joseph Galasso, Psy.D., a clinical psychologist and founder of Baker Street Behavioral Health, a practice with multiple locations in NJ that also offers telehealth. In some kids, anxiety may exhibit as fear or worry, but in others, it can show up as irritability or anger, he says. “This happens because the anxiety is uncomfortable, and the
child does not know how to deal with it yet.”

There is no one way anxiety looks in kids, says Gloria Lopez-Henriquez, DSW, LCSW, a psychotherapist at Ackerman Institute for the Family in New York City. But there are common indications of anxiety in children parents can look out for. For example, younger children may start biting their nails or lips, whereas older children might exhibit a strong attachment to reading or watching television as a way to escape, she says. Children who are fixated on these forms of entertainment might be avoiding certain situations, for instance, playing with other children, says Lopez-Henriquez. “Avoiding socializing with other children because it makes a child anxious may solve the problem in the moment but interferes with the development of coping skills, reinforcing the anxiety over time,” she says. Anxiety can also manifest as difficulty sleeping, fatigue, headaches or stomachaches, says Galasso.

While some kids will be able to tell you they are feeling worried about something concrete such as having to go to school or seeing a particular group of people, not all have the ability to put their anxiety into words, Lopez-Henriquez says. That’s why it’s important to know the signs and talk to your child about how they’re feeling.

We can’t rescue our kids from their feelings around uncomfortable and stressful experiences, but we can empower them with the strength to experience and survive those emotions, says Tzivia Reiter, LCSW, director of Children’s & National Trauma Services at Ohel Zachter Family National Trauma Center in Brooklyn, NY. “If your child has anxiety, the goal is not to eliminate it, but to manage it,” she says.

It’s important to understand your child’s anxiety, Reiter says. To a child with anxiety, the outside world feels scary. “When they’re refusing to go to school, it’s because it feels unsafe to them. They’re not trying to be challenging and difficult, they are in genuine distress.” When they’re feeling this way, try to make your home a place of emotional safety with predictable routines, open communication and physical warmth and connection, she suggests.

Parents need to model that anxiety is a normal emotion, Galasso says. If you’re experiencing anxiety, it’s important to seek treatment and learn to cope. That way, when your child is feeling anxious, you can share an experience where you had similar feelings, and talk about how you coped. “Accommodating the anxiety is not advisable (such as letting your child stay home during a storm if he is afraid of bad weather). Instead, make a plan with your child on how they will manage the anxiety-producing situation,” Reiter says. For example, identify an object that soothes your child that can be used when they feel scared or prepare an activity or object that can be used for distraction, Reiter suggests.

Treatment for anxiety depends on its severity, says Lopez- Henriquez, adding that with children, family therapy is ideal. A therapist can help parents understand how to work through the child’s
anxiety as a family, rather than putting the burden on the child’s shoulders alone, she says.

Treatments for children’s anxiety include Cognitive Behavioral Therapy (CBT), which helps patients develop adaptive behaviors, and Supportive Parenting for Anxious Childhood Emotions (SPACE), which helps caregivers learn to respond effectively to their child’s anxiety.

Children with OCD may have obsessive thoughts, compulsions or both, according to the CDC. Examples include feeling the need to repeat a behavior over and over (like turning a light on and off) and having unwanted repetitive thoughts that cause stress. An estimated 1 in 200 kids has OCD, according to the International OCD Foundation. While it’s normal for a child to express an aversion to a certain activity or object, such as not wanting to wear a certain item of clothing, these behaviors typically fade or evolve in a matter of weeks or months, Lopez-Henriquez says. When a behavior is longer lasting, growing more severe or uncompromising over time, it might be a sign of OCD.

The foremost sign of OCD in children is a repetitive use of rituals or routine to ward off feelings of anxiety about an uncertain future, Lopez-Henriquez explains. The child believes that these routines or rituals will prevent the anticipated event from occurring–they’re an attempt to
control the world around them, she says.

“The most common ritualistic behavior is avoidance. For example, kids might avoid a particular chair or room for fear of contracting an illness in the room. Or they will avoid being near the closet where cleaning solutions and chemicals are kept in the home, because they believe they will die if they get close,” Lopez-Henriquez says. You might also notice a child avoid walking on the floor with bare feet or cleaning their hands very frequently, she adds.

Treatment plans should always involve the engagement of a family therapy professional with specialized training from the get-go, as OCD is more complex, Lopez-Henriquez says.

Treatments for OCD include Exposure & Response Prevention (ERP) and medication, Galasso says. “ERP involves exposing the child to what makes him/her anxious a little at a time until they get more and more comfortable with the feeling. ‘Response prevention’ means that the child is not allowed to do the ritual behaviors they’ve developed,” he explains; eventually, the behavior is extinguished as the child learns strategies to cope with their anxiety.

It’s important to note that OCD does not just impact the child, but also the entire family, Lopez-Henriquez says. “Parents need the support of a family therapist to learn how to support both each other, their child with OCD and any other children they might have.”

For more information about treatment options for anxiety or OCD, visit:
The Child Mind Institute: childmind.org
Anxiety & Depression Association of America: adaa.org
SPACE: spacetreatment.net
International OCD Foundation: kids.iocdf.org

—Heidi L. Borst is a mother and writer based in Wilmington, NC.

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