Helping Your Child with Anxiety
Treatment Options

Treatment Options
 

It can be hard to know whether you need to reach out to a professional when you see your child struggling. And if you do seek help, what kind of treatment is right for your child? There seem to be an endless number of providers who work with children with anxiety and other psychiatric and learning problems.  You might assume, like if your child had a sore throat, that all providers would offer similar treatment options for the same conditions.  Unfortunately, that’s not the case with mental health, which can get confusing even if you have experience with therapy and anxiety yourself!  Here we try to give you the information you’ll need to be able to find the services that have been shown to be effective, or evidence-based, for the treatment of anxiety in children and teens. When you’re ready to start speaking with providers, you’ll be ready with the right questions to ask and you’ll feel more prepared to find the most appropriate and effective care for your child. 

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Cognitive Behavioral Therapy  (CBT)

 
Cognitive-behavioral therapy (CBT) is a type of treatment that has been shown to help kids who have anxiety. CBT is a talk-therapy that teaches different coping strategies to help kids manage their anxiety. The idea is not to cure anxiety or get rid of it given that some anxiety can be helpful, but to learn how to cope with it better and help turn the volume down.
 
CBT views anxiety as having three different parts, each of which impacts the other: the physical feelings of anxiety (e.g., fast-beating heart), anxious thoughts (e.g., thinking worst case scenarios), and actions (e.g., choosing to stay away from situations that make one feel anxious). Parts of CBT relate to each of the three parts of anxiety as seen below:
 
  • Physical Feelings - Relaxation Techniques (such as deep breathing and progressive muscle relaxation)
  • Anxious Thoughts - Learning how to evaluate thoughts and think of coping thoughts
  • Actions - Learning to and practicing approaching situations that make you feel scared
 
The idea is that each strategy will have a positive ripple effect on the entire cycle.  CBT is typically short-term treatment, which means that the treatment typically is provided over the course of 12-20 meetings, so you would be seeing some improvements within 3-4 months. That being said, treatment may vary depending on the type of anxiety the child has and should be tailored to the child’s unique fears and anxieties, so it may take fewer or more sessions than that, depending on your child’s needs and any barriers or complicating factors that may exist. 
 

Not sure if your therapist is providing CBT? 

 
Here are some questions you can ask if your child needs services for an anxiety disorder, such as generalized anxiety disorder, social phobia, separation anxiety disorder, OCD, or a specific phobia:
 
  • Does the type of treatment you do involve exposure? (The answer should be yes.)
  • How much experience do you have diagnosing and treating children with anxiety disorders?
  • Are you board certified and/or licensed?
  • What are the goals and how many sessions should we expect our child to be in treatment? (CBT is typically time limited with clear goals. Even if the therapist expects complications, they should be able to state their goals and estimate a timeline given the results of their initial evaluation or interview with your child). 
  • What is the parents’ role? (CBT typically requires involvement from parents with younger children and support from parents for older teens. Either way, parents should be meeting regularly with the therapist to understand what is happening during the treatment sessions and be informed about goals and homework for the week and how they can support their child. 
  • What research supports the treatment you are providing? 
  • Do you have specialized training in this type of treatment?
 

Medication

Medication can also be a useful treatment for anxiety in youth. Selective Serotonin Reuptake Inhibitors (SSRIs) are the medication of choice for youth anxiety. A recent study found that the combination of sertraline (an SSRI) and CBT resulted in the most improvement in 7-17 years who had generalized anxiety disorder, separation anxiety disorder, or social phobia (Walkup et al., 2008) . Medication and CBT alone were comparable in their effects. The U.S. Food and Drug Administration (FDA) has approved the use of some SSRIs for the treatment of childhood OCD.
 
Medication can be a short-term or long-term option for youth anxiety, depending on how one responds to the medication and how severe one’s anxiety is.  Medications must be prescribed by a medical doctor, such as a psychiatrist or primary care physician. It’s best to find a provider who has extensive training and experience working with youth with anxiety. Child Psychiatrists are likely to have more expertise than general psychiatrists or general pediatricians. 
 
Communication between the medical doctor and mental health provider is encouraged in order to inform treatment planning and monitor progress over time.
 
A warning was issued in October 2004 by the FDA, stating that antidepressant medications, including SSRIs, may increase suicidal thoughts and behaviors in a small percentage of youth. Of note, no suicides were reported in the studies that led to the warning, and the FDA has not prohibited use of these medications for youth.  
 
Although SSRIs are generally well tolerated by users, common physical side effects include headache, stomachache, nausea, and difficulty sleeping. If you opt to seek medication for your child’s anxiety, you should talk to your child’s doctor about any questions or concerns you have.  Your child’s doctor should conduct a thorough evaluation to determine the presence of physical symptoms related to medical problems or anxiety. Side effects, including suicidal thoughts, should be monitored.
 

 

If you’d like to learn more about psychiatric medications for children and teens, you can talk with your child’s pediatrician or meet with a child psychiatrist.

You may also like to read:

Straight Talk about Psychiatric Medications for Kids by Timothy E. Wilens. The Guilford Press, 2008

 

Symptom Checker

 
If you’re not sure if your child is suffering from excessive anxiety, take a moment to complete our “Symptom Checker.” Our symptom checker allows you to click on the symptoms that are consistent with what you’re seeing in your child and provides personalized feedback on your child’s symptom status and recommendations for next steps.  
 
By answering a few short questions, you will get some feedback about which categories to learn more about next. 
 
 

Finding Treatment Providers

Our Global Network
 
Click on our Map to find CBT for child anxiety expert clinics near you: 

Online Referral Resources 

 
If you are unable to find a treatment provider through these websites, you should:
 
  • Contact the psychiatry department at a local medical school or a university psychology department.
     
  • Contact your county mental health department, a local hospital or community mental health center and ask about mental health clinics or staff psychiatrists.
     
  • Search through your insurance company for local behavioral health or psychiatry providers. 
     
  • Search the American Psychological Association provider database.
     

Is it Time to Seek Treatment?

 
Having trouble deciding if it is time to seek treatment? A basic guideline is to think of (A) Intensity, (B) Frequency, (C) Interference and (D) Duration:
 
A. Intensity:  How intense is the anxiety or stress your child is experiencing? Does it seem more intense than what you might expect for someone that age in the same situation? Or is it in the range of what you might expect, but given that there are stressful things going on lately they’ve just been more anxious than usual? 
 
B. Frequency:  Is anxiety too frequent?  Is it an issue more often than you’d like – almost every day, more days than not? Does the anxiety come up almost every time the person is faced with the situation or thing that disturbs them more than other kids?
 
C. Interference:  Is it interfering? Think of how it might be getting in the way at school, how well your child is doing academically but also how much he enjoys going to school, how much he’s getting out of the experience, or how he is functioning when in school. 
  • Is the anxiety getting in the way of your child’s day-to-day activities or school functioning? 
  • Is it difficult to make new friends, keep friends, or enjoy time with friends? 
  • What about family relationships? Is anxiety making things tense at home where people are getting into arguments or feeling like they have to “work around” the anxiety? 
  • Finally, how much is it bothering your child? Does he seem very distressed because the anxiety is intense? Is your child noticing how difficult things are in different situations? Is it hard for your child to stop feeling anxious or to distract once it starts? 
 
D. Duration:  Has it been going on longer than a few months? Does it last or cause problems even over the summer break in different ways than during the school year?