Your child went to class, completed homework, and studied. He or she arrived at the exam confident about the material. But if he or she has test anxiety, a type of performance anxiety, taking the test is the most difficult part of the equation.

Causes of Test Anxiety in Children

• Fear of failure. While the pressure to perform can act as a motivator, it can also be devastating to individuals who tie their self-worth to the outcome of a test.
• Lack of preparation. Waiting until the last minute or not studying at all can leave individuals feeling anxious and overwhelmed.
• Poor test history. Previous problems or bad experiences with test-taking can lead to a negative mindset and influence performance on future tests.

Symptoms

• Physical symptoms. Headache, nausea, diarrhea, excessive sweating, shortness of breath, rapid heartbeat, light-headedness and feeling faint can all occur. Test anxiety can lead to a panic attack, which is the abrupt onset of intense fear or discomfort in which individuals may feel like they are unable to breathe or having a heart attack.
• Emotional symptoms. Feelings of anger, fear, helplessness and disappointment are common emotional responses to test anxiety.
• Behavioral/Cognitive symptoms. Difficulty concentrating, thinking negatively and comparing yourself to others are common symptoms of test anxiety.

Tips for Managing Test Anxiety

Share these tips with your child if he or she is anxious about an upcoming exam:

• Be prepared. Develop good study habits. Study at least a week or two before the exam, in smaller increments of time and over a few days (instead of pulling an "all-nighter"). Try to simulate exam conditions by working through a practice test, following the same time constraints.
• Develop good test-taking skills. Read the directions carefully, answer questions you know first and then return to the more difficult ones. Outline essays before you begin to write.
• Maintain a positive attitude. Remember that your self-worth should not be dependent on or defined by a test grade. Creating a system of rewards and reasonable expectations for studying can help to produce effective studying habits. There is no benefit to negative thinking.
• Stay focused. Concentrate on the test, not other students during your exams. Try not to talk to other students about the subject material before taking an exam.
• Practice relaxation techniques. If you feel stressed during the exam, take deep, slow breaths and consciously relax your muscles, one at a time. This can invigorate your body and will allow you to better focus on the exam.
• Stay healthy. Get enough sleep, eat healthily, exercise and allow for personal time. If you are exhausted - physically or emotionally - it will be more difficult for you to handle stress and anxiety.
• Visit the counseling center. Schools are aware of the toll exams can take on students. They have offices or programs specifically dedicated to helping you and providing additional educational support so that you can be successful.

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The answer to the question, "Can you cure anxiety attacks?" actually depends on you – the type of anxiety you're having, frequency of attacks, and any underlying causes. Everyone has periods of worry in their lives, but people who have anxiety attacks constantly worry excessively about a variety of things. The majority of these people simply need to learn skills and strategies for coping with nervousness, fear, and anxiety.

Learn About Ways to Cure Anxiety Attacks

Take the first step down the road to cure anxiety attacks by making an appointment with you doctor. He or she will most likely give you a routine physical exam and ask questions to determine if something in particular is causing your tension and anxiety. Some types of prescription medication, and even illicit drugs, can cause anxiety attacks. Hyperthyroidism, a condition characterized by an over active thyroid gland, can cause anxiety attacks, as can depression. If none of these are causing your symptoms, you may have generalized anxiety disorder (GAD).

Think Drugs Are the Only Way to Cure Anxiety Attacks? Think Again.

If you think that taking potent, personality-altering medications is the only way to cure anxiety attacks, think again. Consider the many anxiety attack cures that use natural treatment strategies and psychological programs designed specifically for anxiety sufferers – some of these programs even allow you to receive treatment and relief without leaving the comfort of home.

Self Help Books Offering Anxiety Attack Cures

Yes, you can find anxiety attack cures in a book. Simply purchase one of these self-help books and any accompanying materials (like workbooks) written by professionals who specialize in natural cures for anxiety attacks.

• The Anxiety and Phobia Workbook, Fourth Edition, Edmund J. Bourne – This practical workbook teaches specific skills and tools to use in overcoming anxiety attacks, panic attacks, and related phobias. It also includes information about using herbal supplements.
• Beyond Anxiety and Phobia: A Step-by-Step Guide to Lifetime Recovery, Edmund J. Bourne – This guide provides an array of strategies for overcoming symptoms of anxiety and panic forever by examining the deeper origin of the symptoms. Bourne includes information about alternative therapies and homeopathic treatments as well.
• The Cognitive Behavioral Workbook for Anxiety: A Step-by-Step Program, William J. Knaus – Knaus works with the reader to develop a personal plan for recognizing anxiety triggers, changing destructive thought patterns, and stopping unfounded fears before they spiral out of control.

These three represent only a fraction of the effective and highly regarded self-help books available to cure anxiety attacks.

Cure Anxiety Attacks Using Self Help Audio CD Programs, DVDs, and More

Some people find that listening to information or viewing videos about programs that cure anxiety attacks works best for them. Look below to see examples of the many programs available that teach you how to cure anxiety attacks without medicines or long therapy sessions away from home.

• Pass Through Panic: Freeing Yourself from Anxiety and Fear, Audio CD, Dr. Claire Weekes – Dr. Weekes provides listeners with tools and skills for overcoming anxiety, panic, and fear through this 8-part audio CD series.
• At Last a Life – The Complete Book for Cure from Anxiety and Panic, eBook, Paul David – An ex-sufferer of debilitating anxiety and panic, David delivers healing advice, tools, and a recovery plan based upon his 10-year, personal battle with anxiety and panic attacks.
• Viniyoga Therapy for Anxiety Relief, DVD, Gary Kraftsow – Expert Gary Kraftsow takes the viewer through the process of therapeutic yoga techniques for developing physiological balance and cultivating mindful tools to shift mood and alter self-concept. The video gives the impression of participating in a one-on-one multi-session course with Kraftsow.

Find additional resources at Anxieties.com, which bills itself as the largest free self-help site on the Internet. David D. Burns, M.D. also hosts a website called, Feeling Good that has many resources, self-help guides, and helpful links for anxiety and panic sufferers.

Cure Anxiety Attacks Without Drugs or Long Therapy Sessions

You can cure anxiety attacks that have stolen your freedom and joy without taking anxiety drugs and attending expensive therapy sessions away from home. Take your life back from the clutches of anxiety and fear.

Additional Anxiety Attack Information

• Anxiety Attack Treatment
• Dealing with an Anxiety Attack and How to Get Relief
• How to Stop an Anxiety Attack
• How to Prevent Anxiety Attacks

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Learning how to prevent anxiety attacks requires that you build a toolbox of coping skills to aid in dealing with life stresses. The first step involves becoming mindfully aware of everyday stress and which stressors or stimuli tend to increase your levels of anxiety.

Perhaps you start to feel anxious when chores at home, or responsibilities at work, seem to pile up. Or maybe you worry excessively about things over which you have little or no control – worrying whether or not you'll get the job you just interviewed for is unproductive. You completed the interview, now it's up to the hiring manager to decide whether you, or someone else, land the position. You have no control over the outcome at this juncture, so worrying about it only induces unproductive anxiety. Examine which situations and circumstances cause unproductive anxiety.

Tools to Prevent Anxiety Attacks

Awareness of your thought patterns and external triggers is vital in understanding how to prevent anxiety attacks. Once you've identified the things that cause you stress and anxiety, you can develop your collection of tools for coping with them. Some helpful skills in preventing anxiety include:

• Meditation – meditative chants and disciplines have a stabilizing effect on mood and the body's response to stressful stimuli.
• Relaxation activities – yoga, deep breathing
• Visualization – a technique that involves imagining yourself dealing with challenging situations in a rational, calm way. Or you can associate stressful circumstances with a comical figure that you defeat, using calm, methodical strategies.
• Exercise – according to the Mayo Clinic, regular exercise can provide significant help in preventing anxiety and depression. Exercise releases brain chemicals, called endorphins, which have a positive influence on mood. The rise in body temperature caused by exercise has a natural calming effect on a person's perception of events and stimuli.
• Interpersonal skill enhancement – courses in interpersonal skills offer strategies for dealing with difficult people at work, social, and personal situations. Learning to effectively deal with others will prevent stress and a subsequent build-up of anxiety.
• Healthy eating habits – avoid caffeine and other stimulants as these exacerbate anxiety and elicit the body's stress response to challenging circumstances. Eat balanced, nutritionally sound meals to provide the necessary energy to tackle each day.
• Get plenty of rest – a rested body and mind is better equipped to cope with unexpected events and responsibilities. Exhaustion leaves the door open for anxiety and worry to creep in when your body doesn't have the energy or rest to deal with stress.

In a nutshell, living a healthy lifestyle and taking care of your whole self -- physically, emotionally, and spiritually – provides the best foundation and the most effective tools for dealing with stress and preventing anxiety attacks.

Additional Anxiety Attack Information

• Dealing with an Anxiety Attack and How to Get Relief
• How to Stop an Anxiety Attack
• Can You Cure an Anxiety Attack?

article references

If you're plagued by excessive worry and fears, you probably want to know how to stop an anxiety attack. If you have chronic anxiety that impairs your quality of life and keeps you from enjoying favorite activities, you should seek help from a medical professional. Your doctor can prescribe fast-acting medications that will stop anxiety attacks.

These medicines belong to a class of drugs called benzodiazepines. While they're relatively safe and very effective at stopping anxiety attacks, they have a high potential for abuse and if used for long periods, they can become habit forming. Because of this, your doctor will likely only prescribe them at the beginning of the anxiety treatment plan he creates to help you learn how to stop an anxiety attack yourself.

Learn How to Control Anxiety Attacks

Once your physician has evaluated your condition, your next step is learning how to control anxiety attacks. Your doctor will probably refer you to a psychiatrist or psychologist who can provide psychotherapeutic techniques to help you with your anxiety. He may prescribe antidepressants that aren't habit forming and that are safe for long-term use. Depending on the severity and type of anxiety attacks you have, you may need to see your therapist once a week for a month to several months. Your therapist will decide which type of therapy to provide for you. Several types, effective in teaching patients to stop anxiety attacks, are available:

Cognitive-Behavioral Therapy (CBT) – The ultimate goal of CBT involves helping you regain control of your thoughts surrounding anxiety-producing situations and your reactions to those situations. A number of studies indicate that CBT can work effectively alone, without medication, for many patients.

Systematic Desensitization – This technique seeks to break the link you have formed with anxiety-inducing circumstances and the anxiety reaction you've cultivated as a response to these circumstances. You'll confront the situations and circumstances that provoke your anxiety in small doses until you no longer respond in an overly anxious way when they arise.

Modeling Treatment – With this treatment, you will watch an actor approach a situation or circumstance, known to produce extreme feelings of anxiety in you. You may view this live, or on videotape, but the live model works better. You then view this scenario, acted out several times, by the actor and try to model the behavior of the actor in the same or similar environment. When properly acted out and subsequently modeled, you should experience progressively less anxiety when confronted with these formerly uncomfortable situations.

Relaxation Training – The term relaxation training refers to several techniques that invoke a relaxed state for the patient. Relaxed breathing techniques retrain you to stop the hyperventilation common in anxiety attacks. By replacing this shallow, uncontrolled breathing pattern with deep relaxing breathing patterns, you may have success in stopping an anxiety attack before it gets out of control. Another method, biofeedback, measures body temperature, breathing and heart rate, and muscle tension during anxious states. You then use these baseline measures to learn how to control anxiety attacks by controlling these physical responses to anxiety and using relaxing thought patterns.

Warning About Using Herbal Formulas to Stop Anxiety Attacks

Although you may read about using herbal remedies to stop anxiety attacks, some of these can cause serious harm to your body, such as liver damage, and no definitive studies with adequate controls and participation exist that support the use of herbal remedies to control attacks. Further, many herbal supplements can interact with medications your doctor prescribes and result in serious drug interactions or allergies.

Take Back Your Life – You Can Learn How to Stop an Anxiety Attack

While you certainly do possess the ability to learn how to stop an anxiety attack, it's critical to seek the advice and support of a medical or mental health professional. Speak frankly with your physician or therapist about your excessive worrying and fears. Tell him or her about your desire to learn to control these episodes yourself, without medication. He may ask you to start out taking medication just to stabilize your emotions and give you a respite before the hard work begins. Your physician wants to see you succeed and live free of excessive anxiety and medications. He will support you and guide you along the way, letting you know when to taper off any medications you're on, during the course of your therapy.

Additional Anxiety Attack Information

• Anxiety Attack Treatment
• Dealing with an Anxiety Attack and How to Get Relief
• How to Prevent Anxiety Attacks
• Can You Cure an Anxiety Attack?

article references

Dealing with anxiety attacks may seem daunting at first, but many people can overcome the unhealthy thought processes and behaviors that cause their normal, everyday anxiety to develop into a full-blown anxiety attack. Keep in mind; we're talking about anxiety attacks here, not panic attacks. The term panic attack, often incorrectly used interchangeably with the term anxiety attack, refers to a more severe subcategory of anxiety disorders that involve more complex negative behaviors and thought pathways than anxiety attacks.

Strategies for Anxiety Attack Relief

Depending on the severity of the attacks, many people can find anxiety attack relief without seeking professional help. You may find that practicing new thinking strategies, when faced with anxiety-provoking situations, will eventually bring you long-term relief.

If you try these tips numerous times and still find you have issues with anxiety that adversely affects your life, you can always seek professional medical help. But, if your attacks seem mild to moderate, and don't seem to cause you to spiral out of control, why not try the following tips?

Don't Think – A Strategy for Dealing with Anxiety Attacks

It's counter-intuitive, but one of the best ways of dealing with anxiety attacks is to not think about having one. If you know that a particular circumstance always, or usually, causes you to become anxiety-ridden, stop thinking about the possibility of having an anxiety attack. Frequently, thinking about the possibility of having an attack can act as a self-fulfilling prophecy and actually bring on an episode.

For example, imagine that you know that speaking in front of a group of people makes you so anxious that you need to visit the men's room to vomit, or maybe it causes you to tremble visibly and break out in a cold sweat. Consequently, your boss, whom you're hoping will soon give you a raise, tells you that you are to speak in front of visiting company executives at the luncheon that afternoon. You can agonize and worry over the upcoming event and allow yourself to sink into the downward spiral you know so well, or you can take control of your thoughts and push that negative thought pattern away. Everyone feels anxious before speaking in front of a group of important people and peers. Talk rationally to yourself about the event; refuse to engage in self-dialogue about your anxiety.

Think about the worst thing that could possibly happen outside of anything having to do with anxiety or worry. You could get to the podium and freeze, you could begin what was a promising speech and stutter and stumble through it, you could cry up there (granted, a pretty bad outcome), you could start to sing or tell jokes and stay off topic until your boss waves you down (probably a recipe for unemployment), or you could give a stellar speech that wows the crowd.

Even if the worst of your imagined possibilities happen, you still own the outcome. It doesn't own you. And there's a possibility that you'll give a great speech. Even if you get up there and tell jokes until your pink slip arrives, you own it. Anxiety does not. You'll gain personal power and strength no matter the outcome.

Think – A Strategy for Dealing with Anxiety Attacks

Think – for dealing with anxiety attacks, but not before the attack as with the strategy above, but during an attack. When in the throes of a full-blown attack, you're already in the grip of excessive worry, your heart pounds, you may feel cold beads of sweat forming even though the room is cool, and you may feel as if you'll vomit.

It's hard to think rationally with all this inner turmoil happening, but healing comes from facing challenges, hard ones, head-on. Pull on your desire to defeat anxiety and its grip on your life and think about your feelings as normal to the extent that you control them. If the anxious feelings incapacitate you and threaten your ability to function, you are not in control of them and the feelings have reached a place where normal doesn't live.

Even rock stars feel nervous before they go on stage in front of their adoring crowds. The famed Ted Nugent, one of the most talented guitarists and performers of his era, claims he sometimes threw up before going on stage because he feared he would disappoint his fans.

So, with Nugent in mind, think about one anxious physical symptom that you (since you are in control) will allow to stay. Throw up if you must or keep a handkerchief handy if you decide that sweat is the symptom you will allow this time. All other physical symptoms and excessive thoughts must leave. You have the power to send them away. It will take practice and you may backslide at first, but you'll get the hang of it. Become the ruler of your body and your thoughts.

Next Step – Gain an Arsenal of Anxiety Attack Relief Tools

Take up yoga; go to a class that teaches meditative breathing, ask a clergyman to help you learn spiritual meditation. Practice the relaxation and meditative techniques you learn from these experiences daily – like brushing your teeth – and say goodbye to unhealthy anxiety attacks and yes to life.

Additional Anxiety Attack Information

• Anxiety Attack Treatment
• How to Stop an Anxiety Attack
• How to Prevent Anxiety Attacks

article references

The shy child is a common issue for parents. It is thought that sometimes shyness in children is inherited while other times, it is due to environmental factors.

Shyness is not pathological; it is simply a feeling of uneasiness around others, particularly those who are unknown. However, extreme shyness can develop into social anxiety disorder in children.

Signs of a Shy Child

Many of us know what it's like to feel awkward around others and feel insecure. We may blush or feel speechless. These are signs of shyness. Other signs of shyness in children include:¹

• Feeling uncomfortable
• Feeling self-conscious
• Nervousness
• Bashfulness
• Feeling timid
• Being passive an unassertive
• Physical sensations like feeling shaky or breathless

Child shyness is most likely to be seen when the child is in a new situation or is with new people.

Why Are Some Kids Shy?

In addition to some kids being genetically predisposed to shyness, life experiences can also make a child shy. Child abuse, including emotional abuse and ridicule, may cause shyness in a child. Childhood shyness may also start after a child experiences a powerful physical anxiety reaction.²

An overly cautious parent may also cause child shyness as they reinforce the idea that the world is dangerous. This causes the child to think they should back away from new situations.

How to Help a Child in Overcoming Shyness

While some people can see the positive in being shy, for example a shy child may be a very good listener; many shy children wish to overcome their shyness. By encouraging slow, steady steps, overcoming shyness is possible.

Tips for helping a child overcome shyness:

• Encourage and model positive, outgoing, assertive behavior.
• Know that overcoming shyness takes time and reinforce that it's OK to feel awkward sometimes.
• Introduce shy children to new environments or people a little bit at a time to build up their confidence.
• Help a child with shyness prepare for new activities ahead of time. For example, what are some things the child would like to talk about?
• Find group activities your child likes and is good at in which to participate.

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Social anxiety, also known as social phobia, commonly begins at age 10. While some people think social anxiety in children is simply "extreme shyness," this is not the case. Social phobia (anxiety) in children is a recognized mental disorder and goes beyond mere shyness (read The Shy Child: How to Help Your Child Overcome Shyness).

According to the latest version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR), the criteria for social anxiety in children includes:¹

• Distinct and persistent fear of one or more social or performance situations with peers
• Exposure to feared situation produces anxiety. In children with social anxiety this may be tantrums, crying, freezing or shrinking away.
• Feared situations are avoided
• The social anxiety symptoms interfere with normal day-to-day life
• The duration is longer than six months

Social phobia in children is also related to selective mutism; where a child cannot or will not talk in certain situations.

The causes of social phobia in children are unclear; only theories are currently available. Social anxiety in children may be due to:

• Dysfunction in the pathways of the brain chemical serotonin
• Dysfunction in a part of the brain known as the amygdala

Medications for Treatment of Children with Social Anxiety (Social Phobia)

The most important thing any parent concerned about social phobia in children can do is get a professional assessment. Only a mental health or health professional can decide what type of treatment is best for a child with social anxiety. Untreated childhood social phobia often continues into adulthood and may be a precursor to agoraphobia.

Often a combination of medication and therapy is used to treat children with social anxiety. No medication is FDA-approved for social anxiety treatment in children. However, medications approved for adults are sometimes used off-label to treat children. Common medications used in social anxiety disorder treatment include:

• Paroxetine (Paxil) – an antidepressant FDA-approved for social anxiety treatment in adults and considered a frontline treatment in adults.
• Sertraline (Zoloft) – an antidepressant FDA-approved for short- and long-term treatment of social anxiety in adults. Also approved for the treatment of obsessive-compulsive disorder in children older than 12.
• Venlafaxine (Effexor) – an antidepressant FDA-approved for treatment of social anxiety in adults.
• Benzodiazepines – used in some anxiety disorders when antidepressants cannot be taken; not approved for social anxiety disorder, specifically, but some are approved for use in children.

When using antidepressants, it's always important to carefully observe any child as antidepressants may increase suicidal thoughts or self-harming behavior in children.

Therapy for Social Anxiety Disorder in Children

Therapy may be used to treat social phobia in children alone or with medication. Most therapies have been studied in adults, but some, like cognitive therapy, have been proven useful in adolescents. Play therapy is often indicated for young children with social anxiety.

Additional types of therapy used in treating social anxiety include:

• Behavioral – such as gradually introducing the feared situation (desensitization)
• Computerized cognitive behavioral therapy
• Insight-oriented therapies – may be useful in older children
• Stress management and relaxation techniques

Tips for Parenting a Child with Social Anxiety

The first thing to remember is that social anxiety in children is not an indicator of bad parenting. While stress at home can add to social anxiety, no one action can cause social anxiety in a child.

Psychologist Lynn Siqueland, Ph.D., specializes in treating children and adolescents with social anxiety disorder and has the following tips for parents:²

• Set expectations for an anxious child the same way you would for any other child; however, understand the pace may be slower and it may require more work to get there.
• Build your child's personal strength through praise and finding things at which they excel. Also have them do jobs around the house so they know they are contributing to the household.
• Don't continually reassure the child; let them learn by doing things on their own. Teach a child to answer his own questions and show you believe in them.
• Allow your child to feel and express their emotions, including anxiety without the fear of reprisals.
• Keep your own fears to yourself and let your child know it's safe to explore the world around them.
• Work together with other caregivers so the child gets a consistent message.
• Set limits and consequences for inappropriate behavior – don't confuse anxiety with other actions.

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Separation anxiety is common and only seen in children. Separation anxiety can be seen in toddlers, children and teens. This anxiety disorder is often a precursor to school refusal. Separation anxiety is seen, on average, in 2%-4% of children. About one-third of children with separation anxiety have co-occurring depression. An additional quarter have another behavioral disorder like attention deficit hyperactivity disorder (ADHD).

The causes of separation anxiety disorder are not fully understood although one is thought to be early separation from the primary caregiver. Separation anxiety may also be due to lowered levels of a stress-related chemical, cortisol,in the brain.¹

Signs of Separation Anxiety in Children

Separation anxiety in children generally manifests as an unrealistic fear or worry about harm that may come to the primary caregivers. This can result in a refusal to spend significant amounts of time, such as nights or school days (read School Anxiety in Children), away from caregivers or throwing tantrums before separation.

Other signs of separation anxiety disorder include:

• Reluctance to fall asleep without being near a caregiver
• Nightmares
• Homesickness
• Physical symptoms like stomachaches, dizziness and muscle aches

Treatment for Separation Anxiety in Children

The most important thing to do when separation anxiety starts to negatively impact the life of the child is to get a professional evaluation. Only a professional can diagnose separation anxiety disorder and determine the causes behind the disorder. These specific causes will determine the best treatment.

Treatments for separation anxiety disorder in children include:

• Relaxation exercises – led by professionals and practiced at home. Relaxation exercises are useful before other types of therapy and can make them more effective.
• Cognitive behavioral therapy (CBT)– attempts to reactivate thoughts and actions in the child that are more confident. Rewards for returning to a normal routine, such as going to school, can help change behaviors. CBT can be delivered in-person or even by computer using a scientifically validated program: The "Coping Cat."
• Psychological (psychodynamic) therapy – works to outline the underlying reasons both conscious and unconscious behind the separation anxiety. Frequent treatment, two-to-three times a week, has a high success rate. Family participation in therapy can increase effectiveness.
• Social therapy – attempts to use the child's history to determine if non-separation anxiety issues may be causing behavior like school refusal. Examples include learning disabilities and bullying.
• Medication – as many therapies have a high success rate, medication is not the preferred frontline treatment in most cases and should always be used in conjunction with other therapies. Fluoxetine (Prozac), an antidepressant, is the only FDA-approved medication for use in those under 18 for separation anxiety treatment.

Whenever medication, particularly an antidepressant, is prescribed to children, it's important to remember that some medications carry the risk of increased self-harm and suicidal thoughts and behaviors. Close monitoring is important in medication treatment of separation anxiety in children.

Tips on How to Deal with Separation Anxiety in Children

It's important to try to keep the child's routine as much as possible. This includes the child going to school. If a child's separation anxiety is so severe they refuse to go to school or elsewhere, slowly introducing the child to the new environment can help them see there is nothing to fear and can reinforce the positive aspects of these activities. Missing school or other events can reinforce the separation anxiety, rather than help it.

Other ways to deal with separation anxiety in children include:²

• Talk with your child openly about their fears and worries; remain calm and non-judgmental
• Work with teachers, guidance counselors and others that will be caring for the child
• Take part in the child's therapy and reinforce therapeutic principles at home
• Encourage hobbies and interests to help build self-confidence
• Learn about your child's anxiety disorder
• Help build a child's support system including family, friends and others so the child feels safe and supported by many people

Using these positive coping and strength-building techniques has been clinically shown to reduce anxiety in children.

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School anxiety in children is very common. School anxiety typically takes one of three forms:

• School refusal –refusing to go to school
• Test anxiety
• Social anxiety – may be a precursor to agoraphobia

Causes of Anxiety in School Children

The three types of school anxiety can come from a variety of causes. When a child refuses to go to school, this is typically caused by separation anxiety. Separation anxiety is only seen in children and occurs in about 4.5% of children age 7-11. This type of anxiety in school children stems from excessive worry about unreasonable harm to important figures in their lives.¹

Test anxiety in children, on the other hand, is often related to a fear of failure. Childhood test anxiety can continue into adulthood and take other forms of performance anxiety. Other causes of test anxiety in school children include:

• Lack of preparation
• Poor test history

Social anxiety in children, also known as social phobia, can be seen at school and in other parts of a child's life. Typical onset of social anxiety is 13-years-old.² It is thought severe social anxiety in children may be caused due to altered serotonin pathways in the brain.³ Extreme overuse of caffeine can also produce anxiety symptoms.

Signs of School Anxiety in Children

The most obvious sign of school anxiety is a refusal to attend school or other events such as sleepovers. This could be due to any type of anxiety: Separation anxiety, social anxiety or test anxiety. When a child refuses to go to school repeatedly, a screening for an anxiety disorder should be conducted.

Other signs of anxiety in school children include:

• Selective mutism – most occurs with social anxiety
• Low birth weight and possible intellectual disability in children under 3
• Nightmares
• Tantrums

Older children, those age 12-16, often experience physical anxiety symptoms such as:⁴

• Headaches
• Dizziness
• Lightheadedness
• Sweatiness
• Gastrointestinal symptoms such as stomachache, nausea, cramps, vomiting
• Muscle or body aches

Treatments for Anxiety in School Children

Many treatments can reduce anxiety in school children. Techniques include:

• Relaxation exercises
• Cognitive therapy – often associated with the shortest duration (on average, six months) and best outcome
• Psychological therapy
• Social therapy

Medication is also available for children with anxiety but is not considered the preferred treatment in most situations. Medications should always be used alongside therapy for anxiety in school children.

After an incident of anxiety, it's critical to be calm and understanding. However, returning to a normal routine as soon as possible is important so as not to reinforce the anxiety symptoms. Putting an anxious child in home school is not recommended as it may prolong and make the symptoms of anxiety more severe.

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It is quite likely treatment for anxiety in children will be successful, but only a small fraction of those who need help get it.

Anxiety disorders consist of worry, anxiety or distress that is out of proportion with a given situation and is sometimes constant. Many children suffer from various types of anxiety disorders, with symptoms starting to manifest around age six. Research has shown that the earlier a child receives treatment for anxiety, the better off they will be.

Both therapy and medication are available as treatments for anxiety in children and often a combination of approaches is most successful. Improvement is often seen in 2-6 weeks. Ideally parents, or other important figures in the child's life, also take part in the treatment.

However, treating children with anxiety can be challenging, as often more than one form of anxiety is present. For example, the child may have a phobia of insects and also have separation anxiety disorder. More than one treatment may need to be tried before a successful option is found.

Treatment for Anxiety in Children – Medication

Medicating children is always a concern, but in many cases, medication combined with therapy is a better treatment for anxiety in children than therapy alone. Some medications are FDA approved for treating some types of anxiety in children while other medications are often prescribed off-label (practice of prescribing pharmaceuticals for an unapproved indication or in an unapproved age group, unapproved dose or unapproved form of administration).

Medications used for treating anxiety in children are typically selective serotonin reuptake inhibitor (SSRI) antidepressants. These medications are known to have anti-anxiety properties and those with Food and Drug Administration (FDA) approval have been in use in other populations for decades. SSRIs are used for long-term anxiety treatment and are generally prescribed for one year or more.

Another medication for treating anxiety in children is benzodiazepines. Benzodiazepines are sedatives that are sometimes used in short-term anxiety treatment in children.

Some of the specific medications approved to treat anxiety in children include:¹

• Fluoxetine (Prozac) –an SSRI approved for obsessive-compulsive disorder age 7-17
• Fluvoxamine (Luvox) – an SSRI approved for obsessive-compulsive disorder age 8-17
• Sertraline (Zoloft) – an SSRI approved for obsessive-compulsive disorder age 6-17
• Diazepam (Valium) – a benzodiazepine approved for use as sedative age six months and up

Here is a complete list of anxiety medications. Keep in mind that not all medications on this list can be used in children.

Therapy as Treatment for Anxiety in Children

Therapy can be a very effective treatment for anxiety in children. Behavioral and cognitive-behavioral therapies have the most positive research behind them.

Behavioral therapies for anxiety include:

• Relaxation techniques
• Visualizing
• Exposure to feared situation in a clinical setting

Cognitive therapies for anxiety treatment include:

• Identifying and altering self-talk
• Challenging irrational beliefs

Children are also taught about anxiety disorders as a part of therapy. One way of reducing anxiety in children is to teach them to look for the early warning signs of anxiety and then implement a coping plan.

Dealing with Anxiety in Children

There are many things parents and other caregivers can do when dealing with anxiety in children. Aside from formal treatment, reducing anxiety in children can also be achieved by:

• Providing a safe and stable home life including a reliable routine
• Paying attention to your child's feelings
• Staying calm when the child is feeling anxious
• Praising accomplishments and not punishing for experienced anxiety
• Teaching positive coping skills and strategies
• Promoting self-esteem and self-confidence
• Learning about anxiety in children

Using these positive coping and strength-building techniques has been clinically shown to reduce anxiety in children.

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