Anxiety is a normal emotional response that can help children and young people recognise danger, prepare for challenges and manage change. It becomes a concern when worries or fears are persistent, difficult to control and significantly interfere with daily life. This may affect school attendance, friendships, family relationships, sleep, eating, confidence or participation in activities.
At Healing Young Minds, our Anxiety Disorder Assessment & Treatment service provides a careful, child-centred assessment and an individualised treatment plan. We support children and adolescents with a range of anxiety presentations, including generalised anxiety, separation anxiety, social anxiety, specific phobias, panic symptoms and anxiety related to particular situations or experiences.
What anxiety can look like in children and adolescents
Anxiety does not always present as an obvious fear or verbalised worry. Younger children may communicate distress through behaviour, physical symptoms or changes in their routines. Adolescents may conceal their worries, avoid discussing them or appear irritable rather than anxious.
Possible signs include:
- Excessive or repetitive worrying about health, school, family, friendships, mistakes or the future
- Difficulty separating from parents or carers, including distress at bedtime or school drop-off
- Avoidance of school, social situations, activities, travel, animals, medical procedures or other feared situations
- Frequent reassurance-seeking, checking or asking the same questions repeatedly
- Physical symptoms such as headaches, stomach aches, nausea, dizziness, sweating, trembling or a racing heart
- Sleep difficulties, nightmares, irritability, tearfulness or reduced concentration
- Panic attacks or sudden episodes of intense fear
- Reduced confidence, loss of independence or withdrawal from previously enjoyed activities
These symptoms can overlap with other conditions. Anxiety may occur alongside autism, ADHD, depression, obsessive compulsive disorder, trauma-related difficulties, eating disorders or physical health problems. A detailed assessment is therefore important before deciding on treatment.
How anxiety is assessed
Assessment begins with an opportunity for the child or young person and their parents or carers to describe what has been happening in their own words. We consider the individual’s developmental stage, communication style, strengths and preferences, rather than relying on a single questionnaire or symptom list.
Depending on age and circumstances, an assessment may include separate conversations with the young person and their parents or carers. We may also seek information about school, college, friendships and daily functioning, with consent. Questionnaires can help identify patterns of anxiety and measure change over time, but they are used alongside clinical discussion and professional judgement.
Areas explored during assessment
- The main fears, worries or physical symptoms, and when they began
- The situations that trigger anxiety and the behaviours used to cope with or avoid it
- The impact on school attendance, learning, sleep, family life, friendships and independence
- Recent changes, stressors, losses, bullying or difficult experiences
- Mood, motivation, self-esteem, irritability and any symptoms of depression
- Obsessions, compulsions, tics, unusual experiences or concerns about eating
- Developmental history, sensory needs, communication and social interaction
- Physical health, medication, sleep, caffeine, alcohol or substance use where relevant
- Family history of anxiety, mood disorders, neurodevelopmental conditions or other mental health difficulties
We also assess risk sensitively. This may include asking about self-harm, suicidal thoughts, feeling unable to cope, safeguarding concerns and the availability of support. Asking these questions is a routine part of a responsible mental health assessment and does not create these thoughts.
The assessment aims to clarify whether the presentation is consistent with an anxiety disorder, whether another condition may better explain the difficulties, or whether more than one difficulty is present. We explain our formulation clearly and discuss it with the family, including any uncertainty and the next steps recommended.
Evidence-based psychological treatment
For many children and adolescents with anxiety, psychological treatment is the first-line approach. Cognitive behavioural therapy, commonly known as CBT, is recommended in NICE guidance for several childhood anxiety disorders. CBT helps a young person understand the relationship between thoughts, feelings, physical sensations and behaviour. It develops practical skills for responding differently to anxiety.
A treatment programme may include:
- Learning how anxiety works and recognising early warning signs
- Identifying unhelpful thinking patterns and developing more balanced ways of thinking
- Gradually facing feared situations through planned exposure, at a manageable pace
- Reducing avoidance, reassurance-seeking and other behaviours that maintain anxiety
- Practising relaxation, breathing, problem-solving and emotional regulation skills
- Building confidence, independence and a return to valued activities
Exposure is planned collaboratively and is not about forcing a child into a situation before they are ready. The purpose is to help them learn that anxiety can rise and fall, and that feared outcomes may be less likely or more manageable than expected.
Parents and carers often have an important role. They may be supported to respond consistently to reassurance-seeking, encourage gradual steps towards independence and make changes at home that reinforce progress. For younger children, parent-led or family-based approaches may be particularly helpful. Treatment is adapted for developmental level, learning needs, autism, ADHD, language differences and sensory sensitivities where appropriate.
When medication may be considered
Medication is not usually the only treatment for anxiety in children and adolescents. It may be considered when anxiety is severe, persistent, significantly impairing or has not improved sufficiently with an appropriate psychological intervention. Medication may also be discussed when psychological treatment cannot be accessed, is not suitable, or the young person has additional mental health difficulties.
Any medication decision should follow a comprehensive assessment and a discussion of potential benefits, side effects and alternatives. Selective serotonin reuptake inhibitors, known as SSRIs, may be considered by a suitably experienced clinician in line with relevant NICE guidance and regulatory requirements. They require careful monitoring, particularly during the early stages and after dose changes. Medication should generally be combined with psychological support where possible, rather than viewed as a quick solution.
We involve the young person and their parents or carers in treatment decisions, taking account of the child’s views, maturity, consent and confidentiality. We also agree how progress and any concerns will be reviewed.
Working with families and other professionals
Anxiety is often influenced by the child’s wider environment. With appropriate consent, treatment may involve liaison with schools, colleges, GPs or other professionals. Helpful adjustments might include a calm arrival plan, access to a trusted adult, support with transitions, a quiet space or a gradual return to attendance. The right support depends on the individual assessment.
We aim to provide clear explanations, practical recommendations and a plan that can be understood and used beyond appointments. Progress is reviewed regularly, and treatment can be adjusted if symptoms change or new information emerges.
Seeking an assessment
Early support can prevent anxiety from becoming more entrenched and help a child or young person regain confidence and participation in everyday life. You do not need to wait until difficulties become severe before seeking professional advice.
If your child or adolescent is experiencing persistent worry, avoidance, panic symptoms or anxiety that is affecting home, school or relationships, contact healingyoungminds.com to find out more about our Anxiety Disorder Assessment & Treatment service and how we can help.