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The ABC's of Anxiety

The ABC's of Anxiety

girl with teddy bear laying down

Anxiety can impact the lives of children, teens (and adults!), in the following 6 ways:

  1. Affect: Emotionally and physically – what we feel in our body
  2. Behavior: Behaviorally – what we do or our actions, such as avoiding or seeking-reassurance
  3. Cognition: Mentally – what goes through our mind like worrisome thoughts
  4. Dependence: Relying on parents – what happens over time is that children and teens depend too much on their parents
  5. Excess and Extreme: Anxiety is a problem when it is excessive and extreme in relation to the situation
  6. Functioning: How your child manages each day

Note: The pattern of these experiences varies in each child, and from situation to situation, but generally anxious children are impacted in in all six domains.



Anxiety is an emotion that is felt in the body. It is a physical response. Often, when children feel anxious, they do not actually recognize or describe their body symptoms as anxiety or nervousness. Instead, they may say that they feel sick, or have a sore tummy. Teens may complain of headaches, chest pains, and sore shoulder muscles.

Common examples include:

  • Chest pain or discomfort
  • Discomfort or pain in the stomach, nausea
  • Dizzy, lightheaded, or unsteady feelings
  • Feeling foggy, or like things are unreal or a feeling of being detached from oneself
  • Feeling very hot or cold
  • Feelings of a lump in the throat or choking
  • Headaches
  • Numbness or tingling
  • Rapid heart rate
  • Rapid breathing (hyperventilating), feelings of shortness of breath, or breath holding
  • Sweating
  • Trembling or shaking

If 4 or more of these symptoms happen suddenly (within a few minutes) and intensely, your child may be having a panic attack (/parenting/panic-disorder-and-agoraphobia). Panic attacks are uncomfortable but not dangerous. Remember the body is not designed to remain anxious for hours and hours, but will settle back to a resting state. For a child suffering from anxiety, his o rher worries may reoccur, starting off the anxiety cycle of symptoms over and over.


Anxious children and teens avoid! One of the most common behaviors in anxious kids is not doing things or refusing to go places, also known as avoidance. In a situation of real threat (e.g., being cornered by a large, snarling dog), moving away from the threat, or avoiding, is very helpful, as the fight-flight-freeze (/parenting/fight-flight-freeze) response keeps us safe from danger. In other situations where there is no real danger, avoidance prevents children from learning to cope with a challenging situation or from engaging in age appropriate activities.

Common examples include:

  • Difficulty raising hand in class or reading out loud
  • Excessive fear of making mistakes, or desire to be “perfect” in appearance and work projects
  • Not getting routine injections (shots) or dental work
  • Not hanging out with other kids or having few friends because of social fears
  • Not sleeping in his or her own bedroom or refusing to attend sleepovers
  • Refusing to go to school for any number of reasons (e.g. an exam, performances, a bully, social situation, etc.)
  • Refusing to participate in sports, dance, or other performance related activities

Key Point: Avoidance is a habit-forming, unhelpful way of coping with stress. With your patience and consistency, your child will learn a variety of coping skills to practice, and will then learn to face his or her fears with success!


Anxious children and teens worry. These worries can be about a current situation or about some future event. Young children may not be able to identify anxious thoughts even when they are very anxious. This also sometimes happens for older children and teens. However, when they are able to tell us what they are worrying about the thoughts can range from the reasonable (e.g. I will fail my test) to the remote (e.g. I will get sick and die if I eat in a restaurant).

Common examples include:

  • I’ll fail my exam
  • My Mom might forget to pick me up after school
  • My teacher will yell at me and the kids will laugh
  • That dog might bite me!
  • The world is a dangerous place
  • What if I fall off my bike and everyone laughs?
  • What if I throw up at school?
  • What if my Mom or Dad dies?


Anxious children and teens reply and depend on their parents’ far more than same aged peers. These anxious kids either seek reassurance or ask their parents to do things for them that seem unnecessary. While it is normal and helpful for children to ask for information when they are learning about new things, or seek comfort when they are scared, anxious children and teens often ask the same questions over and over again, or demand comfort in non-threatening situations. In addition, these kids often ask their parents to do things for them, or to be available to help just in case something goes wrong, even when the feared outcome seems unlikely. When parents of anxious children compare their children to their peers, parents often notice they are doing far more for their children than are the parents of their children’s friends.

Common examples include:

  • Asking "Are you sure I won't get sick?”
  • Asking "Are you sure you will be on time to pick me up?"
  • Asking parents to talk to teachers to request extra time on an assignment or to manage other academic needs
  • Making the parents give them a complete change of clothes when they go to the movies in case the child gets sick.
  • Not wanting to be away from home unless they have a cell phone
  • Only going to a party if a parent comes with them
  • Requesting ongoing reassurance that eczema is not actual skin cancer

Excessive and Extreme

Anxious children and teens worry in excess and to an extreme. They worry about more things, more often, and in more extreme ways than their peers. Socially anxious teens are not just worried about saying the wrong thing once or twice, but are afraid that they will say the wrong thing repeatedly, be judged harshly by their peers, and embarrass themselves beyond repair for the rest of their lives!

Common examples include:

  • Expecting the worst to happen, all of the time
  • Generating extreme conclusions from vague information
  • Having trouble falling asleep due to excessive worries about daily events, getting enough sleep, or staying asleep
  • Making extreme predictions with catastrophic outcomes
  • Viewing themselves as incompetent, unlovable, worthless, ugly, etc.
  • Worrying for hours rather than minutes about talking to a peer, a girl/boyfriend, or teacher


The daily lives of anxious youth are typically severely impacted by anxiety. Many of these children and teens are functioning at a lower level compared with their peers. They struggle to get up and ready in the morning, and are often late to school or forget things at home. They appear disorganized, unfocused, or fail to reach their full academic potential (and if they can reach their potential it is due to extreme efforts). They miss out on important social and recreational activities due to fear, often missing opportunities to learn important skills like making friends, dating, asserting oneself, and more. They experience more conflict with their families than is typical for teens, or depend more on parents to get their needs met causing them to be unprepared for adolescence or the adult world.

Common examples include:

  • Being unable to do routine tasks without crying, tantrums or having continual reminders
  • Believing, “I can’t cope” or “It’s safer to stay home”
  • Not getting enough sleep or nutrition
  • Over time, academic struggles and/or social withdrawal Struggling to balance reasonable demands such as doing homework and playing a sport

Less common examples include:

  • Engaging in high risk behaviors such as sexual promiscuity or cutting
  • Using drugs and alcohol to “take the edge off”



ABC's of Anxiety | AnxietyBC -