How to Screen a Child for Anxiety Disorders

Anxiety problems are commonly misunderstood by parents, physicians, and mental health professionals. Therefore, anxiety disorders in children are often missed. They may be brushed off as “passing phases,” misdiagnosed completely, or otherwise left untreated. Some reasons for this:

  • lack of training/experience in assessing and treating anxiety problems
  • the waxing and waning nature of all anxiety disorders
  • the fact that children often have more than one anxiety disorder
  • the nature of anxiety, which is often irrational and not obvious to the untrained eye

Does your child have any of these signs of an anxiety problem?

In place of a formal screening tool, you can use the signs listed below to get a sense of whether your child has an anxiety problem.
If you don’t see one or more of the visible signs, look for less easily observable signs. Observe your child closely for a week.

If you notice one or more signs, contact a mental health professional for formal clinical consultation and possible treatment. If no professionals are available, check the Next Steps and Resource pages for more options.

Visible signs of anxiety

  • Physical distress (shaking, crying, hyperventilating, screaming) in particular situations
  • Fleeing, escaping
  • Outright statements of anxiety (“I’m afraid the house will burn down tonight while I’m asleep”)
  • Outright questions expressing fear (“What if you get in a car accident when you go out?”)
  • High levels of distress in various unavoidable situations
  • Extreme distress upon contact with a feared object (dogs, birds, planes, snakes, bees, insects)
  • Excessive concern about natural disasters, robbers, kidnappers, explosions, extreme weather
  • Repeatedly calling and texting seeking reassurance and/or requests for rescue

Less obvious signs of anxiety

  • Clingy behavior, irritability
  • Repeated questions, “what if” questions
  • Avoidance behaviors (reluctance to engage in activities other same-age kids do)
  • Complaints of physical illness, especially related to situations that trigger anxiety
  • Reassurance-seeking behavior (“Will I be okay if…”)
  • Argumentative/oppositional behaviors (to avoid situations that trigger anxiety)
  • Reluctance to try new things (activities, foods, places, routines)
  • Extreme shyness, sensitivity
  • Preoccupation with academic achievements (making mistakes, doing things exactly per a teacher’s instructions, getting poor grades in spite of excellent performance)
  • Lack of class participation
  • Limited social contact with peers, except trusted, well-known friend(s)
  • Preoccupation with concerns about vomiting
  • Discomfort and/or avoidance of doing typical behaviors (eating, writing, using a phone) in front of others
  • Preoccupation with being late, getting in trouble
  • Concerns about having “bad” thoughts
  • Confessing behaviors (your child tells you about thinking or doing things they fear are “bad”)
  • Excessive washing/bathing/ requiring clothing, bedding to be laundered more than typical
  • Keeping their room or a particular space “just so”
  • Adherence to nighttime rituals requiring a parent to perform behaviors
  • Refusal to sleep over, go on overnight trips, etc. without a parent
  • Refusal to sleep in own room (sleeping with a parent, pet, or sibling only)
  • Overly cautious behaviors

This is how parents often experience a child with anxiety problems:

He just is not confident about himself, even though he gets straight A’s and is well liked.
She keeps asking what we are doing next, even when I’ve already told her several times.
They won’t eat anything other than chicken nuggets, pizza, carrots, cereal and sweets.
They are so negative and grumpy most of the time. They don’t want to do anything.
He refuses to go to school some days.
She won’t sleep in her own room at night and comes into our room most nights.

She is so picky about what she will wear. She will only wear one brand of underware and socks and refuses to wear jeans or other things she thinks might be uncomfortable.

They study much more than their friends do. They start doing homework on the way home from school because they’re worried they won’t have time to finish and relax.

He says he wants friends, but he is afraid to invite anyone over or eat lunch with anyone but his best friend from preschool.