She sat across from me focusing on her fingernails, almost obsessively picking at the same one the entire time. Her eye contact was minimal as the intrusive thoughts streaming through her head seemed to steal every ounce of energy she had left. Her body was trembling and her breathing labored. Fear, I’m sure, was all she was feeling in that moment.

When I asked her why she was so scared to get on the plane to go visit her dad, she looked at me quizzically and whispered, “Don’t you know why I’m so scared? What if it crashes? What if we land in the water and they can’t get the door open to let us out? I am just so tired, but I can’t sleep. I have been up every night this week researching the best seat to have on the plane in the event of an emergency, and no matter which way you look at it, I could die.”

As soon as those words left her mouth, she began to hyperventilate. While I recognized what was going on, she had no idea that she was experiencing her first anxiety attack.

In my role as a secondary school counselor, I’ve noticed a trend in the last 10+ years that makes me wonder if we’re facing an epidemic. Girls are reporting symptoms of anxiety in increasing numbers. The symptoms are showing up younger and younger and, with nearly three quarters of afflicted adults developing symptoms by age 22, the amount of female students I see that are struggling and living with anxiety seems to have increased twofold.

We’re surrounded by people living with anxiety disorders, yet our understanding of this complex mental health issue is still very immature. When I think about the severity of this disorder and the statistics overall, I’m frightened for the families who live with anxiety and continue to be shamed as they seek a diagnosis and attempt to get help.

An interview conducted by Parents Magazine with Dr. Harold Koplewicz (CEO of the Child Mind Institute) states that “17.1 million children in this nation suffer from a serious mental health disorder, and anxiety disorders make up the biggest percentage (31) of that number.”

According to the Anxiety and Depression Association of America, anxiety impacts over 40 million people in the U.S. alone and women are twice as likely as men to be diagnosed with general anxiety disorder and panic disorder. For those of us with daughters, we have even more reason to be concerned. Experts are learning that women may be wired to worry.

Research confirms that women are significantly more inclined toward negative emotion, self-criticism, and endless rumination about problems. Many experts have reported that until age 11, girls and boys are equally likely to develop an anxiety disorder. By age 15, however, girls are six times more likely to have one than are boys.

Even more troublesome is the fact that anxiety is actually under diagnosed among women. Robert Leahy, Ph.D., a clinical professor of Psychology and Psychiatry at Weill Cornell Medical College in New York, reports that the “average length of time between the onset of symptoms – the time a woman starts to feel bad – and when she gets actual diagnosis is between nine and 12 years. And of those who are diagnosed, only a very small percentage get adequate help.”

Experts are learning that women may be wired to worry more than men. Research from the Children’s Hospital of Philadelphia suggests that the female brain may be more sensitive to stress hormones and less able to adapt to high levels of them. Females also have a well-known propensity to ruminate and let problems roll around in our heads. All of this leaves me with one thought: have we created the perfect storm for our daughters, nieces, sisters, and students?

When I think about my own struggles with anxiety and how it took over three decades to finally seek help, I have to wonder if women wait so long because we feel like this is a normal way to operate in life. I’ve lived the anxious life of anxiety for so long – overestimating the risk of danger and underestimating my ability to cope with the fear – that I’m not sure if I even know how to look at a situation without “what if” being my filter.

I find myself thinking a lot about that 16-year-old girl who sat in my office so many years ago. I wonder where she is in that nine- to 12-year cycle that Leahy describes. Did she continue to seek help after she graduated from high school or did she cease treatment like so many women do?Has her life continued to be defined by “what if?”

Female shadow on a wall in a square of light

How to recognize anxiety in children.

According to the National Institute of Mental Health (NIMH), occasional anxiety is a normal part of life. One might feel anxious when faced with a problem at work, before taking a test, or making an important decision. But anxiety disorders involve more than temporary worry or fear. For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The feelings can interfere with daily activities such as job performance, school work, and relationships.

The type of anxiety a parent may see is typically tied to a child’s developmental level. The most common forms of anxiety experienced by children and teens are:

  • generalized anxiety disorder
  • separation anxiety disorder
  • social anxiety disorder
  • panic disorder.

Separation anxiety is the most prevalent in preschool or early grade school and social anxiety tends to show up around puberty.

There are many risk factors that might make a child or teenager more susceptible to experiencing anxiety. Some of the most common risks include:

  • genetic factors — family history or mental health problems (specifically anxiety)
  • environmental factors, such as chronic stress or a very stressful event in a child’s life
  • ongoing physical illness and personality factors
  • precocious puberty (showing significant signs of puberty before age seven).

Anxiety can be considered a serious issue in a child’s life when it begins to interfere with daily activity. Some of the more common things to look for in your child or teenager are:

  • being afraid when there is no imminent danger
  • physical symptoms like racing heart, headache, stomach aches/nausea, and tense/sore muscles
  • displaying constant agitation, restlessness, and worry that seems out of control
  • catastrophic thinking and a decision-making process that is based in fear
  • beginning many thoughts and questions with “what if”
  • avoiding new situations because of new challenges
  • having trouble starting or completing school work (can look like perfectionistic tendencies)
  • sleep problems including difficulty falling and staying asleep
  • compulsive behaviors (need to do a particular action or something over and over again).

Many parents are unsure of how to best support their child who is struggling with anxiety. In an attempt to alleviate their discomfort, many are consequently adding to it. No parent wants to see their child suffer and it’s a natural instinct to protect and do whatever we can to make things better. While this is not always a bad thing, when it comes to anxiety, it can be detrimental.

So what can we do?

All of this research and information leaves many parents wondering what they do at home to help. Here are some helpful tips and strategies for parents with an anxious child:

1 | Teach basic mindfulness and breathing exercises.

Guiding children through deep breathing (in through the nose, out through the mouth) while relaxing all the parts of their body can provide instant relief for many kids. Often times, repeating this pattern of breath until their heart rate slows down and their thoughts are off of what is causing them anxiety is all they need.

2 | Help them manage transitions.

Going from one activity to the next without a plan can be difficult for some young children with anxiety. Developing routines and structure can help your child manage the stress and anxiety that can come from unpredictable transitions.

3 | Focus on the positive by asking your child to share one thing that went right during their day.

Ask them to identify how it felt when they experienced success and build on that feeling when discussing situations that make them anxious.

4 | Encourage your child to face their fears.

Sometimes parents help their children avoid these situations because they’re worried it’s too much for them to handle. In fact, they really need to help them face these fears to reduce their anxiety, according to Amy Przeworski Ph.D. “Avoidance of anxiety-provoking situations maintains the anxiety. Instead, if a child faces his or her fears, the child will learn that the anxiety reduces naturally on its own over time. The body cannot remain anxious for a very long period of time so there is a system in the body that calms the body down. Usually your anxiety will reduce within 20-45 minutes if you stay in the anxiety-provoking situation.”

5 | Remind your child that being imperfect is better than okay.

No one is perfect. No. One.

6 | Make sure they have time to relax in their day.

Including activities that they enjoy can help reduce stress.

7 | Model calmness, self-care, and courage by facing anxiety-provoking situations.

Children learn from us and they will do what we do. Parents (especially those who have anxiety) must practice self-care and approach situations that cause anxiety. By facing our fears instead of avoiding them, we show our children that they do not need to fear situations that are safe. The more we can face situations that cause us anxiety, the more likely they are to not avoid them.

8 | Teach your child that she is not her anxiety.

Professionals who practice Cognitive Behavioral Therapy (CBT) have come up with a clever way to teach kids how to distance themselves from their anxiety. A method used by psychologist Jerry Bubrick is gaining attention as kids are finally feeling like they have some power over their anxiety. He teaches kids to distance themselves from the anxiety by having them conceptualize it as a bully in the brain. He encourages children to give the bully a name and talk back to it. He explains that he is going to teach skills to handle the bully, giving children the idea that they can control their anxiety rather than letting it control them.

photography of a butterfly shape cut into a white sheet of paper.

Anxiety is a normal part of childhood, and every child goes through phases involving worry, anxiety, and fear. But sometimes this anxiety crosses the line from normal everyday worries to a disorder that gets in the way of the things they enjoy and also begins to limit the things they need to do. When those phases stop being temporary and start being more permanent, it may be time to seek help.

Above all, we need to be available to listen to our children when they want to talk about what is bothering them. Being empathetic and letting your child know that anxiety is scary and that they are not alone, is one of the first steps in teaching them how to manage their thoughts and feelings. There is no cure for anxiety, but with a lot of support, encouragement, and education, kids can learn the proper strategies to help them cope with the anxieties they face in life.