Anxiety disorders are among the most highly prevalent disorders affecting children and adolescents and can be associated with significant impairment in school, social, and family life. Despite the availability of effective cognitive-behavioral treatments, the majority of youth with anxiety disorders remain undetected and untreated. This can be due to a misunderstanding of what pediatric anxiety may look like and what symptoms may co-occur (Klein & Pine, 2002; Masia Warner, Reigada, Fisher, Saborsky, & Benkov, 2009).

Just to be clear, some worries and fears are completely normal and anxiety is a very necessary part of life. When it doesn’t get in the way for us, anxiety can help keep us out of dangerous situations, and motivate us to work hard. However, when anxiety stops us from doing things or becomes unbearable, research supported anxiety disorder treatments like Cognitive Behavioral Therapy with exposure (offered at Center for Integrated Behavioral Health) may be beneficial to your child.

So when is anxiety a problem and when might it be good to take your child or adolescent for an evaluation? Detect the 4 D’s:

  •  Disproportionate: You notice your child’s reaction to an anxiety provoking situation seems greater than that of another child or individual. Or they react very strongly to something when there is no obvious external danger.
  • Disruptive: Is your child’s anxiety getting in the way for them? Is it stopping them from doing things that they used to enjoy or would like to try? Is anxiety affecting the quality of their life and impairing functioning?
  •  Distress: When your child comes in contact with something that makes them nervous, how much distress do they show? Do they want to avoid the anxiety-provoking situation all together? Do they fight to stop you from placing them into a specific situation? Do they have physical symptoms that go along with their anxiety (e.g. stomachaches, chest pain, headaches, muscle tension)? It’s also important to note that anxiety may also present as increased irritability in children and adolescents.
  •  Duration and Frequency: Does it appear like your child takes a long time to adjust to situations that make them nervous? Have they been upset or anxious about these situations for more than a few weeks? How often do you notice that they seem anxious? When they are in an anxiety-provoking situation, do they stay upset for a longer time than you’d expect?

If you notice that your child or adolescent is having major difficulties with any of these areas, Cognitive Behavioral Therapy may be beneficial. Your child’s therapist will provide them skills to cope with their anxiety, teach them how to be detectives with their thinking, and help them face their fears to conquer their anxiety. With the right skills and strategies, you and your child can make the 4 D’s disappear.


Klein, R. G., & Pine, D. S. (2002). Anxiety disorders. In M. Rutter & E. Taylor (Eds.), Child and adolescent psychiatry: Modern approaches (Vol. 4, pp. 486–509).

Masia Warner, C., Reigada, L.C., Fisher, P.H., Saborsky, A.L., & Benkov, K. (2009). CBT for anxiety and somatic complaints in pediatric medical settings: An open pilot study. The Journal of Clinical Psychology in Medical Settings, 16, 169-177.

Rapee, R., Wignall, A., Spence, S., Lyneham, V., & Cobham, V. (2008). Helping your anxious child: A step-by-step guide for parents (2nd ed.). New Harbinger Publications.