A plethora of articles available on the Internet identify the most common symptoms of anxiety, and how these symptoms tend to play out in children. You can find some great ones here and here.
However, not all signs of anxiety are quite as clear-cut as others. In fact, some traits that we may attribute to misbehavior or personality can sometimes actually be signs of Generalized Anxiety Disorder (GAD). A lot of the children who walk through my door are dealing with anxiety – for some, it’s quite obvious to everyone around them because of the symptoms they’re exhibiting. For others, loved ones and teachers may know something is off, but it’s difficult to pinpoint exactly what. The ones in this latter group are often the ones demonstrating the less-common symptoms of anxiety that I’ve decided to identify in this post.
As usual, I’m going to make my disclaimer that just because your child shows one or two things on this list, does not mean that they have GAD. If they’re otherwise happy and healthy, there’s nothing to worry about. The intention of this list is simply to provide awareness in case you’ve noticed your child seems to be struggling, but you’re not sure why, or what’s going on.
Less-Common Signs of Anxiety
A couple of years ago, my friend’s then-eight-year-old daughter was not exactly the most graceful kid you’ve seen. All children get bumps and bruises now and then, but it seemed like this child was always stumbling, running into things, and falling down. When she later started showing hallmark signs of anxiety, her mother got her into see a therapist. A few months later, the child was showing improvement in her symptoms, and her mother remarked to me that she even seemed less clumsy. Rarely was she bumping into things, nor tripping over stuff. When she said that, a tiny little lightbulb went off in my head, and I was suddenly able to think of a couple of my own little clients, who after experiencing a decrease in anxious symptoms, also seemed to become a bit more “surefooted.” Could it be? Could anxiety be connected with a trait that typically seems so…harmless?
The answer is: probably, but we don’t know exactly how. In 2010, Moruzzi et al. discovered a strong correlation between clumsiness and both GAD and Attention-Deficit Hyperactivity Disorder. However, these disorders were not found to cause clumsiness per se. Instead, the researchers explained that the connection is likely best explained by genetic factors shared between GAD and clumsiness. Regardless, the two can definitely go hand-in-hand.
Do you frequently find yourself exasperated with your child because they struggle to make choices? Even seemingly fun and easy choices, like picking out a candy bar at the store, can have some children hemming and hawing forever. It turns out, indecisiveness is also correlated with Generalized Anxiety Disorder (Koerner, Mejia, & Kusec, 2017). The same study also found a connection with perfectionism.
The brain of a child without GAD might ponder, “what sounds better to me, the Twix or the Snickers? Twix it is!” Meanwhile, the brain of a child with GAD might go through a more complicated process: “What sounds better to me, the Twix or the Snickers? Last time I got a Twix, the caramel was hard and I didn’t like it. It was a waste of a treat. If that happened again, I’d feel like I made the wrong decision again. But what if THESE Twixes are perfect and I’m missing out on the chance to eat a really good one? I wish I could know for sure what would happen. Maybe Dad would let me get both candy bars if I asked nicely! But I don’t want him to think I’m greedy. I need to hurry up and make a decision or he’ll get mad at me for taking too long. I’ll just choose the Snickers to be extra safe! Or wait, should I try something completely different? I haven’t had a Three Musketeers in awhile. I need to hurry.”
For us grown-ups, this constant indecision can be infuriating. It’s hard to maintain empathy when it seems like such a silly thing to fret about it. But that’s pretty much the point – anxiety isn’t rational.
If you’re frequently needing to tell your kiddo to sit still at the dinner table or while completing homework (or if the teacher reports having to do this in class), don’t necessarily assume your child is misbehaving or is hyperactive.
In a 2011 Psychology Today article, author Kasia Galazka explains that anxiety affects the fear-center of the brain, which winds up triggering fight-or-flight symptoms. As a result, the body system is flooded with stress hormone, which can cause sweating, racing heart, and you guessed it – restlessness and fidgeting. When our ancestors faced danger in the caveman days, they needed that extra energy to be able to run faster or fight harder. It was a good thing! But in modern times, when it happens to a child who’s expected to sit still – it ends up looking like hyperactivity.
Children with GAD are more likely to have a difficult time keeping their attention on a task (Elkins, Carpenter, Pincus, & Comer, 2014). They may seem spacey and forgetful at times, or take forever to finish an assignment or chore that you know they can easily do. The explanation once again goes back to the physiology described in the previous section: during anxiety, the brain is flooded with stress hormone to prepare the body to fight or flee. The front part of the brain, which controls our attentiveness and higher-order thinking, goes offline during this time, because who needs to focus on a tough math problem when survival is at stake? Of course, those of us on the outside can objectively say that when a child is sitting at her desk at school, her life is not in danger; however, an anxious brain doesn’t know the difference between real and imagined danger. It just acts.
Side Note: if seeing symptoms like “inattention” and “restlessness” are ringing a bell in your head for ADHD, you’re not wrong. There’s a lot of overlap in symptoms between GAD and ADHD, and it’s often very difficult to separate them; in fact, the two disorders commonly co-occur. This is such a big topic that I could easily use up the rest of this post discussing it; instead, I’ll save that for a future post.
Discomfort with Unpredictability
ALL children have a need for consistency and predictability within their environment; they feel safest when they know that B follows A. However, we all know it’s impossible for things to go according to plan 100% of the time. Reacting to minor changes with a little concern or a disgruntled mood is normal, but reacting with major worry and upset (especially if this reaction happens on a regular basis) is an indicator that something could be wrong.
Cowie, Clementi, and Alfano (2018) discovered a significant correlation between GAD and what is termed “intolerance of uncertainty” in children. This trait refers to one’s tendency to respond to uncertain or unpredictable situations with negative behaviors, thoughts, and emotions. (For example, assuming a situation will be bothersome or scary, even if the child has never experienced it before.)
Intolerance of uncertainty is not born out of simply a pessimistic personality – people with GAD are thought to naturally assume a new situation will be threatening, so that they can help protect themselves from it. When those survival strategies come online, logical thinking shuts off.
If you have reason to think your child may have GAD or other challenges, consider reaching out to a mental health professional for help.
Cowie, J., Clementi, M.A., & Alfano, C.A. (2018). Examination of the intolerance of uncertainty construct in youth with Generalized Anxiety Disorder. Journal of Clinical Child and Adolescent Psychology, 47(6), 1014-1022.
Elkins, R.M., Carpenter, A.L., Pincus, D. B., & Comer, J.S. (2014). Inattention symptoms and the diagnosis of comorbid attention-deficit hyperactivity disorder among youth with generalized anxiety disorder. Journal of Anxiety Disorders, 28(8), 754-760.
Galazka, K. (2011). The physiology of fidgeting. Psychology Today, 44(4), 19.
Koerner, N., Mejia, T., & Kusec, A. (2017). What’s in a name? Intolerance of uncertainty, other uncertainty-relevant constructs, and their differential relations to worry and generalized anxiety disorder. Cognitive Behavior Therapy, 46(2), 141-161.
Moruzzi, S., Pesenti-Gritti, P., Brescianini, S., Selemei, M. Battaglia, M., & Ogliari, A. (2010). Clumsiness and psychopathology: Causation or shared etiology? A twin study with the CBCL 6-18 questionnaire in a general school-age population sample. Human Movement Science, 29(2), 326-338)