All kids can feel nervous sometimes -- about the first day of school or speaking in front of the class.

But when the worry starts to overwhelm a child: that can be a sign of an anxiety disorder. It is the most common mental disorder affecting about 6.5% of children and teens and can have devastating and lasting consequences if it isn't addressed. For seven years, Cassandra Rousseau had such worrying thoughts, it made her sick.

“When it got bad,” says the 14-year-old, “I ended pulling at my eyebrows, my eyelashes and my hair and I scratched my legs.” Rousseau says anxiety would take over her body and she couldn’t do anything about it.It started in Grade 2 she says when a teacher yelled and her.

“I started telling my mom I didn't want to go to school. I feel sick.” Once her mother let her stay home, Rousseau says the symptoms disappeared. By Grade 7, the anxiety disorder was controlling her life.

“She was somebody I didn't recognize anymore,” recalls her mother Lisa Rousseau, “the crying, the screaming. She was asking for help but didn't know what was wrong with her.”

Cassandra was diagnosed with anxiety disorder and was referred to CHEO’s outpatient “Mood and Anxiety Team” for cognitive behavioral therapy in a group setting.

“Anxious kids go around in a kind of persistent state of fear and worry,” says Dr. Lauren Humphreys, a child psychologist at CHEO. “They tend to see danger when there isn't any and it can affect their lives in various ways.”

CHEO psychologists say children with anxiety disorders complain of stomach-aches, have problems sleeping, express worrying statements out loud and want to avoid stressful situations like school.

“If your child is really suffering, crying really seems tormented by worrying, and you can't control them,” says CHEO clinical psychologist Dr. Margaret Flintoff, “you need to do something about that.”

Cognitive behavioral therapy has helped Cassandra handle her anxiety.

“I use coping strategies where you talk yourself out of feeling anxious and into doing whatever you're doing,” says Cassandra, “Say you're writing a test and you're nervous. You just say oh you're going to pass anyway.”

Her mother says the difference in her daughter after 18 months of therapy is remarkable.

“It was a long road, a very scary road because I didn't know where it was going to end up,” recalls Lisa Rousseau. “I'm just glad she's back to being my daughter.”

The Children’s Hospital of Eastern Ontario has some suggestions on how to help children deal with their fears and anxious feelings.

  • Help your child to maintain good physical health and regular routines. Ensure a balanced diet, good sleeping habits, and fitness through exercise. Set time aside for leisure and relaxation with your child.
  • Be patient and reassuring. Talk to them and be positive about their ability to handle the anxiety-provoking situation. Keep the lines of communication open.
  • Reward your child’s coping behaviour. Praise your child’s “brave” behaviour and recognize and praise successes, even partial successes; the focus should be on your child’s efforts in confronting and managing their worries.
  • Manage your own anxieties and don’t allow your worries in the situation to influence your child. Be a model for your child and show him how you do everyday things without being fearful or anxious.
  • Instead of avoiding the issue that is causing fear or anxiety, reinforce exposure. If your child is afraid of spiders, you can start to read a book about spiders. If your child is afraid of speaking out in front of a group, perhaps he can talk about his favourite toy at the next family gathering. Give your child opportunities to work through his fear, by reinforcing exposure and allowing small victories along the way.
  • Teach your child positive “self-talk”. Like the little engine that could, teach your child to repeat a positive phrase that will help her face her fear. “I know I can do this” or “I’m brave and I’m not afraid” can help them be strong when they are feeling afraid or anxious.
  • Teach your child to imagine being in relaxing or pleasant places, places where they feel safe. Distraction can work wonders when trying to deal with anxiety-provoking situations. Children can also learn how to manage anxiety by learning how to calm their breathing and how to reduce tension in their muscles; techniques for learning these are easily available through the Internet (see websites below).
  • Children can begin to feel insecure and anxious if there is conflict between their parents. Difficult conversations between spouses should happen when children are not present.

CHEO also has a number of useful resources:

  • Freeing your Child from Anxiety. By Tamar Chansky. Broadway Books, 2004.
  • Keys to Parenting your Anxious Child. By Katharina Manassis. Barron’s, 2008.
  • Taming Worry Dragons. By E. Jane Garland and Sandra L. Clark (2002). Ideal for children 4-17 years.
  • Worry Taming for Teens. By E. Jane Garland and Sandra L. Clark (2002). Ideal for children 12-17 years.
  • Hole in One: A tale from the Iris the Dragon series. By Gayle Grass. 2008. A children’s book dealing with anxiety disorder.


The Child Anxiety Network
Anxiety Disorders Association of Ontario
Anxiety Disorders Association of Canada
National Institute of Mental Health

American Academy of Child and Adolescent Psychiatry

National Institutes of Health


Nemours Foundation
New York Online Access to Health