Anxiety Treatment

Child & Teen Anxiety Treatment

Anxiety is the most common mental health condition in children and adolescents. Here is what parents need to know about recognizing it, understanding it, and getting help.

Understanding Anxiety in Children and Teens

Anxiety disorders affect roughly 1 in 3 adolescents in the United States, and the numbers have been climbing steadily. But what makes childhood anxiety particularly tricky is that it often does not look the way adults expect it to. Anxious children do not always appear worried or nervous. Some become irritable. Some develop stomachaches and headaches. Some become perfectionists. And many simply withdraw, pulling back from activities, friendships, and experiences that used to bring them joy.

As a parent, you might notice that your child is more clingy than usual, is avoiding situations they used to handle fine, is having trouble sleeping, or seems to be on edge much of the time. These are not phases. They are signals. And the earlier you address them, the better the outcomes tend to be.

At NS Psychiatry, we evaluate and treat anxiety in children, teens, and adults. Jonathan Stevens, M.D., M.P.H. is Harvard-trained and triple board-certified in general psychiatry, child and adolescent psychiatry, and addiction medicine. Our team understands that anxiety rarely exists in isolation. It often coexists with ADHD, depression, or behavioral challenges. A thorough evaluation helps us understand the complete picture so we can recommend the right treatment, not just the most obvious one.

Mother comforting her son in Palm Beach, Florida

Types

Types of Anxiety Disorders

Anxiety is not one-size-fits-all. The symptoms, age of onset, and the right treatment approach all depend on which type of anxiety your child is experiencing.

Generalized Anxiety Disorder

Excessive, uncontrollable worry

Children with GAD worry excessively about a wide range of things: school performance, health, safety of family members, world events, and everyday situations. The worry is persistent, difficult to control, and disproportionate to the actual risk. Physical symptoms like muscle tension, stomachaches, headaches, and fatigue are common. These children frequently seek constant reassurance from parents and may have difficulty sleeping.

Social Anxiety Disorder

Far more than shyness

Social anxiety involves an intense fear of being judged, embarrassed, or rejected in social situations. A child with social anxiety may refuse to participate in class, avoid birthday parties, dread group projects, or have panic-level reactions before school events. In teens, it often looks like increasing isolation, refusal to eat in the cafeteria, or declining every invitation from friends.

Separation Anxiety Disorder

Beyond the preschool years

While some separation anxiety is normal in toddlers, it becomes a clinical concern when it persists past age 6, is severe, or interferes with daily functioning. Children with separation anxiety disorder may refuse to go to school, be unable to sleep without a parent nearby, have nightmares about separation, or become physically ill at the thought of being away from their caregiver.

Panic Disorder

Panic disorder involves recurrent, unexpected panic attacks: sudden surges of intense fear accompanied by physical symptoms like a racing heart, shortness of breath, dizziness, chest pain, and a feeling of losing control. While less common in younger children, panic disorder can develop in adolescence and is often terrifying for both the teen and their parents. Many families first go to the emergency room thinking their child is having a heart attack or a medical crisis. Once medical causes are ruled out, a psychiatric evaluation can determine whether panic disorder is present and what treatment approach makes sense.

School Refusal

School refusal is not a standalone diagnosis, but it is one of the most common and disruptive ways anxiety manifests in children and teens. A child who was previously attending school without issue may start complaining of headaches or stomachaches every morning, begging to stay home, or having meltdowns at drop-off. The underlying cause is usually one of the anxiety disorders described above, but identifying the specific one and ruling out other contributing factors else is also contributing, requires a thorough clinical evaluation. The longer school avoidance continues, the harder it becomes to reverse, which is why early intervention matters.

Signs of Anxiety Parents Often Miss

Anxiety in children does not always look like anxiety. Many of the signs are easy to attribute to something else: a sensitive temperament, a picky eater, a strong-willed child. Here are signs that may indicate your child is struggling with more than typical worry:

Frequent physical complaints with no medical explanation, like stomachaches, headaches, nausea, or fatigue, especially on school mornings or before social events
Irritability and meltdowns that seem disproportionate to the situation. Anxious children are often misidentified as having behavioral problems when anxiety is actually the driving force.
Perfectionism and rigidity. If your child erases and rewrites homework repeatedly, refuses to turn in work that is not perfect, or has a meltdown when plans change, anxiety may be driving the behavior.
Sleep difficulties such as trouble falling asleep, nighttime waking, nightmares, or insisting on sleeping with a parent well past the age when this is developmentally typical
Avoidance.Declining activities they used to enjoy, not wanting to go to friends' houses, refusing new experiences, or always wanting to stay home
Constant reassurance-seeking.Repeated questions like “Are you sure everything is okay?” or “What if something bad happens?” multiple times per day
Difficulty concentrating that looks like ADHD but is actually a mind consumed by worry

If several of these sound familiar, it may be time for an evaluation. You know your child better than anyone, so trust what you are observing.

When Worry Becomes a Disorder

Every child worries sometimes. A certain amount of anxiety is normal and even healthy. It helps children be cautious in genuinely risky situations and motivates them to prepare for challenges. The line between normal worry and an anxiety disorder comes down to three factors: intensity, duration, and impact.

Intensity: Normal worry is proportionate to the situation. A child might feel nervous before a big test, but they can still take the test. Clinical anxiety is disproportionate. The child may refuse to go to school entirely, have a panic attack in the car, or spend hours the night before in tears.

Duration: Normal worry passes once the situation resolves. Clinical anxiety persists. The child continues to worry long after the event is over, or the worry shifts to the next thing, and the next, without relief.

Impact:This is the most important factor. When anxiety starts interfering with your child's ability to attend school, maintain friendships, participate in activities, sleep through the night, or function at home without constant distress, it has crossed the line from normal worry into a treatable condition.

At NS Psychiatry, we help parents understand where their child falls on this spectrum. Not every worried child needs medication. Not every anxious child has a disorder. But the children who do deserve a clear diagnosis and a treatment plan that actually works. Our initial evaluation is up to 90 minutes, which is enough time to understand the full picture and give your family a concrete path forward.

How We Treat Anxiety

Effective treatment for childhood anxiety often involves a combination of approaches. The right plan depends on your child's age, the type and severity of their anxiety, and whether co-occurring conditions are present. At NS Psychiatry, every treatment plan is built under the clinical direction of Dr. Stevens and tailored to your child's individual needs.

Comprehensive Psychiatric Evaluation

Everything starts with understanding what is actually going on. Our 90-minute initial consultation ($450) covers your child's full history, current symptoms, and behavioral patterns. We screen for co-occurring conditions like ADHD, depression, and learning differences that can either cause or complicate anxiety. Getting the diagnosis right is the foundation of effective treatment.

Therapy Coordination

While NS Psychiatry focuses on psychiatric evaluation and medication management, we recognize that therapy, particularly cognitive behavioral therapy (CBT), is a cornerstone of anxiety treatment. CBT helps children identify anxious thoughts, challenge them, and develop coping strategies. Exposure-based approaches gradually help children face feared situations in a structured, supportive way. If your child is already in therapy, we coordinate with their therapist to ensure alignment. If they are not, we can help you find the right fit.

Parent Guidance

Parents play a critical role in a child's anxiety treatment. Well-meaning accommodations like letting your child skip school to avoid anxiety, answering every reassurance question, or removing triggers entirely can actually reinforce the anxiety cycle over time. We help parents understand how to respond to their child's anxiety in ways that are supportive without being enabling, and we give you practical tools you can use at home every day.

Medication for Child and Teen Anxiety

Medication is not always the first step in treating childhood anxiety, but when it is needed, it can be transformative. For moderate to severe anxiety, or when therapy alone has not produced enough improvement, medication can reduce the volume on anxious thoughts enough for your child to engage with the world again.

SSRIs (selective serotonin reuptake inhibitors) are the first-line medication for anxiety disorders in children and adolescents. Medications in this class, including fluoxetine (Prozac), sertraline (Zoloft), and escitalopram (Lexapro), have decades of clinical research supporting their safety and effectiveness in young patients. They work by increasing serotonin availability in the brain, which helps regulate mood and reduce excessive worry.

SSRIs generally take 4 to 6 weeks to reach full effectiveness. Side effects are usually mild and often resolve within the first week or two. The most common include nausea, headache, and mild changes in sleep or appetite. Our providers monitor your child closely during the initial weeks and adjust the dose as needed based on response and tolerability.

SNRIs (serotonin-norepinephrine reuptake inhibitors) such as duloxetine (Cymbalta) may be considered when SSRIs are not effective or not well tolerated. For specific situations like acute performance anxiety or panic symptoms, other short-term options may also be discussed.

At NS Psychiatry, we never pressure families into medication. We lay out the evidence, explain the options, discuss the risks and benefits honestly, and let you make an informed decision. If we do start medication, the goal is always the lowest effective dose, with regular check-ins ($225 per follow-up) to make sure things are moving in the right direction. Many follow-up visits can be done by telehealth for your convenience.

Common Questions

Frequently Asked Questions About Childhood Anxiety

Is it normal for kids to be anxious?

Some anxiety is a normal part of childhood. Fear of the dark, nervousness before a test, worry about fitting in. Anxiety becomes a clinical concern when it is persistent, disproportionate to the situation, and starts interfering with daily life. If your child's anxiety is causing them to avoid activities, miss school, have frequent meltdowns, or struggle to sleep, it is worth getting an evaluation.

What age does childhood anxiety typically start?

Anxiety disorders can emerge at any age, but certain types tend to appear at predictable stages. Separation anxiety is most common between ages 3 and 6. Social anxiety typically emerges between ages 8 and 15. Generalized anxiety can develop at any point during childhood or adolescence. Earlier intervention generally leads to better outcomes.

Will my child need medication for anxiety?

Not always. For mild to moderate anxiety, therapy (particularly cognitive behavioral therapy, or CBT) is often the first recommendation. For moderate to severe anxiety, or when therapy alone is not enough, medication can be very effective. SSRIs are the most commonly prescribed medications for childhood anxiety and have a strong evidence base. We make medication decisions carefully and collaboratively with parents.

How long does anxiety treatment take?

This varies by child and severity. Some children respond well to treatment within a few months. Others benefit from longer-term medication management. We do not believe in indefinite prescribing. We reassess regularly and adjust the plan as your child grows and their needs change.

Can anxiety look like ADHD?

Yes, and this is one of the most common diagnostic overlaps we see. A child with anxiety may have trouble concentrating, seem distracted, fidget, or avoid tasks, all of which can look like ADHD. A thorough evaluation matters because getting the diagnosis wrong means the treatment will not work, and in some cases can make things worse.

My teenager will not talk to me about their anxiety. What should I do?

This is extremely common, especially in adolescence. Teens may be embarrassed, may not fully understand what they are feeling, or may worry about being judged. A psychiatric evaluation gives them a safe, confidential space to talk with someone who is not their parent. Our providers are experienced at building rapport with reluctant teenagers.

How much does an anxiety evaluation cost?

The initial consultation at NS Psychiatry is $450 for up to 90 minutes. Follow-up visits are $225. Sessions with Dr. Stevens, our medical director, are $950 (initial) and $450 (follow-up). We are a self-pay practice with transparent pricing, no insurance paperwork, and no surprise bills. We can provide a superbill that you may submit to your insurance company for potential out-of-network reimbursement.

Anxiety Treatment in Palm Beach County

Worried About Your Child's Anxiety?

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