The Hidden Ways Anxiety Shows Up in Kids

Anxiety is often thought of as something loud, such as panic attacks, tears, or refusal to go to school. But more often, anxiety in children is quiet, subtle, and easy to miss. But sometimes, anxiety shows up as something far more dramatic.

Dr. Roy Boorady, a child psychiatrist, reminds us of while some fear and worry is a normal part of childhood, anxiety can gradually grow into something more serious, impacting how children think, feel, and interact with the world around them.

Take James, a 10-year-old boy whose story Caroline Miller shared at the Child Mind Institute. After being upset by a classmate’s comment, James shoved the boy and then had a full-blown meltdown, throwing papers, running out of class, and even kicking the vice principal. Staff called 911, and James ended up in the emergency room.

To anyone watching, James looked like a kid with anger issues. But what was driving his conduct? Crippling, unrecognized social anxiety.

When Anxiety Wears a Mask

According to Dr. Jerry Bubrick, the clinical psychologist who treated James, he was “off the charts” for social anxiety. James could not tolerate even mild criticism—he was terrified of embarrassment and lacked the emotional tools to manage these overwhelming feelings. His body went straight into fight or flight mode, and the result looked like aggression.

This is the reality for many children. Anxiety is an expert in disguise. It can look like oppositional behaviour, inattentiveness, irritability, or even ADHD. Anxiety is what Dr. Laura Prager of Massachusetts General Hospital calls “a great masquerader.” Especially in children who do not yet have the words—or safe people—to talk to, anxiety often manifests behavioural meltdowns, tantrums, or what school staff may interpret as defiance.

It is Not Always Obvious

An anxious child may not be “melting down.” They may still smile, laugh, and do well in school. But that homework that takes an hour instead of 20 minutes? That could be anxiety. Or the child who needs to ask the same reassurance questions daily about something that happened weeks ago? Anxiety, again.

Because anxiety is often internal, even engaged, and happy children may be quietly battling it.

What Anxiety Actually Looks Like

Here are some less obvious signs of anxiety that might be dismissed or misunderstood:

• Frequent stomachaches or headaches without a medical cause
• Trouble falling asleep or staying asleep
• Clinginess or strong reluctance to be away from a caregiver
• Trouble focusing, fidgeting, or appearing hyperactive (often misread as ADHD)
• Angry outbursts when overwhelmed (misread as defiance or “bad behaviour”)
• Constant reassurance-seeking or fear of minor mistakes
• Avoidance of social situations or school
• Describing themselves as “shy,” “worried,” “nervous,” or “not good enough”

One of Dr. Boorady’s most important points? Not all children use the word anxiety. They may say they are scared, feel “weird,” or just want to stay home. These words can mask what is really going on—an anxiety disorder.

Why It Matters

Untreated anxiety can lead to:

• Avoidant coping (e.g., skipping school, avoiding social situations)
• Lower self-esteem and academic struggles
• Increased risk of depression and even substance use in teens
• Lifelong anxiety that carries into adulthood

Studies show that more than 30% of youth experience anxiety disorder before age 18, but 80% never receive treatment.

Helping Kids Break the Anxiety Cycle

(Insights by Clark Goldstein, PhD)

When children are chronically anxious, even the most well-meaning parents can unknowingly make things worse. As Dr. Clark Goldstein points out, this often happens when caregivers try to protect kids from their fears rather than help them manage them. The goal is not to eliminate anxiety but to support children in learning how to cope with it. Below are ten practical tips to guide parents and caregivers:

1. The goal is not to eliminate anxiety, but to help a child manage it.
   Anxiety will naturally lessen over time as children build confidence in their ability to manage stressors.
2. Do not avoid things just because they make a child anxious.
   Avoidance may provide short-term relief but reinforces fear.
3. Express positive, but realistic expectations.
   Rather than promising outcomes, offer assurance that your child can manage the situation and that things will get easier with practice.
4. Acknowledge their feelings, but do not let fear take the lead.
   Validate what they are feeling but gently encourage them to move through it rather than around it.
   • For example, if a child is really scared about going to the doctor because they are getting a needle shot, it is important not to dismiss their fear, but also not to make it seem bigger than it is. Instead, respond with empathy: help them name what they are feeling, acknowledge that it is tough, and reassure them that they can manage it. The message you want to send is, “I understand that you are feeling scared right now, and that is completely okay. I am right here with you, and we will get through this together.”
5. Do not ask leading questions.
   Use open-ended questions to explore their feelings without unintentionally planting worries.
6. Do not reinforce the child’s fears.
   Be mindful of your tone and body language so that you are not sending mixed messages.
7. Encourage the child to tolerate their anxiety.
   Teach them that it is okay to feel anxious and that those feelings will decrease over time with exposure.
8. Try to keep the anticipatory period short.
   Too much lead-up time can heighten anxiety. Keep prep time brief and calm.
9. Thinking things through with the child.
   Talking through potential outcomes can reduce uncertainty and increase their sense of control.
10. Try to model healthy ways of handling anxiety.
    Children learn a lot by watching the adults in their lives. Demonstrate how you manage stress in a calm, constructive way.

Helping kids move through anxiety rather than avoiding it builds resilience and long-term emotional strength. It is not about creating a stress-free world for our children, but giving them the tools and confidence to thrive in the one they are in.

The Good News: It is Treatable

Cognitive Behavioural Therapy (CBT) is a gold standard treatment for anxiety in children and teens. Therapy helps kids:

• Name their fears
• Understand that anxiety is not dangerous, just uncomfortable
• Learn how to gradually face what scares them
• Build confidence and emotional resilience

Sometimes, medication may be part of the picture, but often, consistent therapy alone can bring meaningful relief.

Final Thoughts for Parents & Caregivers

If your child seems easily overwhelmed, avoids things they used to enjoy, or complains often about physical symptoms, pause and wonder if anxiety could be underneath it.

Your child does not have to “look anxious” to be struggling. By learning how anxiety can hide in plain sight, you are already one step closer to helping them feel understood, supported, and safe.

Final Thoughts as a Therapist

As a therapist and daughter of immigrant parents, I often reflect on how cultural expectations around success, emotional expression, and discipline influence how we view children’s behaviour. In many communities, including myself, there is pressure to be tough, obedient, and high achieving. Emotions like fear or worry may be dismissed or misunderstood, especially if a child is not crying or “looking” anxious.

But the truth is, many children are quietly battling inner storms, and the first step in helping them is recognizing what is really going on beneath the surface.

Let us stop punishing kids for the way they show us they are in pain—and start listening.