When adults picture an anxious child, they often imagine a quiet, clingy, visibly nervous little person. And sometimes anxiety does look like that. But more often, anxiety in young people wears disguises that adults do not recognise - and that is where things get more complicated.
The disguises anxiety wears
Anxiety in children and adolescents frequently presents as physical symptoms. Stomach aches are the classic one - the child who complains of tummy pain every school morning but is fine at weekends. Headaches, nausea, dizziness, fatigue, and a general sense of feeling “unwell” without any identifiable medical cause. These are not made up. Anxiety genuinely produces these symptoms. The child really does feel ill, and dismissing their physical experience as fabrication undermines trust and leaves the underlying anxiety unaddressed.
Anger and irritability are common anxiety presentations that adults frequently misinterpret. An anxious child whose nervous system is in chronic high alert may have very little tolerance for additional stressors. The result looks like anger, defiance, or aggression - slamming doors, shouting, meltdowns over seemingly trivial things. The adult sees a “difficult” child. The child is actually overwhelmed and drowning.
People-pleasing and perfectionism are anxiety’s quieter disguises. The child who is desperate to get everything right, who becomes disproportionately distressed by mistakes, who spends hours on homework that should take twenty minutes, who seeks constant reassurance that they are doing well - this is often being driven by anxiety. Because these children tend to be “good” and high-achieving, their anxiety frequently goes unrecognised. They are rewarded for the very behaviours that the anxiety is producing.
School refusal is one of the most misunderstood anxiety presentations. A child who refuses to go to school is rarely being “naughty” or “lazy.” School refusal is almost always driven by anxiety - social anxiety, separation anxiety, academic pressure, sensory overwhelm, bullying, or a combination. Punitive responses (threats, loss of privileges, forced attendance) typically make things worse because they add shame and fear to an already overwhelmed nervous system.
Avoidance in young people takes many forms beyond school refusal: declining invitations, refusing to participate in activities, not wanting to be away from home, avoiding anything new or unfamiliar, needing excessive preparation before events, or becoming upset if plans change. Each of these may look like a personality trait rather than an anxiety symptom: “She is just shy.” “He does not like new things.” “She is a homebody.” Sometimes these are personality traits. But if the avoidance is driven by fear and distress rather than genuine preference, it is anxiety.
Reassurance-seeking in anxious young people can be relentless and is often exhausting for parents. “Will it be okay?” “What if something goes wrong?” “Are you sure?” “But what if…” The instinct is to reassure, and reassurance does provide temporary relief. But as with adult anxiety, excessive reassurance-seeking creates a dependency that maintains the anxiety cycle. The child learns that the only way to manage uncertainty is through external confirmation, rather than developing their own capacity to tolerate not knowing.
Sleep difficulties are both a symptom of anxiety and a factor that maintains it. Anxious young people often have difficulty falling asleep (the mind will not switch off), staying asleep (waking with anxious thoughts), or experience nightmares. Poor sleep then reduces their emotional resilience the following day, making them more vulnerable to anxiety, creating a vicious cycle.
What parents and teachers can do
So what can parents and teachers do? The first step is recognition. Understanding that the stomach aches, the anger, the people-pleasing, and the avoidance may be anxiety rather than character traits or behavioural choices changes the response entirely. You move from “stop being difficult” to “you seem to be finding this really hard right now” - and that shift makes an enormous difference to a child who is struggling.
Validate the feeling without reinforcing the avoidance. “I can see you are really worried about the school trip. It makes sense that you feel nervous about something new. I also know that once you get there, you usually enjoy it. Let us think about what might help you feel more prepared.” This acknowledges the anxiety without giving it the final word.
Help them name what they are experiencing. Many children do not have the vocabulary for anxiety. They know something feels wrong but cannot articulate what. Teaching a child to recognise and name their anxiety - “That feeling in your tummy might be your brain’s worry alarm going off” - gives them a framework for understanding their experience rather than being controlled by it.
Create predictability where you can. Anxious children find uncertainty particularly difficult. Clear routines, advance warning of changes, visual timetables, and explicit explanations of what to expect can significantly reduce anxiety in everyday life.
Model your own anxiety management. Children learn about emotions primarily from watching the adults around them. If you can name your own mild anxiety out loud (“I am feeling a bit nervous about the presentation tomorrow - I think I will go for a walk to settle my nerves”), you normalise the experience and demonstrate healthy coping.
Know when to seek help. If your child’s anxiety is affecting their ability to attend school, maintain friendships, participate in age-appropriate activities, sleep, or eat, it has moved beyond what self-help strategies alone can address. Therapy for anxious children is gentle, age-appropriate, and effective. The earlier anxiety is addressed, the better the outcomes.
Dr Victoria Froome
Integrative Psychotherapist | Dragonfly Psychotherapy
www.dragonflypsychotherapy.co.uk