When Worry Wears a Mask: Understanding Anxiety, Trauma, and Challenging Behaviors in Children

 

Anxiety is one of the most common mental health challenges affecting young people today. While many children worry about typical things like homework or making mistakes, anxiety disorders are widespread and can begin early in development. These conditions don’t always just manifest as internal feelings of tension or worry; they can also show up as behaviors that might be misinterpreted as simply “poor behavior”. Understanding this connection is crucial for providing effective support and limiting long-term negative consequences for youth. 

 

Anxiety Showing Up as “Poor Behavior” 

Youth with anxiety disorders frequently struggle with regulating their emotions. This difficulty can lead to behaviors that adults might perceive as disruptive or intentionally bad. 

 

Common signs of anxiety often misinterpreted as behaviors include: 

 

• Irritability 

• Restlessness 

• Inability to sit still or relax 

• Inattention or difficulty concentrating 

• Impulsivity 

• Avoidance of feared situations, which might look like defiance or lack of motivation 

• Emotional reactivity 

• Hyperactivity 

(Benjamin et al., 2011, 173)  

 

Some of these signs, like inability to sit still, are observable, but others, like difficulty paying attention or mood changes, are less obvious. Sleep problems are also commonly linked to anxiety in youth and can contribute to daytime issues such as inattention, impulsivity, and emotional dysregulation, potentially being misconstrued as behavioral problems. Because many internal anxiety symptoms aren’t visible, chronic irritability can be a clue that something more is going on beneath the surface. (Poznanski et al., 2017, 352) 

 

The Impact of Traumatic Experiences 

Childhood trauma can significantly influence a child’s development and their experience with anxiety. Trauma can take many forms, including physical, sexual, or emotional abuse or neglect, exposure to violence, loss of a loved one, medical trauma, and disasters. When children experience complex trauma, they may develop coping mechanisms to survive day-to-day. These adaptations, while helpful for survival, can become counterproductive later and interfere with healthy functioning. These interferences with healthy functioning can include issues relationships and attachment (hypervigilance and unwilling to trust), chronic physical conditions and participation in risky behaviors (smoking, substance abuse, unhealthy diet/exercise habits), poor emotion regulation, and low self-esteem or poor self-image. (Herzog JI, et al. 2018.) (Copeland WE, et al. 2018.)  

 

Trauma can affect children in numerous ways, particularly impacting their emotional responses, physical health, and behavior. Complex trauma can lead to difficulties identifying, expressing, and managing emotions, sometimes resulting in unpredictable or explosive emotional responses. Children may feel stress, depression, or anxiety and in turn show it as anger towards others. Traumatized children might be overly sensitive to others’ moods or withhold their own emotions. Even mild interactions can trigger intense emotional responses because they might serve as reminders of traumatic events. Having learned the world is dangerous, these children may become vigilant and guarded, perceiving situations as stressful or dangerous. (McLaughlin KA, et al. 2010). 

 

Trauma can also impact the body’s stress response systems and brain development. Growing up in fear or under constant stress can cause these systems to develop abnormally, leading to over- or under-reactions to ordinary stress later. This can manifest as rapid breathing or heart pounding, shutting down, or body dysregulation where they over- or under-respond to sensory stimulation. Children may develop chronic physical complaints like headaches or stomach aches. (Gerin MI, et al. 2019). 

 

Behaviorally, children who have experienced trauma might be easily triggered, struggle with self-regulation and impulse control, and lack the ability to consider consequences. Their behavior can seem unpredictable, oppositional, or extreme. They may react defensively or aggressively when feeling blamed or attacked. Dissociation, or mental separation from an overwhelming experience, is also common in children with complex trauma. When dissociation becomes an automatic defense, it can look like “spacing out,” daydreaming, or not paying attention, affecting learning and social interactions. (Benjamin et al., 2011, 173) (Herres et al., 2018, 387-388) 

 

Trauma can also profoundly impact a child’s self-concept and view of the future. Abuse and neglect can make children feel worthless, leading to shame, guilt, low self-esteem, and poor self-image. They may blame themselves. Sometimes the symptoms of traumatic stress, like restlessness, fidgeting, or trouble paying attention, can be confused with conditions like ADHD. While not all children exposed to trauma develop long-term issues like PTSD, trauma can contribute to a child’s vulnerability to developing anxiety disorders and other mental health conditions later in life. (The National Child Traumatic Stress Network. (n.d.). Effects.) 

 

How Caregivers Can Help 

Recognizing that challenging behaviors might be a sign of underlying anxiety, potentially rooted in trauma, is the first step. If you suspect your child is struggling with anxiety or is exhibiting a trauma response, talking with a healthcare provider for an evaluation is crucial. A health provider skilled in talking with children and families may be needed, especially if trauma is involved. 

 

Once anxiety or trauma is identified, evidence-based interventions can be very effective. Making the child feel safe and supported is a primary step, involving support from parents, friends, and school, and minimizing the chance of further traumatic events. Seeking referrals for a mental health provider from various sources like the child’s school, primary care provider, or health insurance is recommended. Resources are available to help find specialists like psychologists or child and adolescent psychiatrists. (American Psychological Association. 2020) 

 

First Witness also has the capability to help refer both caregivers and kids to therapy-based services, or other services they may benefit from. First Witness is recognized by the National Children’s Alliance and accredited as a Child Advocacy Center. In turn, they follow the criteria outlined by the National Children’s Alliance, or NCA, when referring individuals to services. First Witness also has a linkage referral agreement with HDC, or the Human Development Center in the Twin Ports. This means that First Witness can refer children and caregivers to services provided by HDC. The process is as follows; one of the family advocates would speak with a caregiver regarding services they believe would be a positive fit. If that is deemed to be a need by the caregiver, an ROI (release of information) would then be sent over, filled out by the caregiver, and sent to the agency (in this regard, HDC), and would allow for the advocate to align and recommend the caregiver or child for services through that agency. The company would then reach out to the caregiver and set up services.  

 

Therapy is not a one size fits all, so advocates can help navigate the processes of contacting other agencies if necessary. Referrals and services are also chosen to fit an individual’s needs, and are not set in stone, so speaking with an advocate and working together to meet your needs is always the best route to take. Advocates are here to engage and aid the families, caregivers, and children they work with. (First Witness CAC).  

 

Additionally, certain stress management techniques can be incorporated: 

• Environmental Planning: Adjusting the environment to avoid or better confront anxiety-provoking situations. 

• Relabeling: Giving an anxiety-provoking situation a new name to make it less anxiety-inducing 

• Self-talk: Using positive statements about a potentially anxiety-provoking event. 

• Thought Stopping: Redirecting attention away from anxious thoughts. 

• Systematic Desensitization: Gradually experiencing or imagining an anxiety-provoking scene alongside relaxation exercises. 

• Mindfulness-based therapies: Practices like meditation may help reduce anxiety symptoms, though more research comparing them to first-line trauma therapies (first line meaning recommended initial treatments) is needed. 

• Complementary and alternative treatments: Options like aerobic exercise, progressive relaxation, deep breathing, tai chi, yoga, and music therapy may help reduce anxiety and trauma-related symptoms. 

(Greenberg, J. S. 2021) 

 

Childhood trauma and anxiety are treatable. By recognizing that challenging behaviors are often a “mask for worry” and seeking appropriate support, parents can help their children process their experiences and build a healthier future.