Black Children Often Exhibit Anxiety in Unexpected Ways

Anxiety is common in many children and adults. But here's how the risk factors—and treatment plans—can look different for Black youth in particular.

Young girl sitting with her mother on their living room sofa and watching something on a laptop

Ivan Gener/Stocksy

As a child, I knew my anxiety was more than “just nerves,” even though no one else did. I felt like some invisible force was always taking my breath away or giving me stomach aches and making me late. The adults in my life cared but didn’t know the signs of severe anxiety in a young Black girl. They didn’t understand that my hyperverbal speech or “nervous talking” and good grades were signs of anxiety from the pressure to excel, not joy, and I needed help. 

Black children encounter many stressors while developing in an anti-Black world that adultifies them at every opportunity. These stressors leave Black youth vulnerable to mental health concerns, including anxiety, with few resources for support. Cassandra Raphaël, MD MPH, a double board certified child-adolescent and adult psychiatrist who works for the New York State Office of Mental Health in New York City, says fears and worries are common and developmentally appropriate as they’re exposed to new things at different stages. She uses an infant’s fear of strangers or a toddler’s fear of the dark as examples. But she says anxiety is different. “Fears may become anxiety if they do not subside with time or, especially if they impair a child’s daily functioning,” says Raphaël. 

But all isn’t lost. Read on for a few things to keep in mind when seeking the signs of anxiety in Black youth and how to support them. 

Anxiety may not look the way you expect.

 My anxiety wasn’t obvious. On the outside, I seemed engaged and interested in the world. But inside, I was overwhelmed and fearful. Raphaël says the signs and triggers of anxiety can appear in many ways. She says anxious children may seem more clingy and afraid of being away from home or in social situations. “In addition, they may be irritable or distracted at home or school, especially if they do not often talk about feelings but rather show their feelings,” she says.

I received confirmation that I have had generalized anxiety disorder since childhood, and that anxiety has been present in my family for generations, in my late twenties. I often wonder how I would have grown up if my family had understood what I was processing.

Raphaël notes parents may see their child’s performance declining in school or other activities the child enjoys in severe cases. “Disturbances in sleep or experiencing frequent nightmares, as well as changes in appetite, increased aggression, anxious restlessness, and persistent negative mood may be present as well.” She also says children may experience physical symptoms like shortness of breath, sweating, a fast heartbeat, or frequent complaints of headaches or stomach aches like I did. They may also experience other symptoms. “Some anxious children may also be very quiet or eager to please and readily compliant with grown-ups,” she says. “In these cases, their anxious feelings are internalized and can be missed.” 

Look out for—and challenge—misdiagnoses.

 Raphael says there’s a promising growing conversation on mental health and illness in Black communities. But stigma is a barrier to support in Black communities, especially Black youth. Further, research says Black children who grow up in poverty face a greater risk for stressful circumstances that impact their school performance, behavior, and health. Black children who show signs of anxiety or depression are often misdiagnosed with conditions like conduct disorder or oppositional defiant disorder due to bias and racism. 

Stigma and racial bias make it harder for Black youth to receive the support they need. I was labeled “disruptive,” given a behavior plan, and regularly sent to the principal office instead of being seen as a child who needed support. If needed, parents should be prepared to advocate for their children and challenge misdiagnosis.

Seek a therapist who is a cultural fit.

Deciding on therapy for a child can be difficult for Black parents, but it’s often necessary. Raphaël notes that children won’t need to see a mental health professional to process their anxiety. But it’s crucial that those who do need professional support work with a licensed mental health professional. Families and mental health professionals can work together to diagnose the condition and its severity. A professional can also help Black children struggling with anxiety create personalized treatment plans and learn about any risks from treatment. 

Raphaël says the cost of treatment or diagnostic resources might require paying out of pocket, creating a barrier for some families. She says concerns about being misunderstood due to cultural differences or marginalization can make engaging in therapy difficult for those in treatment. She also notes a shortage of mental health professionals complicates this further.

 “This is especially important because discrimination and microaggressions are linked to increased anxiety and depression in the Black community,” she says. “Validating experiences with racial trauma is key in Black mental wellness. Therapy must be a safe space for these discussions.”

Remember to include your child in their support plan.

I didn’t have any help creating a plan to manage my anxiety, and I often felt powerless. Raphaël says anxiety often leaves children feeling a loss of control. Under ideal circumstances, parents will notice anxiety-related shifts in their children, affirm how difficult it is to manage anxiety, and collaborate to create a support plan. 

“Getting your child’s input for how they wish to be helped allows them to feel autonomous and empowered,” she says. “With a clinician’s collaboration, a child can be gradually and safely exposed to anxious situations with the goal of overcoming that feeling.”

Understand overcoming anxiety isn’t easy, but it is possible. 

I received confirmation that I have had generalized anxiety disorder since childhood, and that anxiety has been present in my family for generations, in my late twenties. I often wonder how I would have grown up if my family had understood what I was processing. Instead, I was told I had a nervous personality. I carried that assessment with me, often brushing off my fears. 

Raphaël reminds us that fear is a physiological process between the brain and other organs in the body and that fear is chemically mediated and exists to keep us safe. “That system can be over-activated as a result of genetics, environmental factors, life experiences,” she says. “It doesn’t make a person weak, but validating the anxious person’s emotional experience is very helpful.”

Raphaël says those battling anxiety are more likely to plan and accept help from those who acknowledge the challenges of it. “Living with untreated anxiety can beget feelings of hopelessness and negative mood, which can predispose to depression,” she says. “Anxiety can be overcome, but the process may differ a lot between cases.” 

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