How to Recognize High-Functioning Anxiety in Children

Millions of children live with anxiety. In fact, more than 9 percent of those aged 3 to 17 have been diagnosed with this condition. That means nearly 6 million children in America have (and live with) anxiety. And while the signs of anxiety are different in children than they are in adults—toddlers, for example, tend to complain of physical ailments, like stomaches and headaches, while older children usually experience angst, apprehension, irritability, and difficulty concentrating—some children will experience this mental health condition differently. Some have high-functioning anxiety.

But what is high-functioning anxiety, really? From the causes and symptoms to how it's treated, here's everything you need to know about high-functioning anxiety in kids.

What Is High-Functioning Anxiety?

While many people use the phrase "high-functioning" to describe their anxiety and/or depression, there is no such thing as high-functioning anxiety, at least not from a clinical standpoint, i.e. it is not an official diagnosis. However, as Rachel Delany, M.D. and inpatient service line chief in the child unit at Sheppard Pratt explains, some people use the term to better explain their situation.

"High-functioning anxiety, while not a separate diagnosis in the DSM-IV [the diagnostic manual used by psychologists and psychiatrists] is a term used to describe individuals who experience high levels of internal anxiety but come across as successful and high-achieving," says Dr. Delany. "Their anxiety mostly lives within their own minds and does not show itself through avoidance or excessive coping behaviors. On the outside, these people look confident, poised, professional and are often at the 'top' of their class or respective fields."

What Are the Symptoms of High-Functioning Anxiety, Particularly In Kids?

The signs of anxiety vary, from person to person and case to case; however, common symptoms include:

• Overthinking and overanalyzing
• Dwelling on past mistakes
• Restlessness
• Irritability
• Insomnia and fatigue
• Intense fear of failure
• Difficulty saying no
• Nervous habits and tics, like nail biting, skin picking, leg bouncing, etc.
• Excessive worry
• Difficulty expressing emotions

Young children may exhibit physical symptoms, adds Dr. Delany. "Children with anxiety may experience physical symptoms, such as frequent stomaches or headaches."

That said, it's important to note that many of these symptoms are not visible. "High-functioning anxiety is differentiated from more severe or limiting anxiety because the child continues to perform well in their daily activities," Dr. Delany adds. "A tween or teenager with high-functioning anxiety may externally exhibit perfectionistic qualities, including good organization skills, punctuality, good planning, and are often detail-oriented." They may also appear ambitious and/or hard-working. Those living with high-functioning anxiety are usually high-achieving and well-prepared.

What Causes High-Functioning Anxiety?

As with the symptoms of anxiety, the causes of high-functioning anxiety vary greatly. A family history of anxiety, for example, may make you predisposed to the condition. Exposure to negative or stressful life events can also trigger anxiety, as can alcoholism and/or substance use disorders, and medical conditions and environmental stressors can induce anxiety. In short, there is no one answer. Anxiety can be caused by one or numerous factors.

What Is the Difference Between Anxiety and High-Functioning Anxiety?

While high-functioning anxiety is not "official," i.e. individuals cannot be diagnosed with this condition, Amanda Mintzer, PsyD, the director of the social anxiety program, and a clinical psychologist in the anxiety disorders center at the Child Mind Institute notes those living with this type of anxiety may experience different sensations and/or symptoms.

"Even though high-functioning anxiety isn't a specific diagnosis, some kids who struggle with [high-functioning] anxiety may perform very well in school and their perfectionism—often considered a good thing—can actually be a sign of their anxiety disorder," says Dr. Mintzer. "This is particularly common in kids who are diagnosed with generalized anxiety disorder."

How Are Children With High-Functioning Anxiety Treated?

There are several ways to treat anxiety. For some, talk therapy is an effective way to manage symptoms. Speaking to a therapist or counselor can help you understand your anxiety and teach you techniques to cope—and live with it. For others, medication is the best course of action. Common anxiety treatments include benzodiazepines, like Xanax and Valium, and SSRIs. And others find a combination of the two is best. Many children manage anxiety with therapy and medication.

But what should you do? How should you and your child approach treatment? According to Dr. Mitzner, your approach will depend on the severity of your child's condition."Most experts recommend that kids with mild-to-moderate anxiety be treated first with CBT [cognitive behavioral therapy]," says Dr. Mintzer. "Medication can be added after the child starts CBT if therapy alone does not seem to be working to relieve their symptoms. But for more severe anxiety, it's recommended that kids start on medication along with therapy—or even before therapy starts, to help them get comfortable enough to participate."

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"The best medications for most kids with anxiety are antidepressants called SSRIs," she adds. These are less addictive and tend to have less side effects.