We can all think of the “anxious” child and imagine the child who retreats into a corner, won’t speak when spoken to, and cries when separated from his or her parent. As one of the most common disorders of childhood, anxiety can often look just like this description for many kids. Transitions can be difficult, new situations intolerable and specific fears paralyzing. These children are at high risk for difficulties throughout their lives if their anxiety is not treated.

However, there is another group of children suffering from anxiety who often get overlooked or misdiagnosed. These are the kids who act out as a result of their anxiety, rather than withdraw. It partly comes down to a biological mechanism. We’re wired, in the face of danger, for either “fight” or “flight.” The “typical” anxious child goes the “flight” route, but there are many whose brains predispose them to “fight” when threatened.

So, what does this look like?

  • Kids who present less typical symptoms of anxiety may be particularly sensitive to criticism and fight back when corrected.
  • When they go into a new situation or aren’t sure how to act around a peer, they might start getting silly, act out or have trouble controlling their emotions.
  • These children tend to have more temper tantrums, particularly in stressful situations, including when demands on their behavior are high, when they are around new people or when being asked to go to bed, especially if this is something they fear.

Acting out vs. anxiety

When children present less typical symptoms of anxiety, parents and teachers can often mistake their behavior as “acting out” or “behaving badly.” A parent or teacher’s automatic response is to be very firm and correct the behavior, enacting punishments or consequences.

Although this response may work well for a child without anxiety, it could make the problem worse if a child is suffering from anxiety. Additionally, when a child does not get help with their anxiety and therefore the problems tend to escalate.

What can parents do?

If you have a child who displays these disruptive or out-of-control behaviors in a number of situations, and it hasn’t improved, it is important to get your child assessed by a mental health professional and ask specifically about anxiety.

This is especially true if you have a family history of anxiety, as this is a genetic illness. If we can identify children who would benefit from treatment for anxiety, we can prevent more difficulties as they grow up.


Eleanor Mackey, PhD, is a child psychologist and works primarily with the Obesity Institute and Children’s Research Institute. Dr. Mackey is also a mother of two girls.

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