Every child worries sometimes. A little nervousness before a test, shyness around new people, or reluctance to try something new — these are all normal parts of growing up. But how do you know when your child's worry has crossed the line from normal development into something that needs professional attention?
As a child psychologist who has spent over two decades helping anxious children, I have seen many parents struggle with this question. They wonder if they are overreacting or if they should have sought help sooner. Here are the signs that it may be time to reach out.
Normal Worry vs. Clinical Anxiety
All children experience worry. The distinction lies in intensity, duration, and interference:
| Normal Worry | May Need Help |
|---|---|
| Nervous before a big test | Cannot attend school due to worry |
| Shy in new situations, warms up gradually | Avoids all new situations, refuses to participate |
| Occasionally has trouble sleeping | Cannot fall asleep without a parent present every night |
| Asks a few questions about a scary topic | Asks the same reassurance question dozens of times daily |
| Brief separation difficulty that resolves | Cries, clings, or has panic attacks when separating |
10 Signs Your Child May Benefit from Therapy
1. Avoidance Is Growing
Your child is refusing to do things they used to enjoy or that are expected of them — birthday parties, sports, sleeping in their own bed, going to school. The list of “can't do” is getting longer, not shorter.
2. Physical Complaints Without Medical Cause
Frequent stomachaches, headaches, nausea, or feeling “sick” — especially on school mornings or before specific activities. Your pediatrician has ruled out medical causes.
3. Sleep Has Become a Battle
Difficulty falling asleep alone, nightmares, needing you to stay in the room, or waking up anxious in the middle of the night — on a regular basis.
4. Constant Reassurance-Seeking
Your child asks the same worried questions over and over: “Are you sure you will pick me up?” “What if I get sick?” “Will there be a fire?” No amount of reassurance seems to stick.
5. Meltdowns That Seem Disproportionate
Intense crying, screaming, or shutting down when facing routine situations that other children handle. These are not tantrums for attention — they are panic responses.
6. School Performance Is Suffering
Grades dropping, difficulty concentrating, refusing to participate in class, or frequent trips to the school nurse.
7. Friendship Difficulties
Withdrawing from friends, difficulty making new ones, or anxiety about social situations that limits their social development.
8. Repetitive Behaviors or Rituals
Checking, counting, arranging, hand-washing, or other repetitive behaviors that seem driven by anxiety. This may indicate OCD.
9. Your Family Is Reorganizing Around the Anxiety
You are changing your routines, avoiding certain places, or tiptoeing around topics to prevent your child's anxiety from being triggered. When the whole family accommodates one child's anxiety, it is a sign that professional help is needed.
10. Your Own Efforts Are Not Working
You have tried talking to your child, offering comfort, using reward charts, and reading parenting books — but the anxiety is not improving. This is not a failure on your part. It means your child needs specialized support.
The Sooner the Better
Research consistently shows that early intervention produces the best outcomes for childhood anxiety. Anxiety that is left untreated tends to worsen over time and can develop into more complex issues in adolescence and adulthood. The skills children learn in therapy serve them for life.
What Treatment Looks Like
At CBTI of SoCal, we offer several evidence-based approaches to help anxious children:
- CBT for children — Teaching kids to understand their worry brain and gradually face fears
- SPACE protocol — Working with parents to reduce accommodation and build children's coping skills (effective even without direct child sessions)
- PCIT — Parent-Child Interaction Therapy for younger children
- Play-based and creative interventions for younger children
We also offer telehealth sessions across all of California, so geography does not have to be a barrier to getting your child the help they need.
Take the First Step
If you recognized your child in several of these signs, we encourage you to reach out. A brief consultation can help you understand whether therapy would be beneficial and what approach might be the best fit.
Call 800-317-8010 or contact us online to schedule a consultation.
Dr. Paul DePompo, Psy.D., ABPP is a board-certified clinical psychologist specializing in child anxiety, OCD, and tic disorders at CBTI of SoCal in Newport Beach, California.
