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November 3, 2022
July 18, 2023

Signs Your Child Is Suffering from High-Functioning Anxiety and How to Help

Anxiety is a normal emotional response to stress that may occur at differing points throughout one’s life. When fear or dread gets to the point where it makes it hard for an individual to think clearly, leads someone to overreact in the moment, is causing a lot or problems or distress, or if it results in physical symptoms like sweating or a pounding heart, it may be a sign of something more than occasional anxiety. Observing anxiety symptoms may be especially worrying as a parent of young children or teenagers. 

Anxiety disorders are the most common mental health concern in the US, according to the National Alliance on Mental Illness. Children and teenagers experience similar worries as adults, with approximately 7% of children ages 3-17 experiencing issues with anxiety each year. In most instances, an individual will begin developing symptoms before age 21. Fortunately, there are signs and symptoms to keep an eye out for in addition to many ways to treat a child’s high-functioning anxiety.

What Is High Functioning Anxiety?

Anxiety is a perfectly natural emotional response to stress, a vital tool in avoiding potentially dangerous situations or even in staying motivated to complete a task. Anxiety is an adaptive response, however, the challenge comes when it causes a person disproportionate distress and they must fight through these strong emotions simply to get through the day. Children and teenagers, for example, may have excessive worries about their performance at school or sporting events, as well as added social pressure when trying to “fit in.”

While high-functioning anxiety is not recognized as a mental health condition in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5), it is still important to recognize that it can negatively impact a person’s quality of life. This type of anxiety is experienced by many each day, but often appears hidden because an individual with “high-functioning” anxiety is able to excel at school, at home, and in their relationships, despite feeling a roller coaster of fear, anxiety, and self-doubt. You can think of these individuals like ducks, calmly floating on the surface of the water, legs paddling frantically below. 

The primary difference between high-functioning anxiety and generalized anxiety disorder is how a person responds to the stressful stimulus. With generalized anxiety, a fight or flight response may kick in and an individual may try to remove oneself from an anxiety-provoking situation. In comparison, for those with high-functioning anxiety, a fight response is more likely to appear, and they are likely to push themselves to work harder against the stressor to combat the anxiety. 

Signs of High-Functioning Anxiety

Among children and teenagers, high-functioning anxiety can present itself in myriad ways, according to Dr. Amy Kranzler, Head of Clinical Services for Handspring Health. While a formal diagnosis of any kind of anxiety will require a licensed mental health professional who can rule out other possible factors, there are some common signs and symptoms to be mindful of. 

While there is no high-functioning anxiety test, an individual can work closely with a healthcare professional to determine a diagnosis. Signs of high-functioning anxiety include:

  • Frequent stomach aches and headaches
  • Increased heart rate
  • Excessive anxiety or worry on most days
  • Restlessness that may make one jittery or shaky
  • Frequent checking and double-checking, asking for reassurance 
  • Avoidance of situations that cause anxiety
  • Reduced appetite, or conversely, emotional eating
  • Feeling tired or exhausted after a high degree of stress
  • Irritation when things don’t go as planned
  • Muscle tension, like clenching fists or jaw
  • Problems with sleep, including not getting enough, waking up and not falling back to sleep, or trouble falling asleep
  • Always feeling on edge, even jumpy
  • Talking fast about multiple things at once
  • Self-critical with unrelenting standards

For children, anxiety can develop as a paired association with something that does not typically cause their anxiety. For example, if a child experiences a panic attack at school for the first time, they may start to associate school with the onset of this intense fear. Eventually, this may create a strong somatic response, wherein the body responds involuntarily, each time a child thinks about going to school and ongoing physical anxiety. 

“Keep close track of the nature of your (or your child's) anxiety and worry,” Kranzler says. “Begin to pay attention to whether there are patterns in the timing or content of your child’s worries. What types of things does your child worry about most? It can also be helpful to notice how anxiety may be impacting your child’s functioning in other important areas like sleep, and eating, which can in turn worsen anxiety.” 

Causes of High-Functioning Anxiety

Certain risk factors may contribute to  high-functioning anxiety. These can include a family history of anxiety disorder, stressful life events or experiences, and certain medical conditions, such as thyroid disease. In adults, substances and alcohol abuse can also be a contributing factor, while in children, exhibiting a high level of shyness may play a role.

“There are many different triggers for anxiety,” Kranzler says. “While there is some genetic predisposition for anxiety, experiencing one or many stressful or scary events or situations can further exacerbate anxiety symptoms.”

How to Treat High Functioning Anxiety

There are many tools and treatments available to help children and teenagers work through their high-functioning anxiety, and treatment looks much like it does for other anxiety disorders. There are many proven strategies licensed mental health clinicians use for those suffering from anxiety, with one approach being Cognitive Behavioral Therapy (CBT), Kranzler says. 

Cognitive behavioral therapy

A common type of talk therapy, CBT typically involves an individual working with a mental health professional to become more aware of inaccurate or negative thinking. CBT is an important tool to help a person view and cope with challenging situations and see their symptoms more clearly. 

Parent-management therapy

Used to treat children and adolescents, parent-management therapy focuses on teaching parents techniques to help their children improve behaviors and learn new coping skills. 

Solution-focused brief therapy

SFBT is a short-term, goal-focused form of therapy that incorporates positive principles to help a person construct solutions to their challenges. Therapists generate a detailed description of how the client’s life will be different when the situation improves and they work together to reach those goals.

Deep-breathing exercises

Breathing techniques can help alleviate a child’s symptoms of anxiety and help them feel better. This can include actions like lengthening the exhale, deep belly breathing, as well as slow and focused breathing patterns.


In some instances, a doctor may prescribe a medication to treat anxiety symptoms. These may include commonly prescribed medication to treat depression and anxiety like selective serotonin reuptake inhibitors (SSRIs).

In addition to seeking treatment, focusing on self-care, exercise, and eating a well-balanced diet can also help manage a child’s high-functioning anxiety symptoms. 

“In small doses, anxiety can be adaptive and even helpful, allowing us to work harder or perform better on a big project or game,” Kranzler says. “But when anxiety is really getting in the way or causing distress, it can be helpful to seek professional support to learn the skills to cope effectively with anxiety.”

High-functioning anxiety is experienced by many children and teenagers, but often it remains hidden because an individual may still excel at school, at home, and in relationships, despite grappling with immense amounts of underlying fear, anxiety, and self-doubt. Maintaining the facade of high function often comes at the expense of overall health and wellness and can result in fatigue, exhaustion, and burnout. 

Understanding the signs of high-functioning anxiety can help to recognize when it is time to seek help, and fortunately, there are proven treatments available to manage the condition. To get help for a child suffering from high-functioning anxiety, start with a free consultation from a licensed Handspring Health therapist today.

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