When people picture anxiety, they often imagine a child who’s nervous or shy, maybe someone who cries a lot or clings to their caregiver. However, anxiety doesn’t always look like worry on the outside. In fact, many anxious kids don’t seem “anxious” at all. Sometimes, anxiety in children shows up as big behaviors: anger, defiance, or even perfectionism. Other times, it hides behind stomachaches, school refusal, or difficulty sleeping.

Let’s take a closer look at some of the surprising ways anxiety can show up in kids and why recognizing it matters.

A young girl with long brown hair, wearing a white knit sweater and black pants, sits near a window with her eyes closed and her hands pressed to the sides of her face. She appears deep in thought or distressed. The setting is bright with natural light coming through the window.

Anger, Tantrums, or “Bad Behavior”

An anxious child might explode over small things, seem constantly on edge, or react with aggression. That’s because anxiety can put the brain in a state of fight-or-flight—even when there’s no clear danger. When a child’s nervous system is overwhelmed, they may lash out instead of shutting down.

Perfectionism or Fear of Making Mistakes

Does your child get extremely upset when things aren’t “just right”? Do they avoid trying new things for fear of failing? Kids with anxiety may seek control by being overly perfectionistic. Mistakes might feel physically uncomfortable or terrifying—not just disappointing.

Sleep Struggles

Worries tend to get louder at night. Kids may resist bedtime, have trouble falling asleep, or wake up frequently. Nightmares or bedtime battles can be signs that your child’s brain is working overtime.

Frequent Physical Complaints

Headaches, stomachaches, and general “I don’t feel good” comments—especially when medical issues have been ruled out—are common red flags. Anxiety often shows up in the body before it shows up in words.

School Avoidance or Refusal

If your child regularly resists going to school, struggles with separation, or complains of illness before leaving the house, anxiety could be the root cause. School can feel overwhelming for kids who are anxious about performance, social situations, or transitions.

Anxiety Is Common (and Treatable!)

Anxiety is one of the most common mental health concerns in children, and with the right support, kids can learn to manage it. At Duncan Lake Speech Therapy, our pediatric mental health therapist, Kerina, works with children and families to identify what’s going on beneath the surface and build tools for emotional regulation, confidence, and calm.

If something in this post made you think, “Wait…that’s my kid,” you’re not alone. We’re here to help.

A young girl with long brown hair wearing a white knit sweater stands indoors with a worried expression, holding her face in her hands. The text below her reads: "Understanding Anxiety in Kids: It’s Not Always What You Think." The image has a scrapbook-style design with torn paper accents and the Duncan Lake Speech Therapy, LLC logo in the top left corner.