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Assessing & Treating Anxiety in Foster Children

Updated: May 20


May is the month of many things. We welcome the Spring with its beautiful flowers, showered by the rain. We prepare for our summer vacations, beaches, and parks! We also begin our spring cleaning, getting rid of old and beginning with the new. To me, the main reason why May is so important it is because it is a month to reflect and bring awareness to mental health and foster care! So, what better topic to discuss, then mental health concerns with foster care children. According to the AFCARS report, in 2018 there were 437,283 children in foster care.[1] Each one of these children are experiencing some level of stress, anxiety, and depression. Many have experienced severe trauma, separation, abandonment, neglect, and abuse. I can spend page after page discussing the various triggers, symptoms and treatment when it comes to foster children. For the goal of this article, I mainly want to focus on anxiety. Anxiety can be presented in various ways, particularly with children. They may appear in the following ways:

1. Physical symptoms (i.e. headaches, stomachaches, or nausea)

2. Crying and struggling with regulating emotions

3. The need to be in control over events and people

4. Feelings of frustration, irritability, or anger

5. Difficulty with focus, concentration and paying attention

6. Constant worry about situations (They typically say they cannot ‘shut their mind off’)

7. Defiance towards authority figures

8. Avoiding activities or school events

9. Intolerance of uncertainty

10. Difficulty with sleep (staying up late or waking up in the middle of the night)


Many of these symptoms may be viewed and misdiagnosed with attention-deficit/hyperactivity disorder (ADHD) or oppositional defiant disorder (ODD). In order for the child to receive proper treatment, they need to be assessed by a psychologist and evaluated for proper diagnosis.


Here are some great tools to assess your child, to determine if they are struggling with anxiety.

1. https://www.massgeneral.org/psychiatry/treatments-and-services/pediatric-symptom-checklist

They have a rating scale for children and offer in various languages

2. Reaching out to a licensed clinical psychologist to conduct a psychological testing, requesting to rule out anxiety disorder or differential diagnosis between anxiety, ADHD and ODD.


The prognosis and outcome of treatment for anxiety is positive, particularly with children. The main type of treatment that has shown to be beneficial with children that struggle with anxiety symptoms is cognitive behavioral therapy[2] and the use of selective serotonin reuptake inhibitors (SSRI)[3] medications. The combination of the two lead the treatment into a quick recovery. We do have to remind ourselves that foster children have gone through pain and suffering, removed from what they have known (good or bad), feeling abandoned, and now have to adjust to a new environment. In all of the chaos, it is only natural for them to be reactive to the situation. We as adults must have patients; give them time to heal, and recover. Monitor your children, if any symptoms are present please talk to your pediatrician to assess the symptoms and determine what level of treatment is needed. Our children cannot speak up for themselves at times, so it is our responsibility to be their voice.

[1] Resource: https://www.acf.hhs.gov/sites/default/files/cb/afcarsreport26.pdf [2] Ollendick TH, King N. Empirically supported treatments for children with phobic and anxiety disorders: current status. J Clin ChildPsychol 1998;27:156-167. [3] The Research Unit on Pediatric Psychopharmacology Anxiety StudyGroup. Fluvoxamine for the treatment of anxiety disorders in children and adolescents. N Engl J Med 2001;344:1279-1285.

About the Author- Arezoo "Azy" Khanzadeh has been working in the mental health field for over 20 years with an emphasis on trauma, anxiety and mood disorders. Her approach to therapy allows clients to take their own course, with her challenging guidance surfacing only when necessary. With a love of arts and crafts, Azy sometimes incorporates her sessions with art projects in an attempt to hear her clients’ stories and guide them through their own journey. Her community work has ranged from attending round table discussions, events, and providing training throughout the Fredericksburg-Stafford area in Virginia.

Born in Iran and raised in the United States, Azy currently resides in Stafford, Virginia where she enjoys spending time with her family and friends. She’s bi-lingual and gets most passionate when she’s volunteering and gaining international experience from traveling abroad.

Book release: My Magical Three, That Sets Me Free: A Quick Intervention for Anxiety. Available on Amazon, FREE on Kindle Unlimited. https://www.northstartherapy.org/book-release