Recognizing Anxiety and Depression in Children

While it’s often assumed that childhood is a carefree, happy-go-lucky time, that’s not always the case. Of course, having some worries and fears and even sad times are normal and present at every stage of development. For example, the first day of school is a tough time for lots of toddlers and young children. While some do just fine, for others, all of a sudden, the very idea of separating from mom or dad leads to fears, tears, and maybe even a few tantrums. The good news is that for most kids, those worries ease, and they adapt to the new routine knowing mom or dad is waiting for them at the end of the day. 

Sometimes, though, a child’s fears and worries persist, and maybe even worsen over time, interfering with their day-to-day ability to function. When that happens, those fears and worries may indicate the presence of anxiety or even depression. 

Disorders like anxiety and depression are what’s known as internalizing disorders. In other words, they are primarily driven by internal thoughts and feelings, and are characterized primarily by internal processes such as anxiety, somatization, and depression. 

On the surface, tears and tantrums and irritability might not look like anxiety or depression. Children will respond to their thoughts and feelings in ways that make sense for them developmentally. For example, a younger child may lack the skills to verbally express or manage their worries and instead respond with somatic complaints (e.g., tummy aches, headaches, etc.) or school refusal. 

So, how can you recognize the symptoms of anxiety in children? What are the signs of depression in children? And what can you do to help?

Signs of Anxiety in Children

Anxiety disorders are the most common psychiatric conditions in children and teens.

Common signs of anxiety in children can include:

• Fears or worries
• Feelings of nervousness
• Irritability or anger
• Poor sleep
• Somatic complaints like tummy aches, headaches, fatigue
• Clinginess
• Avoidance of certain situations

Anxiety presents differently depending on the root of the fear or worry. For example, a toddler may fear being left alone or fear the dark. A 10 year old may be fearful of having to read aloud in class. A teen might worry about what their friends think of them.

Some of the most common types of anxiety in children include:

Separation anxiety – Most often seen in young children, this is the anxiety that is driven by the fear of being separated from mom, dad, or important others. The child may have an intense fear of something bad happening (e.g., getting lost or an accident) that will separate them. Separation anxiety may present as a fear being alone, having nightmares about being separated from their parents, or avoidance of activities like sleeping away from home, or going to school.

Social anxiety – In children, social anxiety disorder (sometimes referred to as social phobia) is characterized by the fear of being in social or performance situations like school and having to engage with others, especially their peers. Social anxiety is driven by a worry about being scrutinized or judged by others. Their fear or anxiety may present as excessive crying, tantrums, clinginess, avoidance of interaction, school refusal, or failing to speak in social situations.

Generalized anxiety – Generalized anxiety disorder (GAD) is characterized by excessive worry about the future and bad things happening. Children with GAD may worry excessively about things like school or their family’s safety, or even a natural disaster happening. They may experience physical symptoms such as headaches, muscle tension, restlessness, heart palpitations, or stomach upset. Children with GAD may be overly self-critical and avoid activities for fear of failing. They may seek frequent reassurance and approval from others.

Specific phobias – Specific phobias are fears that are attached to specific things or situations. These fears activate the “fight or flight” response and create feelings of danger that are not congruent with the reality of the situation. Common phobias include a fear of dogs, a fear of flying, or a fear of the dark. Specific phobias are the most common anxiety disorder in children.

It isn’t uncommon for children with anxiety to also experience depression.

Signs of Depression in Children

Occasional bouts of sadness or melancholy are not uncommon, even for kids. Sometimes, that sadness or disinterest doesn’t abate, and they may feel helpless to manage the situation. When feelings of sadness or hopelessness persist, it may be indicative of depression.

Common signs of depression in children can include:

• Sadness
• Feelings of helplessness or hopelessness
• Increased irritability
• Decreased interest in things they used to find enjoyable
• Changes in sleep
• Changes in appetite
• Changes in behavior or academics
• Trouble paying attention or getting things done
• Self-injurious behavior
• Thoughts of suicide

Teens are especially at risk with depression. Aside from accidents, suicide is the number one cause of death for youth ages 10-24.

Left unaddressed, anxiety and depression can worsen and impact a child’s ability to function well. It can also lead to continued problems into adulthood.

What Helps

Kids don’t always talk about what they’re thinking and feeling. Sometimes they may not even understand what’s happening to them. It’s important to pay attention to not just what they say, but what they don’t say. What is their behavior saying?

The good news is childhood anxiety and depression are treatable.

The first step is to have a conversation with your healthcare provider. They can rule out any medical issue that might be underlying the problem. They may also be able to recommend a mental health provider who is experienced working with children and teens.

Therapy, in particular a type of therapy known as cognitive behavioral therapy (CBT), is generally the first-line treatment for anxiety and depression. This type of therapy is especially effective for older children and teens. CBT helps them understand how their thoughts, feelings, and behaviors are connected. They can learn to recognize negative thought patterns and find healthy ways of coping.

Even younger children can benefit from therapy. Child therapy, play therapy, and family therapy are common approaches for working with younger children.

Above all, support and understanding are the secret sauce to helping a child overcome their anxiety or depression. They need to know that they didn’t do anything to cause their symptoms and that they have the power to change them. When they are empowered and supported, they can do the work needed to heal.