Many children have fears and worries, and may feel sad and hopeless from time to time. Strong fears may appear at different times during development. For example, toddlers are often very distressed about being away from their parents, even if they are safe and cared for. Although fears and worries are typical in children, persistent or extreme forms of fear and sadness could be due to anxiety or depression. Because the symptoms primarily involve thoughts and feelings, they are sometimes called internalizing disorders.
When a child does not outgrow the fears and worries that are typical in young children, or when there are so many fears and worries that they interfere with school, home, or play activities, the child may be diagnosed with an anxiety disorder. Examples of different types of anxiety disorders include
Anxiety may present as fear or worry, but can also make children irritable and angry. Anxiety symptoms can also include trouble sleeping, as well as physical symptoms like fatigue, headaches, or stomachaches. Some anxious children keep their worries to themselves and, thus, the symptoms can be missed.
Related conditions include Obsessive-Compulsive Disorder and Post Traumatic Stress Disorder.
Learn more about anxiety in children
Occasionally being sad or feeling hopeless is a part of every child’s life. However, some children feel sad or uninterested in things that they used to enjoy, or feel helpless or hopeless in situations they are able to change. When children feel persistent sadness and hopelessness, they may be diagnosed with depression.
Examples of behaviors often seen in children with depression include
Extreme depression can lead a child to think about suicide or plan for suicide. For youth ages 10-24 years, suicide is among the leading causes of death. Read about youth suicide prevention.
Some children may not talk about their helpless and hopeless thoughts, and may not appear sad. Depression might also cause a child to make trouble or act unmotivated, causing others not to notice that the child is depressed or to incorrectly label the child as a trouble-maker or lazy.
Learn more about depression in children
The first step to treatment is to talk with a healthcare provider such as your child’s primary care provider, or a mental health specialist, about getting an evaluation. The United States Preventive Services Taskforce recommends screening for anxiety in children aged 8 to 18 years and for depression in adolescents aged 12 to 18 years. Some of the signs and symptoms of anxiety or depression in children could be caused by other conditions, such as trauma. Specific symptoms like having a hard time focusing could be a sign of attention-deficit/hyperactivity disorder (ADHD). It is important to get a careful evaluation to get the best diagnosis and treatment. Consultation with a health provider can help determine if medication should be part of the treatment. A mental health professional can develop a therapy plan that works best for the child and family. Behavior therapy includes child therapy, family therapy, or a combination of both. The school can also be included in the treatment plan. For very young children, involving parents in treatment is key. Cognitive-behavioral therapy is one form of therapy that is used to treat anxiety or depression, particularly in older children. It helps the child change negative thoughts into more positive, effective ways of thinking, leading to more effective behavior. Behavior therapy for anxiety may involve helping children cope with and manage anxiety symptoms while gradually exposing them to their fears so as to help them learn that bad things do not occur.
Treatments can also include a variety of ways to help the child feel less stressed and be healthier like nutritious food, physical activity, sufficient sleep, predictable routines, and social support.
Here are tools to find a healthcare provider familiar with treatment options:
Being healthy is important for all children and can be especially important for children with depression or anxiety. In addition to getting the right treatment, leading a healthy lifestyle can play a role in managing symptoms of depression or anxiety. Here are some healthy behaviors that may help:
It is not known exactly why some children develop anxiety or depression. Many factors may play a role, including biology and temperament. But it is also known that some children are more likely to develop anxiety or depression when they experience trauma or stress, when they are maltreated, when they are bullied or rejected by other children, or when their own parents have anxiety or depression.
Although these factors appear to increase the risk for anxiety or depression, there are ways to decrease the chance that children experience them. Learn about public health approaches to prevent these risks:
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General anxiety disorder, panic disorder, specific phobia, social anxiety disorder, separation anxiety disorder, and selective mutism.
You, as someone living in a situation with fear, can relate to the struggles experienced by a child with an anxiety disorder. Your experience with fear can be used to support the child moving through this phase of life, by modeling a positive outlook, displaying trust in their ability to cope, and encouraging a sense of control over their own emotions. You can also ask questions that allow the child to focus on problem-solving skills, as well as connecting the scared feeling to moments of bravery and resilience. Being present with the child and providing comfort and support, while giving them the freedom to express their feelings freely, can assist in the child feeling safe and secure. Drawing on the courage and resilience you have drawn on in your own life to guide the child can be very meaningful for them. Re-reading the text and exploring ways in which your own experience of overcoming fear can be helpful to the child can better equip you to support them in this process.
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