Understanding Anxiety in Children and Teens

This essay from Child Mind Institute president Harold S. Koplewicz, MD and Anxiety and Depression Association of America (ADAA) board president Beth Salcedo, MD is a companion to “Understanding Anxiety,” the Child Mind Institute’s 2018 Children’s Mental Health Report.

Anxiety is making waves. Increasing recognition by health care providers over the past 10 years has led to a 17% increase in anxiety disorder diagnoses in young people, according to one study.  Teens and their parents are recognizing that anxiety disorders can be serious, and they are beginning to advocate for treatment at a level that far surpasses care-seeking a generation ago. Anxiety is the number one cause for concern at college counseling services.

Still, the proportion of youth who receive treatment for anxiety is the lowest of all major categories of mental health disorders, while the prevalence of anxiety in the population is very high.  At some point, 30% of children and adolescents will meet criteria for an anxiety disorder, yet 80% of these kids never get help.

It is no mystery why there is such a stark gap between need and access to care — anxiety is perhaps the most misunderstood childhood mental health problem. While some children with anxiety avoid situations or objects that trigger fears, others react with explosive outbursts. That behavior is often misread as anger or opposition. Children and teenagers who are in extreme distress are still dismissed as shy and expected to “grow out of it.”

On the contrary, it is important that these young people receive care because anxiety disorders are not harmless. Untreated anxiety is a “gateway disorder” that increases risk in adulthood for several poor outcomes, including depression, substance abuse and suicidality.

As psychiatrists and advocates for access to mental health care, we are concerned that the popular view of childhood anxiety can prevent it from being taken seriously. Too often we hear charges that we, or nervous parents, are “pathologizing” normal children.

The real facts are included in the recently published Child Mind Institute 2018 Children’s Mental Health Report. Most “shy” kids aren’t clinically anxious. But there are a lot of kids who are, and they deserve treatment, which is effective in more than 80 percent of young patients.

We have an incredible opportunity to help children who are developing impairing clinical anxiety disorders before they lead to troubling, dangerous and sometimes tragic outcomes. Anxiety disorders affect millions of kids who often go on to develop further mental health disorders and unhealthy coping methods like self-injury and drug abuse. Our treatments work. But we need to dramatically improve our ability to reach the vast majority that never get help.

Dr. Koplewicz is the president and founder of the Child Mind Institute, an independent, national nonprofit dedicated to transforming the lives of children and families struggling with mental health and learning disorders. Dr. Salcedo is the president of the Anxiety and Depression Association of America, an international nonprofit membership organization dedicated to the prevention, treatment, and cure of anxiety, depression, OCD, PTSD, and co-occurring disorders through education, practice, and research.

For more information on anxiety and depression treatment, visit adaa.org