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Overview

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 can often become 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.

Signs and symptoms

Anxiety

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. Anxiety is not one disorder but rather a category of conditions.

• Separation anxiety disorder: Being very afraid when away from parents, sometimes with extreme fear of the potential for being separated.
• Phobia: Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor.
• Social anxiety disorder: Being very afraid of going to places where there are people, such as school.
• Generalized anxiety disorder: Experiencing excessive, ongoing anxiety and worry that is difficult to control and interferes with day-to-day activities, but not necessarily specific to a particular situation or context.
• Panic disorder: Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty.

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 stomach-aches. Some anxious children keep their worries to themselves and, thus, the symptoms can be missed.

Depression

Occasionally being sad or feeling hopeless is a part of every child's life. However, some children feel sad or are 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. Like anxiety, depression is not one disorder but a category of conditions. Major depressive disorder is the most common.

Examples of behaviors often seen in children with depression include:

• Feeling sad, hopeless, or irritable a lot of the time
• Not wanting to do or enjoy doing fun things
• Changes in eating patterns—eating a lot more or a lot less than usual
• Changes in sleep patterns—sleeping a lot more or a lot less than normal
• Changes in energy—being tired and sluggish or tense and restless a lot of the time
• Having a hard time paying attention
• Feeling worthless, useless, or guilty
• Showing self-injury and self-destructive behavior

Extreme depression can lead a child to think about suicide or plan for suicide. For people ages 10-34 years, suicide is the second leading cause of death.1

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 troublemaker or lazy. Depression can also cause children to act irritable or angry. Depression and anxiety often co-occur among children, adolescents, and adults.

Treatment for anxiety and depression

The first step to treatment is to talk with a health care provider such as your child's primary care provider, or a mental health specialist, about getting an evaluation.

• The United States Preventive Services Task Force recommends screening for anxiety in children ages 8 to 18 years, and for depression in adolescents ages 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.
• It is important to get a careful evaluation to get the best diagnosis and treatment.
• Consultation with a health care 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.
• Behavior therapy for anxiety may involve helping children cope with and manage anxiety symptoms while gradually exposing them to their fears to help them learn that bad things do not occur.
• 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 and coping, leading to more effective behavior.
  

Spotlight

Early diagnosis and access to services for children and their families can make a difference in the lives of children with mental health conditions. Learn more about treatment.

What ÐÇ¿ÕÓéÀÖ¹ÙÍø is doing

Prevention

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 the following: trauma or stress; violence, abuse, or neglect; being 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:

Resources

• – American Academy of Child & Adolescent Psychiatry (AACAP) fact sheet
• – AACAP fact sheet
• to reduce depression and anxiety symptoms (Community Preventive Services Task Force)
• – AACAP health care provider guidelines for diagnosing and treating mental health conditions in children and adolescents
• ÐÇ¿ÕÓéÀÖ¹ÙÍø's Mental Health Homepage