Depression and Anxiety in Children and Teens

Posted by Nurse Linda in Daily Dose on August 19, 2022 # Health

ChildrenChildren can range in emotions from minute to minute. Ever-changing moods are a natural occurrence for all individuals of all ages. However, occasionally, feelings can become predominant in a personality. There are instances where anxiety or depression can affect a child’s mental health as well as family dynamics. If your child has paralysis or feels they are different in any way, they may become anxious or depressed. Teens are particularly susceptible due to peer pressure. This does not mean they will have anxiety or depression. However, it is good to know the signs so you can help your child.

Anxiety is a reaction to stress exhibited by overwhelming, excessive, and continuous worry about everyday situations. In some situations, it can be a normal reaction to put a person on alert for trouble. You can see this if a stranger stops a child in the store, even with the parent present, to say hello. What used to be a normal situation, has become a situation of alert today because children are taught stranger danger, and rightly so. A parent reassures the child, and things return to normal. However, anxiety becomes an issue if the intense feelings of anxiety carry over to other situations affecting daily activities and do not resolve.

The CDC lists these symptoms of anxiety in children and adolescents:

  • Being very afraid when away from parents (separation anxiety).
  • Having extreme fear about a specific thing or situation, such as dogs, insects, or going to the doctor (phobias).
  • Being very afraid of school and other places where there are people (social anxiety).
  • Being very worried about the future and about bad things happening (general anxiety).
  • Repeated episodes of sudden, unexpected, intense fear come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder).

Several types of anxiety include anxiety or panic due to a child’s medical condition, such as agoraphobia, fear of particular places or situations, panic disorder, separation disorder, social anxiety, phobias, selective mutism, and generalized anxiety disorder. Children with neurological conditions can be affected by multiple anxieties due to their medical condition, separation from knowledgeable caregivers, fear of situations that may be challenging, or a combination of triggers. Drug abuse can lead to substance-induced anxiety disorder either from abusing drugs causing the start of the disorder or to the misuse of drugs used to combat their anxiety or medical situation.

Anxiety in children is often misinterpreted as Attention Deficit Hyperactivity Disorder (ADHD) because both anxiety and ADHD have the symptom of difficulty paying attention. Anxiety can fill your mind with worry, so it becomes difficult to concentrate on other things. Differentiating between the two diagnoses may require a professional diagnosis.

Depression is a mood disorder that leads to ongoing sadness or loss of interest in a person’s usual activities and happiness. Certainly, anyone can have a bad day or even a major event that makes them uninterested in their usual pursuits. It is the prolonged sadness that is a clue to depression. Sometimes, it can be erratic such as ups and downs in mood in a repetitious or irregular pattern.

Many things can cause depression, genetics (it sometimes runs in families), death or loss especially of function such as brain injury or neurological disease or injury, major events such as catastrophic disease or trauma, abuse including physical, sexual, mental, and conflict that can occur in families or other individuals or groups interacting with your child. Depression does not differ by gender, but traditionally, it has been seen more in females because they are more likely to seek treatment. Medications can also lead to depression, making a review with your child’s healthcare profession the first step of treatment.

In children and adolescents, the CDC lists these symptoms. Your child may exhibit one, a combination, or all the symptoms.

  • Feeling sad, hopeless, or irritable a lot of the time
  • Not wanting to do or enjoy doing fun things
  • Showing changes in eating patterns – eating a lot more or a lot less than usual
  • Showing changes in sleep patterns – sleeping a lot more or a lot less than normal
  • Showing 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. Suicide is the leading cause of death in children ages 10-24

There are many types of depression, including clinical depression, long-term depression called a persistent depressive disorder, and up and down mood swings called bipolar disorders.

Asking your child open-ended questions will provide more information about their thinking than suggesting reasons why they may be behaving differently. Open-ended questions may include statements like, “How are you feeling today?” “What did you think about a certain event?” or even, “I noticed that there were a lot of children from your school at the party.” These types of questions let the child respond with their ideas. Too specific questions will direct your child to respond to your thoughts as opposed to their own. For example, “I saw that Jimmy did not talk to you” sets up a barrier between your child and Jimmy. Another example of a closed question is, “That party was crowded. Did that make it more difficult for you to participate?” This leads to the child commenting on their challenges rather than getting to their perception of the issue.

If you are concerned about your child’s mental health, the first step is to consult their medical professional. Discuss your observations as the parent or guardian; you know your child best. Children are very adept at reporting their feelings one way in front of a healthcare provider and another way in their more relaxed home setting.

There are some screening tools that your health professional will use to identify the issue. These include The Screen for Child Anxiety Related Disorder (SCARED) which consists of 41 questions answered on a three-point scale. There are companion versions, one for the child and one for the parent, which allows different points of view to be taken into account. Spence Children’s Anxiety Scale (SCAS-Child) is another assessment of anxiety given similarly. Depression may be assessed with the CDI 2 Children’s Depression Inventory. Your health professional may use other assessments as well.

Treatment of anxiety or depression involves the help of medical professionals with knowledge of the mental wellness of children and adolescents. Often the entire family participates as this is not a situation that resides just with one person in the family unit.

Seek professional assistance if your child has a lot of worries that interrupt school and family life, if their behavior is difficult for them to control, or if they are abusing drugs or alcohol. If they have suicidal thoughts or actions, seek help emergently by calling the new hotline number: 988.

Anxiety and depression in children can be successfully treated. Cognitive Behavioral Therapy (CBT) is an intervention for both anxiety and depression. It is an individualized plan to gain control over thoughts, feelings, and behaviors. CBT is often used in conjunction with medications. For anxiety, serotonin reuptake inhibitors, antidepressants, or benzodiazepines may be selected for your child's specific needs. These may be prescribed temporarily or long-term. Depression is treated with CBT or psychotherapy and medications such as SSRIs, antidepressants, or antipsychotics, which are individualized for your child.

A neurological disease or injury does not cause anxiety or depression but can be a reaction to it. Knowing the signs and how to find help is essential for treating mental wellness. Recovery in children is excellent as they are resilient. Also, be sure to critically review your mental well-being as the life of a parent can be stressful. Seek help if you need it as well.

Linda Schultz is a leader, teacher, and provider of rehabilitation nursing for over 30 years. In fact, Nurse Linda worked closely with Christopher Reeve on his recovery and has been advocating for the Reeve Foundation ever since.

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The National Paralysis Resource Center website is supported by the Administration for Community Living (ACL), U.S. Department of Health and Human Services (HHS) as part of a financial assistance award totaling $8,700,000 with 100 percent funding by ACL/HHS. The contents are those of the author(s) and do not necessarily represent the official views of, nor an endorsement, by ACL/HHS, or the U.S. Government.