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 some fears and worries are typical in children, persistent or extreme forms of fear and sadness could be due to anxiety or depression.

Facts

• Anxiety and depression affect many children
  • 9.4% of children aged 3-17 years (approximately 5.8 million) had diagnosed anxiety in 2016-2019.
  • 4.4% of children aged 3-17 years (approximately 2.7 million) have diagnosed depression in 2016-2019.
• Anxiety and depression have increased over time
  • “Ever having been diagnosed with either anxiety or depression” among children aged 6-17 years increased from 5.4% in 2003 to 8% in 2007 and to 8.4% in 2011–2012.
  • “Ever having been diagnosed with anxiety” among children aged 6-17 years increased from 5.5% in 2007 to 6.4% in 2011–2012.
  • “Ever having been diagnosed with depression” among children aged 6-17 years did not change between 2007 (4.7%) and 2011–2012 (4.9%).

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

• 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)
• Having repeated episodes of sudden, unexpected, intense fear that come with symptoms like heart pounding, having trouble breathing, or feeling dizzy, shaky, or sweaty (panic disorder)

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.

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

• 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

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.

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.

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:

• Having a healthy eating plan centered on fruits, vegetables, whole grains, legumes (for example, beans, peas, and lentils), lean protein sources, and nuts and seeds
• Participating in physical activity for at least 60 minutes each day
• Getting the recommended amount of sleep each night based on age
• Practicing mindfulness or relaxation techniques

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 American Academy of Child and Adolescent Psychiatry (AACAP) recommends that healthcare providers routinely screen children for behavioral and mental health concerns. 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.

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:

• Suicide prevention
• Bullying prevention
• Child maltreatment prevention
• Youth violence prevention
• Depression after birth
• Caring for children in a disaster

Family-centered treatment program can help reduce stress for all

The best way to help children with an anxiety disorder may be to help their parents first, a new NIH-funded study has found.

Most children worry or feel anxious from time to time. But for children with an anxiety disorder, their feelings are more constant and intense. It can cause problems at school, disrupt their sleep, and prevent them from making friends.

To help their children deal with anxiety, many parents try to accommodate them. For example, they might sleep in their bedroom to calm nighttime fears or avoid social situations that upset the child.

Teaching parents better ways to help children with anxiety disorders may be as helpful as child therapy.

While this works temporarily, it doesn't teach the child how to deal with worries on their own as they get older.

NIH-supported researchers with the Yale Child Study Center decided to take a different approach. They taught parents how to respond to their child's anxieties in new ways.

The new program assigned 124 children, ages 7 to 14, who had been diagnosed with an anxiety disorder, to receive weekly cognitive behavioral therapy (CBT) sessions. The sessions helped them learn strategies to cope with their worries.

Half of the parents went through a training program at the same time. These parents learned supportive ways to respond to their child's anxiety and ways to change their own accommodating behavior.

After 12 weeks, the authors found that CBT had reduced the children's levels of anxiety. They also found that parents who were in the training program (compared to those who were not) exhibited a lower level of parenting-related stress.

Though treatment like CBT can teach children ways to cope with their worries and emotions, only about half of them respond well to it. This dual approach may help children who don't respond well to CBT.

According to a 2012 national survey, nearly 12 percent of children and teens (about one in nine) in the United States are using some form of complementary health product or practice, such as chiropractic or spinal manipulation, yoga, meditation, or massage therapy. Mind and body practices include a variety of procedures and techniques done or taught by a trained practitioner or teacher to help improve health and well-being. Older children and teens can do some mind and body activities on their own (or with help from a parent or guardian), such as relaxation techniques and deep breathing. Mind and body practices are generally safe if used appropriately, but the number of studies looking at their safety specifically for children is limited.

Here are 7 things to know about common mind and body practices for children and teens.

1. Biofeedback, guided imagery, mindfulness, and yoga are some of the mind and body practices that have the best evidence of being effective for children and are low-risk.

2. Acupuncture appears to be safe for most children, but side effects can occur if it’s done by poorly trained practitioners.

3. Massage therapy appears to have few risks when done by a trained practitioner. However, massage therapists need to take extra precautions with people who have certain health conditions, such as bleeding disorders.

4. Relaxation techniques are generally safe for healthy people, including children. However, there have been rare reports that some relaxation techniques might cause or worsen symptoms in people with epilepsy or certain psychiatric conditions, or with a history of abuse or trauma.

5. Spinal manipulation is usually safe for healthy people but is also associated with rare but serious complications.

6. Follow the Centers for Disease Control and Prevention’s vaccination recommendations to safeguard your child against vaccine-preventable diseases. Vaccinating children helps protect our community’s and our children’s health.

7. It’s important that you talk with your child’s health care provider about any complementary health approach that you’re using or considering for your child, and encourage your teenagers to do the same.

Kevin Love has achieved a lot in 31 years. He's a five-time National Basketball Association (NBA) All-Star. He won an NBA championship with the Cleveland Cavaliers in 2016. He's also a basketball world champion and a U.S. Olympic gold medalist.

But he has experienced challenges. He lives with depression and anxiety and has suffered from panic attacks. He even had one during an NBA game.

Recently, he opened up about his mental health and shared his story with the public. By speaking out about his own experiences, he has sparked a movement to raise awareness about mental health—especially for men and athletes. He talked to NIH MedlinePlus magazine about his journey.

Your panic attack during an NBA game was a turning point for you. Can you tell us about that?

It's a really scary thing to feel something happening to your body and have no idea what's going on. Especially in the middle of an NBA game in front of thousands of people.

In that moment, my heart was racing. I couldn't catch my breath. I thought I was having a heart attack. Even after it was over, I didn't know that I had had a panic attack. I thought there was something physically wrong with me and it wasn't until everything tested out OK physically that I realized there was something else going on that I needed to address.

"We need to share our stories and make sure people know they are not alone."

- Kevin Love

What has been helpful for you in dealing with your anxiety and depression?

I work with a therapist and I am one of the people whom medication has helped. I know people have different outlooks when it comes to medication. It's a very personal decision, but for me it has helped a lot.

Taking care of my total health has also been a really effective tool. I try to meditate regularly and get enough sleep. Exercise is a great way that I let off steam and feel good about myself, and not just because I'm an athlete. I'm also very focused on my diet and eating well.

What advice do you have for other men and boys who might experience similar issues?

I encourage everyone to speak their truth. One saying I always default to is "nothing haunts you like the things you don't say." When I was younger, I held it in because I was afraid of what my friends and family would say and what the people around me would think. I was worried what my teammates and other people on the court would think of me, too.

Now, I feel more comfortable in my own skin than I ever have. It's really important to know that others are going through it too and that a lot of good can come through your experience.

Could you talk about fighting the stigma attached to mental health/mental illness, particularly among men?

Mental health is not something that has traditionally been talked about among men. We're taught that we're supposed to bury our feelings and not be vulnerable.

If you look at the past, things like melancholy, depression, anxiety, and mood disorders were actually seen as endearing or as something that could lead to great things. I read a book about President Abraham Lincoln called "Lincoln's Melancholy" that talks about his depression and the role it played in driving him to greatness. It was eye-opening for me. It really wasn't until the 20th century that mental illness was looked at as devastating.

So to change that, we need to keep talking about it more, especially as men. We need to share our stories and make sure people know they are not alone. There is a vast community that empathizes with them and understands what they are dealing with.

Since you began speaking out, have you heard from other men or boys who are facing these challenges?

Absolutely. I have heard from guys who are going through something themselves and from guys who have a loved one or family member who is suffering and they want to help. It just goes to show that everyone really is going through something. A lot of people feel alone.

Anxiety and depression are extremely isolating, so I am glad I can be a part of helping people feel supported and encouraged.

What is next for Kevin Love?

When I decided to share my story, I didn't realize how many people it would resonate with or what a lightning bolt of a topic it would become. Or that I would actually find my life's work. Basketball is my career now and for the foreseeable future. But there is so much to be done in this space, it will keep me busy for a long time. For instance, I launched the Kevin Love Fund. Its goal is to help normalize the conversation around mental health. We really want to focus on inspiring people to live their healthiest lives while providing tools for both physical and emotional well-being.