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Childhood Anxiety: An Introduction

Already in 2010 – a full decade ago – health professionals were pointing out alarmingly high rates of childhood anxiety disorders: between 6% and 20% of children and teens. In 2014, the Children’s Hospital of Philadelphia, one of the world’s top children’s hospitals, painted an even bleaker picture: “excessive anxiety is one of the most common mental health conditions in children.” 

Anxiety disorders affect about 30% of kids.

Children’s Hospital of Philadelphia

In a 2016 Vogue article, psychiatrist Rob Haskell even argued that disorders related to childhood anxiety are grossly underdiagnosed, suggesting that up to 80% of cases went undetected.

Historically, anxiety hasn’t been on the radar for pediatric psychiatry/psychology. The field originated in the early 1900s amid growing concerns about juvenile delinquency, and for much of the 20th century pediatric psychology was focused on other kinds of ambiguous afflictions like “psychosis,” “mental deficiency,” or “maladjustment,” before honing in on more specific (and exotic) diagnostic labels, such as schizophrenia.

By the 1980s, these fields turned their attention to emergent conditions like attention-deficit/hyperactivity disorder (ADHD), obsessive compulsive disorder (OCD), and depression. But anxiety in children was still on the fray – “it was thought to be innocuous, even cute” in children, says Haskell – until very recently.

Anxiety is, in many ways, a subjective and problematic diagnosis. In part, it’s because anxiety itself is not a “problem” – in fact, anxiety is a universal human experience. From an evolutionary perspective, anxiety was helpful and healthy; in other words, it served an important purpose (fight/flight in response to a threat).

Health professionals only begin to think about anxiety as disordered (“pathological”) when it becomes blown out of proportion, worsens over time, and/or exerts truly negative effects on our daily lives. 

This is hard enough for us adults. But when you consider that toddlers are prone to completely erratic behavior (which is totally normal, BTW), it can be even more tricky to clue into our children’s anxiety.

So how are we supposed to differentiate between “normal” struggles and “real” problems? How can we tell when a toddler or preschooler’s harmless (if frustrating) reticence around dogs, for example, becomes clinically pathological into childhood? Think on this for a minute and you can begin to see why childhood anxiety, especially in the early years, might be overlooked or hard to detect. 

Not to mention, our society has been more likely to respond to “problematic” children with physical discipline than with understanding. Traditionally in the US, “difficult” children simply needed to learn their place and be “kept in line.” Not offered counsel. Thank goodness this is changing.

Today, professionals from every corner attest that childhood anxiety is overlooked – grossly overlooked – despite the fact that anxiety disorders have skyrocketed in number recently (rates have increased by at least 20% in the last 10-15 years). 

A confession: I’m the kind of person who’s primed to think about this kind of dramatic change critically. I’m skeptical. Is the increase “real”? Or are we just (a little) better at talking about anxiety? Are our children really that much more anxious than we were? Than our parents, or grandparents? 

After learning more about this topic, I’ve become convinced of a few things: 

  1. Yes. (Probably.) 
  2. Maybe it doesn’t matter – let’s meet our children where they are. 
  3. Unlike many other medical interventions, the best “treatment” for anxiety (which Marissa walks us through in the rest of this series) poses virtually no risks to apply. Furthermore, these techniques are universally applicable – for adults, teens, children… they’re useful in coping with any kind of anxiety, be it fleeting and normal or prolonged and pathological.

And even though anxiety is an essential, useful sensation, with ancient biological origins – anthropology teaches us that hunting and gathering was no walk in the park, right? – we can’t help but feel that there is something different about the nature of anxiety on the eve of 2020.

Especially as it concerns our children and their day-to-day wellness. Here’s the thing: our kids are dealing with some serious threats to their ability to live calm and peaceful lives.

There are all kinds of “big-picture” reasons why anxiety among children appears to be more prominent in this millennium (seriously, we could write a book on this, y’all) – but in the interest of time, let’s just run through a bullet-point list with a few of the highlights (we’ll be diving deeper into these in subsequent articles). These stem from our own collective experiences, as well as research findings from some really smart people who’ve dedicated their careers to thinking about these issues. 

  • The downturn in children’s play time – especially free (outdoor) play time, without adult supervision, which is super-important for helping children learn to navigate social situations and manage their own emotions;
  • The rat race – children and teens (especially those in privileged, middle- and upper-class families) are internalizing the anxieties they perceive about their performance in school, their extracurriculars and status among their peers, and even competition for college;
  • Thanks to the constant news cycle and social media, American children are growing up in an “environment that anticipates catastrophe”– instead of feeling safe and secure in their world, they expect the worst: mass shootings, natural disasters, lockdowns; active shooter trainings have, tragically, become ingrained in everyday school culture because there is real precedent for them;
  • The rise of screens and social media has “radically changed” the nature of childhood and adolescence in America — virtually every aspect of youth has been affected; 
  • The constant barrage of immediate information. Nowadays, most parents are inundated with the myriad of articles, message boards, and videos at their fingertips. While easy access to information can be useful, if not entertaining, it can also be paralyzing, which takes us to our next point…  
  • Our own anxiety. So many of us parents are dealing with anxiety in our own lives and guess what?… kids learn it from us (hanging my head in shame — Meg);
  • And yes, friends, let’s not forget: our modern culture of parenting, which tends to be much more restrictive, paranoid, and overbearing than in previous generations, may be stifling our children’s maturation.

If you’re not nodding your head in agreement right now, then I don’t even know… 

One theme linking all of these factors is a decrease in opportunities for children to experience autonomy. Our children have fewer chances to explore the world freely – on their own – and are thus deprived of all the learning, confidence-building, and developmental strides that come along with gaining independence.

And the result? They’re also more likely to experience – and suffer from – anxiety.

Oh.

It blows my mind that – go figure – the most effective strategies for mitigating anxiety are about waging a battle against the negative influences of some of these huge social factors ^^.

Indeed, the underlying premise behind how we can help our children overcome anxiety is that we work with them to gain experience and exposure to the world in ways that encourage them to actively develop independence, confront novel circumstances (and even, dare we say, take some risks), while also showing them that we support them.

And regardless of what you think about the “epidemic of childhood anxiety,” doesn’t this sound like a good thing?

I think so. 

And so do the experts… keep reading to see what else they have to say.

In this series, Marissa – our in-house mental health authority – walks us through successful strategies for better understanding and overcoming childhood anxiety (or any kind of anxiety, really). We hope you find it useful — I know all of our team learned something along the way.

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