In the last ten years, diagnoses of anxiety disorders in young people under the age of 17 have increased, from 3.5% to 4.1%.
This is stated by the Child Mind Institute, an American not-for-profit organization whose purpose is to facilitate the lives of children and families dealing with mental health and learning disorders. In its report on Mental Health in Children in 2018 about childhood and adolescent anxiety disorders, it analyzes its current prevalence, the impact of early risk factors, and describes effective treatments.
As the report points out, some children react by avoiding or showing disproportionate fear of certain situations or objects. In contrast, others exhibit more explosive behavior, which can sometimes be misinterpreted as oppositional or hostile.
The myth of shyness
In young people with phobias or social anxiety disorder, their difficulties can be attributed to “shyness,” and few people acknowledge the serious distress they experience. Many young people don’t realize that the overwhelming reactions they experience stem from a problem that can be effectively treated.
In light of the above, the Institute considers it interesting to address this problem in depth.
Summary of the report
We have collected the main conclusions below:
- In childhood and adolescence, anxiety disorders are the most common, both in the United States and worldwide. In fact, its clinical recognition has increased in the last decade, registering an increase in anxiety disorder diagnoses in young people under 17 years of age, which have gone from 3.5% to 4.1% today.
- Approximately 117 million children and adolescents worldwide have suffered from an anxiety disorder. Although about 10% of children ages 6 to 17 will have an anxiety disorder early in adulthood, nearly 20% will have anxiety-related functional difficulties in at least one area of their lives. In children, anxiety disorders can affect all aspects of their lives, but mainly their social and educational functioning.
- The percentage of American teens who will meet the criteria for an anxiety disorder is 13% for a specific phobia, 9% for Social Anxiety Disorder, 8% for separation anxiety, 2% for panic disorder, and 2 % for generalized anxiety disorder. Without treatment, many subtypes persist into adulthood.
- Currently, high school students have more anxiety symptoms and are twice as likely to see a mental health professional than in the 1980s.
- Anxiety is the leading cause of concern in university counseling services. It surpasses depression as the primary demand among university students who attend mental health services, with anxiety being the most frequent concern (48%), followed by stress (39%).
- One of the most substantial risk factors, which can be detected first, is temperament. Some research highlights the link between early temperament and later behavioral patterns: inhibition of behavior in the early years of life predicts social isolation in childhood. The data in this regard suggests that 15% of adolescents who exhibit inhibited behavior are five times more likely to develop social anxiety than those who do not. Likewise, 61% of adolescents who already showed inhibited behavior at two years of age, showed signs of social anxiety at the age of 13, when interacting with unknown adults.
- Many children whose anxiety is causing severe distress, such as those with selective mutism, are labeled “shy children.” In this regard, the report warns, “of the general concern to medicalize all shyness.” For this reason, it stresses the importance of distinguishing between normal shyness and clinical anxiety, recalling that, according to some studies, around 50% of adolescents consider themselves “shy”, and yet, only 12% of those shy adolescents meet criteria for a social anxiety disorder.
- Anxiety disorders manifest at different times in childhood and adolescence. Separation anxiety mainly affects younger children (up to 10 years old), while social anxiety comes later when peer relationships become more critical (around 14 years old). In the case of social anxiety disorder, an earlier age of onset is associated with greater severity in later years.
- Regarding gender, women are at increased risk for anxiety disorders, and this gender difference begins at puberty. Teenagers are twice as likely to have an anxiety disorder.
- Genetic risk factors play a particularly important role in panic disorder and generalized anxiety disorder. Children of anxious parents are five times more likely to develop an anxiety disorder.
- The origin of social anxiety disorder in adolescents is related to a stressful event. Half of all adults with a social anxiety disorder may report a specific embarrassing event during their teens that started it. At the same time, a third identify an extremely stressful event that likely played an essential role.
Anxiety disorders are frequently associated with medical problems. Studies show a significant association between asthma and anxiety disorders, the rates of which increase with the severity of physical symptoms.
Allergic conditions and anxiety disorders can be the result of common underlying risk factors. Some research reveals a relationship between atopic disorders (including eczema and hay fever) and anxiety. Likewise, anxiety at five years of age is associated with severe and persistent asthma in adolescence.
Childhood anxiety disorders are closely related to an increased risk of depression, anxiety, behavior problems, and subsequent substance abuse:
Social anxiety disorder has a high correlation with the development of depression: twice that of other anxiety disorders and triple compared to young people without anxiety. Social anxiety disorder with onset in childhood and adolescence causes earlier onset of depression and poor social functioning. In adolescence, when depression coincides with social anxiety, it is strongly associated with suicidal thoughts, suicide attempts, and more depressive symptoms.
Childhood anxiety is a strong predictor of an anxiety disorder during adolescence: Childhood separation anxiety disorder predicts adolescent separation anxiety. Generalized anxiety disorder is also associated with anxiety and subsequent panic attacks. Social anxiety disorder in children is associated with adolescent generalized anxiety disorder, ongoing social anxiety, and ADHD.
The risk of substance abuse is doubled in people with anxiety disorders. Childhood anxiety disorders, including panic and social anxiety, are linked to an increased risk of substance use, particularly alcohol abuse and dependence.
Multiple studies have also evidenced a link between the symptoms of early anxiety and the subsequent development of behavioral problems and disruptive behaviors.
Untreated social phobia is associated with many negative consequences, including poor school and work performance, school dropout, and unemployment.
Children whose anxiety manifests itself in temper tantrums, opposition, or violent outbursts often encounter disciplinary problems.
- There is a growing obsession among teens with connecting with their friends on social media. The 2018 data regarding the prevalence and habits of social networks among adolescents reveal that 95% have a smartphone, and 45% are online “almost constantly” (compared to 24% in 2014).
- 24% of adolescents consider that networks have a negative impact; the main reason being the spread of rumors and bullying. For 31%, social networks have a mostly positive effect, facilitating the connection with friends and family.
- 97% of young people between 11 and 17 years old use social networks. 35% of them reveal sleep problems and 47% anxiety. Greater emotional investment in social networks is strongly correlated with higher levels of anxiety: the amount of time dedicated to using social networks is directly related to greater anxiety symptoms and a high probability of meeting the criteria for an anxiety disorder.
The authors of the report suggest two theories that could explain this phenomenon: social media can be a source of stress that contributes to anxiety symptoms, or young people with high anxiety tend to become more involved in social media, perhaps, as a form of reaffirmation that seeks to alleviate anxiety symptoms.
Detection and prevention
Regarding detection and prevention, most people who experience an anxiety disorder do not seek treatment, particularly those with less severe symptoms. According to this report, it is essential to ensure that mild and moderate cases have access to care, thus avoiding a substantial burden.
Unfortunately, anxiety disorders often go unnoticed: just 1% of young people with anxiety seek treatment in the year their symptoms begin, and most anxiety symptoms go untreated for years.
Although more children are diagnosed, there are still many that go undetected – and therefore do not receive treatment – due to the lack of external signs or because young people have difficulty identifying when their anxiety is not normal.
How to help
The first step in helping young people is to identify anxiety symptoms correctly. Anxiety is often confused with other disorders, resulting in ineffective treatment. Some common diagnostic errors are learning disorders like ADHD, depression, autism, psychosis, and negative defiant disorder.
There is some research to suggest that prevention, for example, intervention before an anxious child develops a complete anxiety disorder, is effective in school-age children and young adults. Interventions using community prevention programs targeting young adults have been shown to be effective, reducing anxiety symptoms by 60%.
Regarding treatment, the data shows that adolescents and their parents are beginning to recognize that anxiety disorders can become serious, and more and more families are seeking care and treatment.
However, despite growing awareness, the proportion of youth receiving treatment remains the lowest of all major categories of mental health disorders, well below the overall rate of anxiety in the population. The report suggests that “at some point, 30% of children and teens will meet the criteria for an anxiety disorder, but 80% of those will never receive help.”
At this point, the report highlights the vital role of cognitive-behavioral therapy (CBT) in the treatment of anxiety disorders. Along these lines, exposure and response prevention works by helping children address their anxiety and fears in incremental steps, within a safe and controlled environment. The benefits of CBT are long term in almost 93% of children and adolescents.
Regarding online cognitive-behavioral interventions, some research has shown that patients are more open and honest about their symptoms when they interact with “virtual humans” and do not believe that they are observed or judged.
Mindfulness meditation is increasingly being introduced in various contexts, like school and clinical mental health centers, to help young people manage stress and behavioral problems.
The family plays an essential role in response to treatment. Therapy with guidelines for parents is showing beneficial results, producing high satisfaction in parents, who report a reduction in children’s symptoms. More than 60% of children show better results after their parents follow parental therapy.
To read the whole report, you can download it here.