What parents should know about anxiety and depression in kids
A child psychiatrist answers your top questions about therapy for children — plus medication and how to open an honest conversation.
The pandemic has been really hard on kids and teens. In the first year, a report from JAMA Pediatrics estimated that 1 in 4 youths experienced elevated symptoms of depression and 1 in 5 had clinically elevated anxiety. That’s double the pre-pandemic levels.
There are a lot of factors behind this drop in well-being. An uptick in stress, routine changes, isolation and other social upheavals have all played a role. Plus, a 2021 study out of Canada found that the more screen time kids had, the more likely they were to have mental health symptoms.
So what can parents do to nurture their children’s mental health? To answer your top questions, we spoke with Avanti Bergquist, MD. She’s a child and adolescent psychiatrist at the Eating Recovery Center and Pathlight Mood & Anxiety Center in Bellevue, Washington.
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Q: Have you seen an increase in the number of young people who have mental health conditions during the pandemic?
Dr. Bergquist: Yes. We’ve seen a big spike in mental health conditions, including depression and anxiety. One area where we didn’t expect to see such a huge jump among children and adolescents was in eating disorders. Changes in routines, loneliness and breaks in treatment may play a role.
Q: Say my child was recently diagnosed with anxiety or depression. How can I best support them?
Dr. Bergquist: Try to be in tune with your kids and check in with them often. It’s easy to want to fix everything for them. But it can be even more helpful to simply validate their emotions, rather than trying to solve their problems, even if you don’t think they should feel that way.
To do that, avoid statements such as, “You shouldn’t feel that way.” Instead, say, “I understand that you’re feeling anxious and depressed because of what’s happening in your life.” Better yet, expand on that and list the reasons life may be more difficult right now. For example, “School is more challenging right now,” “You’re not able to play sports” or “You aren’t friends with so-and-so anymore.”
Parents should also keep track of changes in their child’s behavior. Maybe they’re spending less time doing the things they like. Or they’re opting to isolate — even when they don’t have to. If you notice those changes, something is going on with your child. Here’s how to talk with your child about anxiety and depression.
Q: What role does therapy play in treatment? And how does therapy evolve as they get older?
Dr. Bergquist: For mild anxiety or depression, children and teens can start with just therapy. For more moderate or severe conditions, medication is often added to the treatment plan.
When children are young, it’s common for you to be in the room with them during therapy. The therapist may encourage your child to express their feelings and thoughts through talking, playing or other activities. Or you may work with the therapist alone to talk about your child’s behaviors. At times, you may feel like you’re doing most of the work yourself.
As children get older, though, parents may not have to be quite as involved. Older children are better able to cognitively understand cause and effect. So they can recognize how and why they may be thinking in certain ways.
Q: My child’s doctor recommended an antidepressant medication. How can I make an informed decision?
Dr Bergquist: First, it’s important to understand your child’s diagnosis. Deciding to bring medication into the treatment plan depends on how severe their mental health condition is. Plus, for moderate to severe anxiety or depression, medication and therapy together often do better than either one alone.
Then ask your child’s doctor to outline the benefits and risks of starting a medication. Other questions to ask may include:
- What is the goal of treatment?
- How might their symptoms improve?
- How long will it take to notice a difference?
- What are the side effects? Are there warning signs I should be on the lookout for?
- What lifestyle changes can help? (For example, a consistent sleep schedule, social and physical activities, and eating a variety of good foods are all important for mental health.)
Q: How likely is it that my child will come off the medication eventually?
Dr. Bergquist: Very likely. In general, once a young person feels better, it’s recommended that they continue the medication for an additional 9 to 12 months. (Talk to your child’s provider about what “feeling better” looks like for them.)
When people stop too early (which can happen if they say they feel better and don’t think they need it any longer), their brains literally haven’t healed enough. They need a full 9 to 12 months of treatment after they feel better to find long-lasting relief.
Q. In 2020, emergency department visits for suspected suicide attempts among 12- to 17-year-olds increased by 31% compared with the year before, according to data from the Centers for Disease Control and Prevention. That is incredibly scary for any parent. What should I do if my child talks about suicide?
Dr. Bergquist: Definitely don’t dismiss their feelings. And don’t panic. Try to remain calm. It’s a good thing that your child is coming to you in the first place. That means you’ve built a trusting relationship with them.
Make sure you talk about it — and ask what’s going on with them. Don’t be afraid to ask the hard questions, such as “Are you being bullied?” or “Did someone assault you?” Then listen, understand and validate their emotions.
Q: What signs should parents watch out for that indicate their child may be thinking about suicide?
Dr. Bergquist: Be sure to watch for any change in behavior, such as not enjoying activities the way they used to. Also look for changes in sleeping and eating patterns.
The best thing you can do is be proactive. Be involved in your child’s life. That means knowing about their friends, how they’re doing in school and about any new activities. When you’re “in the know,” you’ll often be able to tell when something starts to go awry. And they’ll also feel comfortable coming to you when something does go sideways.
If your child talks about suicide, you should ask them if they plan on acting on these thoughts. If so, you may need to take immediate action and visit an emergency room.
Q: What additional resources do you recommend for parents who are helping their children work through mental health challenges?
Dr. Bergquist: I often provide my patients’ families with additional information to look through at home. The American Academy of Child and Adolescent Psychiatry has great resource centers for families, including guides about anxiety, attention deficit hyperactivity disorder, bullying and depression.
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Analysis on young people and depression: JAMA Pediatrics (2021). “Global prevalence of depressive and anxiety symptoms in children and adolescents during COVID-19: A meta-analysis”
Canadian study on screen time and mental health: JAMA Network Open (2021). “Screen use and mental health symptoms in Canadian children and youth during the COVID-19 pandemic”
Statistics on suspected suicide attempts among young people: Centers for Disease Control and Prevention