By Davis Hobley
Stress and anxiety levels in children are at an all-time high and continue to grow over the years (Lebrun-Harris et al., 2022). Among children aged 4-14, the prevalence level of anxiety continually increases, with approximately 5% of 14-year-old adolescents experiencing some form of anxiety (Steinsbekk et al., 2021). Anxiety during childhood is unarguably detrimental to normal development (Beesdo, et al., 2009). Not only does it often persist into adulthood, but it is also correlated with co-morbid disorders such as depression, substance misuse, and poor education and employment outcomes (Morales-Muñoz et al., 2023).
Much of the increase in youth anxiety has been attributed to the COVID-19 pandemic, which came with a sharp increase in mental health disorders (Meherali et al., 2021). Additionally, technological advancements, such as social media, have been linked to negative mental health outcomes in children through a variety of causes (Saleem et al., 2024). One of these is increased anonymity online, specifically in the context of bullying (Kaloeti et al., 2021). The subsequent uptake in peer bullying has been correlated with the onset of anxiety. Social media also creates unrealistic life expectations for youth, particularly as their peers share only the positive aspects of their lives (Mohr et al., 2023). As a result, youth may feel as if they are the only ones struggling with difficult life circumstances, which can further worsen anxiety.
Treatment options for childhood anxiety include both medication and behavioral treatments. Selective serotonin reuptake inhibitors (SSRIs), often prescribed as antidepressants, are effective in treating anxiety symptoms as well (Walter et al., 2020). Mood disorders like anxiety and depression are often linked to chemical imbalances of neurotransmitters in the brain, including serotonin. For example, mood disorders tend to come with a deficiency in serotonin. SSRIs primary mechanism, therefore, is linked to preventing serotonin in the synaptic gap (space between neurons) from being taken back up by the sending neuron. This leads to a higher concentration of serotonin in the synaptic gap, which helps correct the deficiency.
Figure 1
Molecular mechanism of selective serotonin reuptake inhibitors (SSRIs)
Healthcare providers typically will not spring to medication as the first treatment path for anxiety, especially in children (Walter et al., 2020). Alternative treatment options include cognitive behavior therapy (CBT) (Kaczkurkin & Edna, 2015). CBT integrates behavioral therapy and talk therapy to address issues the patient faces on multiple fronts. CBT can include any number of treatment strategies, such as exposure therapy, cognitive therapy, and eye-movement desensitization and reprocessing (EMDR). These treatment paths seek to provide the patient with methods/tools to control their anxiety while also exploring its underlying causes with the assistance of a skilled practitioner. The exact formulation of these treatment strategies depends on the patient's particular needs (see Table 1).
Table 1
Treatment types and details for anxiety disorders
Treatment | Mechanism and Treatment Plan | Use Cases | Side Effects and Risks |
Selective Serotonin Reuptake Inhibitors (SSRIs) | Reuptake transporters of the sending neuron are blocked by a reuptake inhibitor. This allows more of the serotonin that is sent from the sending neuron to remain in the synapse. This often corrects for serotonin deficiency which is seen in mood disorders (Walter et al., 2020). |
(Cleveland Clinic, “SSRIs”) |
(Cleveland Clinic, “SSRIs”) |
Cognitive Behavioral Therapy (CBT) | CBT is a combination of talk therapy and behavioral therapy that works to treat mental health disorders on multiple fronts. Exposure-based techniques are commonly used as a means for patients to better understand the problems driving their mental health symptoms. Exposure-based therapy is especially useful for treating anxiety disorders where the patient may be strictly avoiding their triggers (or reminders of their trauma) to avoid reliving negative experiences. CBT allows the patient to process their experience safely and productively (Kaczkurkin & Edna, 2015). |
(Mayo Clinic) |
(Mayo Clinic) |
Eye Movement Desensitization and Reprocessing Therapy (EMDR) | EMDR is a mental health treatment that treats PTSD and other disorders by focusing on traumatic events from the past. EMDR was founded based on adaptive information processing, which suggests that there is a different process for storing traumatic memories compared to normal ones. Traumatic events can often be disconnected from normal thought patterns and memories to reduce the pain of reliving that trauma, though this can inhibit the healing process. EMDR emphasizes tackling the root of this trauma (Kaczkurkin & Edna, 2015). EMDR is typically an eight-phase treatment plan. For a full overview of the phases, see Cleveland Clinic, “EMDR Therapy.” |
|
|
The proper treatment plan for any patient is going to be a collaborative decision between the patient and their clinicians. Often, a combination of therapy, behavioral changes, and medication can yield the best results. However, everyone’s personal situation will vary (Mayo Clinic).
As the new generation is ushered in, advancements in treatments and a deeper understanding of developmental contexts are necessary to reduce the stress culture currently affecting today’s youth.
References
Beesdo, K., Knappe, S., & Pine, D. S. (2009). Anxiety and Anxiety Disorders in Children and Adolescents: Developmental Issues and Implications for DSM-V. Psychiatric Clinics of North America, 32(3), 483–524. https://doi.org/10.1016/j.psc.2009.06.002
Cleveland Clinic. “EMDR Therapy: What It Is, Procedure & Effectiveness.” Cleveland Clinic, 29 Mar. 2022, my.clevelandclinic.org/health/treatments/22641-emdr-therapy.
Cleveland Clinic. “SSRIs.” Cleveland Clinic, 3 May 2023, my.clevelandclinic.org/health/treatments/24795-ssri.
Kaczkurkin, A., & Foa, E. (2015). Cognitive-behavioral therapy for anxiety disorders: An update on the empirical evidence. Dialogues in Clinical Neuroscience, 17(3), 337–346. https://doi.org/10.31887/dcns.2015.17.3/akaczkurkin
Kaloeti, D. V. S., Manalu, R., Kristiana, I. F., & Bidzan, M. (2021). The Role of Social Media Use in Peer Bullying Victimization and Onset of Anxiety Among Indonesian Elementary School Children. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.635725
Lebrun-Harris, L. A., Ghandour, R. M., Kogan, M. D., & Warren, M. D. (2022). Five-Year trends in US children’s health and well-being, 2016-2020. JAMA Pediatrics, 176(7), 1–11. https://doi.org/10.1001/jamapediatrics.2022.0056
Mayo Clinic. “Cognitive Behavioral Therapy.” Mayoclinic.org, Mayo Clinic, 16 Mar. 2019, www.mayoclinic.org/tests-procedures/cognitive-behavioral-therapy/about/pac-20384610.
Meherali, S., Punjani, N., Louie-Poon, S., Abdul Rahim, K., Das, J. K., Salam, R. A., & Lassi, Z. S. (2021). Mental Health of Children and Adolescents Amidst COVID-19 and Past Pandemics: A Rapid Systematic Review. International Journal of Environmental Research and Public Health, 18(7), 3432. https://doi.org/10.3390/ijerph18073432
Mohr, M., Vár Honnudóttir, Mohr, M., & Annika Helgadóttir Davidsen. (2023). The paradox of endless options and unrealistic expectations: understanding the impact on youth mental health. International Journal of Adolescence and Youth, 28(1). https://doi.org/10.1080/02673843.2023.2242475
Morales-Muñoz, I., Mallikarjun, P. K., Chandan, J. S., Thayakaran, R., Upthegrove, R., & Marwaha, S. (2023). Impact of anxiety and depression across childhood and adolescence on adverse outcomes in young adulthood: a UK birth cohort study. The British Journal of Psychiatry, 222(5), 1–9. https://doi.org/10.1192/bjp.2023.23
Neurotorium. “Selective Serotonin Re-Uptake Inhibitors (SSRIs).” Neurotorium, 5 Oct. 2016, neurotorium.org/image/selective-serotonin-re-uptake-inhibitors-ssris-2/.
Saleem, N., Young, P., & Yousuf, S. (2024). Exploring the Relationship Between Social Media Use and Symptoms of Depression and Anxiety Among Children and Adolescents: A Systematic Narrative Review. Cyberpsychology Behavior and Social Networking. https://doi.org/10.1089/cyber.2023.0456
Steinsbekk, S., Ranum, B., & Wichstrøm, L. (2021). Prevalence and course of anxiety disorders and symptoms from preschool to adolescence: a 6‐wave community study. Journal of Child Psychology and Psychiatry, 63(5). https://doi.org/10.1111/jcpp.13487
Walter, H. J., Bukstein, O. G., Abright, A. R., Keable, H., Ramtekkar, U., Suhler, J. R., & Rockhill, C. (2020). Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 59(10), 1107–1124. https://doi.org/10.1016/j.jaac.2020.05.005
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