The Anxiety Problem

May 15

I don’t think a whole week goes by – sometimes mere days – without seeing some headline about today’s “higher-than-ever” anxiety rates. In children. In teenagers. In women. In men. Apparently, everyone is anxious and we are all anxious about it. I examine the science behind the headlines, explore why this might be happening, and even what we as parents CAN do about it. Because when we feel like we can take action, we all feel less anxious.

My skeptic brain, primed even more by graduate school drilling in the habit of questioning everything we read, first wonders: Is this anxiety epidemic even true?

Numbers can be misleading, with many reasons for higher numbers besides actual increases in anxiety. Are people young and old simply speaking up more? Are we asking more? Could mental health stigma actually be decreasing so we are simply more aware? Or are we collectively facing anxiety at levels never seen before?

Is It True?

According to some large surveys by reputable sources, the percentages would suggest anxiety is in fact increasing quickly and substantially. A couple of examples: the National Survey of Children’s Health looked at youth ages 6-17 and found a 20% increase of anxiety diagnoses between 2007 and 2012. The Higher Education Research Institute at UCLA has surveyed incoming college first-years about feeling “overwhelmed.” In 1985, 18% agreed; in 2000, 28%; in 2016, almost 41%. So in just over 30 years, feeling “overwhelmed” more than doubled.

Some experts have also echoed my questions about whether it’s an issue of reporting more symptoms, more people using mental health services, or more clinicians diagnosing anxiety (or all three converging).

It turns out at least one psychologist, Jean Twenge, has published a book about it, Generation Me. She presents data showing anxiety has indeed increased across generations, and she accounts for the very biases I mention above. Dr. Twenge argues that both anxiety and depression increased significantly between the 1930s and early 1990s. But the only mental health trend that has shown improvement is a decrease in teen suicide, likely due to better antidepressants being available in the 90s. In fact, Dr. Twenge reports on research suggesting that generational differences are actually four times more likely to predict anxiety than family environment.

Why Is Anxiety Increasing?

My best analysis from what I could find on the normal internet (meaning I could not find solid scientific information from academic sources): there are many theories, no one “answer,” and not enough causal data to make evidence-based conclusions.

“We can do this for ourselves and our children by looking away from the world at large and focusing on what we can do in our daily lives to build up the antidotes to anxiety: confidence, calm, and safety. ”

Social media is widely blamed, but digging into these data shows it’s not that clear. There’s definitely common sense to the theory that posts on social media platforms inflame the fear of missing out, and contribute to bullying, which clearly causes mental health problems.

I would also venture to say that the notifications pinging constantly from the cell phone leave all of us in a greater state of tension and vigilance, which are physical parts of anxiety.

But research has not yet demonstrated clear, unequivocal causation of social media and technology on anxiety in children and teens. With time it may, but not yet.

In my own practice, I see the harm of high academic pressure. Teen girls present with stomach pain and digestive problems, or headaches, or mysterious other body pain; they stay up late and get up early to study, making sure they are also excelling at sports or band or debate (or all three). I do not know what the data says about how academic pressure has changed, but it sure seems like today’s adolescents face much higher expectations than when we were teens.

Finally, there is no way to discuss anxiety in youth without mentioning the epidemic of gun violence. I mean, anxiety is all about fear and worry, and kids in preschool are practicing active shooter drills. Besides the obvious rippling trauma effect of school shootings, many of our youth also live in neighborhoods with constant exchange of gunfire. That should not be normal and it is not healthy. But it is the current reality and all of us worry about the effects on our kids.

The answer to why anxiety is increasing in our children likely lies in the covergence of many parts of our modern world. Like any mental health construct, anxiety works on a continuum and can have varying presentations depending on the child and the reasons. But the bottom line is our brains are built to turn on anxiety as a survival mechanism, and that biological drive is going haywire.

What Do We Do?

That brings me to the most important part: US.

As the parents, we DO matter when it comes to our children’s anxiety. In fact, that idea recently made headlines when a study found treating only the parents for their child’s anxiety had better outcomes than standard therapy treating the child. This kind of finding is made for the headlines, but the truth is we have known this in the child mental health field for a very long time. Our anxiety greatly affects our child’s anxiety, especially in younger children.

In my specialty of working with kids with medical problems, including procedural anxiety (think shots and anything related to a needle), we know that the frantic parent feeding off their child’s wailing makes it worse. When the parent can stay calm and reassuring, it helps the child, like a mirror.

So what do we do this knowledge in the day-to-day of our parenting?

First, we’ve got to stop rescuing our children. Our temptation is to remove whatever is worrying our children and reassure them. I do it all the time with my 4-year-old, even though I know “better.” He claims he’s scared going to the bathroom by himself and will whine and cry about it until we give in and send one of his sisters with him because it is just easier when we are rushing around trying to get dinner on the table.

He also predictably cries and complains the mornings of going to any activity – first it was gymnastics, then swimming, and now soccer. We have started to validate he feels nervous, and he even said it himself recently without any prompting (progress!). We do reassure him, but what really works is not paying too much attention to his crying and defiant statements (“I’m NOT going!) and to keep moving through our morning routine until we end up on the soccer field. Then he runs off and has a blast for an hour, his nerves a distant memory.

Anxiety feeds on itself. The more we indulge it, the stronger it gets, kind of like Seymour in Little Shop of Horrors. So when we can work with our kids to face and do what makes them nervous, we deprive anxiety of oxygen, and build their confidence in themselves. In fact, I wonder if the parenting movement of increased empathy toward our children may have served a paradoxical effect of rescuing our children from worries and fears instead of helping them work through them.

So obviously this response to the seeds of anxiety (not wanting to do activities, having fears) fits the more traditional idea of anxiety, but going to the bathroom alone and getting ready for soccer has nothing to do with active shooter drills.

Is It Safe?

The reality is the world has many threats we cannot control. We cannot promise safety, but we also cannot live in a state of fear because that’s not healthy. Or fun.

Anxiety can be rooted in the world not feeling safe, and we are our children’s first line of defense in the world. If we are spinning in our own fears, we should at least be aware of what we are projecting to our children, and then do our best to work on this anxiety we may be carrying around within us.

What we can also do is be the safety for our children – WE show up predictably, WE do not hurt them, WE make good decisions to ensure their basic physical safety (the reason we wrangle Houdini toddlers into car seats).

When children have a safe home base to return to from an unpredictable world, this provides a critical layer of protection for their overall mental well-being.

Is It Me?

The burden of parenthood includes blaming ourselves for pretty much everything. If we have anxiety, we may feel responsible when we see the first blooms of anxiety in our children. If we follow all the advice we hear and read to help our child with anxiety, and they still suffer, we feel we must be doing it wrong.

One truth I can say with certainty after many years of working with children and families: our kids come to us wired to be certain ways, no matter how we are parenting. As mentioned earlier, our current generation of children is simply more anxious, and data supports it is not because of the family.

It can be helpful to shift from focusing on why a problem happened (“my child is anxious because of me”) to how to be part of the solution. Parents are often not the reason for the problem, but are ALWAYS part of the solution. And a child’s “solution” looks different depending on the child.

Is My Child Anxious?

It can be hard to determine when normal worries and fears may cross over into anxiety as diagnosed by a professional. All of us are skating on the continuum of anxiety — feeling more anxious some days, and less anxious other days. How do we know if our child has anxiety that needs help?

The biggest consideration is how impairing the symptoms are for your child — how much does anxiety get in the way of life? You can also work on strategies at home first to see if those are helpful (see workbook suggestions in resource list below), and if not, then a professional may be warranted. Some common symptoms include:

Difficulty sleeping most nights
Physical restlessness
Increased physical complaints, like stomachaches and headaches
Avoiding certain activities or situations (eg, not wanting to go to school or be with friends)
Problems concentrating (this often affects schoolwork)
Pervasive worries that are hard to control
Difficulty separating from a main caregiver after experiencing a scary event
Increased fears (that fall outside developmental norms)

Please remember this blog post is not a substitute for a mental health evaluation.

Anxiety Antidotes

Our world may feel like a mounting pile of worries and fears, infecting all of us at all ages. It may very well be causing more anxiety now than ever before. That is probably why mindfulness, meditation, and yoga are super trendy right now: we need them to counteract our anxious realities.

One of the core strategies to manage anxiety is to break down the big picture into smaller steps. We can do this for ourselves and our children by looking away from the world at large and focusing on what we can do in our daily lives to build up the antidotes to anxiety: confidence, calm, and safety.

The good news is we can do this in even small ways that make a difference, from staying calm and comforting during their wellness shots, to teaching our kids how to meditate, to prioritizing managing our own anxiety.