Depression and anxiety in kids and teens: What are the signs?

The statistics are repeated again and again in news coverage of the youth mental health crisis, but they’re no less startling: The number of children living with depression and anxiety reportedly doubled during the pandemic.

With the number of stresses bearing down on young people today — the climate crisis, social isolation, pressure to succeed, and so many others for kids with marginalized identities — I don’t find this surprising. But I also think we have a cultural tendency to become numb to this kind of information because it’s so overwhelmingly troubling.

If you’re a parent, this rise in emotional distress among children may feel like a vague and shadowy boogeyman, especially if you aren’t sure of what signs to look out for in your own kiddos.

One reader asked us: Do depression and anxiety look different in kids than in adults?

The short answer is — kind of. There is more similarity than difference in the way anxiety and depression present in kids and adults, but there are some nuances. I thought it would be helpful to lay out what these conditions can look like for children and teens, and how you can support your kids if they’re struggling in these ways.

You’ll notice that there’s some overlap in how anxiety and depression present in children, and they often co-occur in both adults and children. That’s because these conditions share many of the same risk factors, including environmental stressors and traumatic experiences. Someone who has an anxiety disorder is more likely to be depressed, and vice versa. Also, psychologists invented these categories to organize symptoms into diagnosable mental disorders, so they’re imperfect and sometimes reduce complex problems into labels (an issue I’d like to explore in a future newsletter).

I also want to note that almost everyone feels depressed or anxious at different points in their lives, including kids. But when feeling bad gets in the way of kids living full and meaningful lives, they may be dealing with something more. My goal here isn’t to help you diagnose your little ones, but instead to help you notice patterns that might be out of the ordinary so that you can be there for them.

Depression in kids

Here are some signs of depression to look out for in your kids, according to this week’s experts:

Changes in mood: Frequent crying or sadness may also be a symptom of depression but doesn’t always appear in kids, said Judy Garber, professor of psychology and human development at Vanderbilt University.

The biggest difference in how depression presents in children versus adults is that, instead of appearing sad, kids struggling with depression can often seem irritable or cranky.

This can be tricky when we’re talking about teens in particular, said Jocelyn Carter, professor of pediatric psychology at DePaul University.

“The stereotype is that a lot of teens are grouchy or easily irritable. The kind of grouchiness associated with depression would be a change from their normal personality or way of interacting with the world,� Carter told me. “They might appear irritable most of the day, not just when you ask them to do something they don’t want to do.�

Changes in sleep and appetite: Fluctuations in sleep patterns are normal, but when the changes are significant — sleeping a lot less or a lot more — it could be cause for concern.

Sleeping in late, or staying up late and being tired during the next school day, is pretty common for teenagers, so such sudden changes would need to be accompanied by some of these other shifts in behavior I’m listing.

“You might ask your kid, ‘How have you been sleeping? Have you had any problems falling asleep? Have you been waking up and can’t fall back asleep?’� Garber recommended.

You might also notice that your child is eating more or less than usual. For example, you make their favorite meal and they don’t want it. Or if they’re eating more than usual, that change isn’t related to being more physically active or having a growth spurt, Garber said.

Less energy: “I’ve never met a teen that wasn’t tired,� Garber joked. But fatigue becomes an issue, she said, when their energy levels are so low that they aren’t hanging out with friends or doing their homework because they’re too tired.

Loss of interest in activities they usually enjoy: Kids who are depressed might withdraw socially from friends or their usual hobbies. Younger children might play with their toys less or engage in more solitary behaviors away from other kids, Garber said.

If teens stop hanging out with their friends, they don’t have anyone they consider to be a close friend, or if they suddenly stop using social media and texting, you should check in with them, she added.

Teens, of course, drop interests and pick up new ones all the time.

“It’s fine if someone isn’t playing five sports and an instrument, but there are some kids for whom nothing seems to really work,� said Stanley Markowski, a clinical psychologist in Oakland who works with kids and teens. “They can’t seem to push over that hump — the growing pains of being in the discomfort of trying something new.�

Also, this is a generalization and a product of socialization, but teen boys may be more likely to say, “I don’t care� or “I don’t feel like it,� rather than directly telling you that they’re sad, Garber said.

Feeling bad about themselves: Kids struggling with depression often feel like they can’t do anything right or that no one likes them. “Little kids might say that no one wants to be their friends,� Garber said, “or they’re no good at school and they might as well not try.�

Difficulty concentrating: If your child isn’t able to get their schoolwork done (above and beyond what that usually looks like for them), their mind is constantly wandering and they’re experiencing some of these other symptoms, it could be a symptom of depression, Garber said.

Other considerations: Instead of going inward and withdrawing, some kids externalize their depression, Markowski said. This can look like being mean to their peers or parents, or acting out in other ways. “Boys especially,� he said, “might try to overcompensate for feelings of sadness and vulnerability, and instead act as if they’re invincible.�

Anxiety in kids

As I mentioned earlier, anxiety and depression share some symptoms. Changes in sleeping and eating, irritability, and difficulty concentrating are also signs of anxiety. Beyond that, here is what anxiety may look like in kids:

Frequent worrying: Kids with anxiety are often worried all the time, and it’s hard to make it stop. What they worry about will vary from child to child. They might be preoccupied with something bad happening in the future to themselves or their family.

“Kids with anxiety may want guarantees of safety, that bad things won’t happen,� Carter said.

�One of the things I love about children is that they have a lot of great questions. For most kids, if they’re a little scared or nervous about driving over a bridge, they might ask us what would happen if the bridge collapsed while we drove over it. We could say, ‘That would be bad, but structural engineers work on bridges to make sure we’re safe.’ A kid without anxiety would accept that. A child more prone to anxiety would have many more follow-up questions, be in a lot of distress as you’re driving over it, or refuse to be in the car as you’re driving over it.�

Worry can sometimes show up as separation anxiety in younger kiddos, Garber said, whereas older children and teenagers tend to worry more about school or have social anxiety. They might not go to parties or try out for a team, or never raise their hand in class.

Physical behaviors and symptoms: Anxious kids might pick or bite their nails, or complain of stomachaches and headaches, Markowski said. Older kids might also experience muscle tension or pain in their limbs and back.

In some Latinx and Asian cultures, kids may be more likely to talk about their anxiety symptoms as these sensations in the body. “It’s thought that, within those cultures,� Carter said, “it’s more culturally relevant and less stigmatizing to be talking about a bodily expression of these emotional states rather than emotions directly.�

Other considerations: Garber noted that anxiety tends to be more constant, while depression comes and goes.

How you can help

It’s normal to feel scared and maybe even a little helpless when you can see that your child is struggling. But there’s a lot you can do as a parent to help your kids manage and understand what’s going on.

First off, it’s important to normalize anxiety, depression and difficult feelings.

“Let them know that everyone experiences stress, and many people experience anxiety,� Garber said. “You can tell them that depression is a little less common but that it’s treatable and doesn’t have to last forever.� When you’re anxious or sad, model what it looks like to work through those feelings.

And it might seem obvious, but having these conversations in a warm and accepting way is vital. Let them talk, don’t judge, and don’t tell them what to do. Just listen and don’t try to fix things, Garber said.

“Reflect back on how they’re feeling,� she added. “Say, ‘That’s really hard, and I can understand why you’re feeling that way.’�

Encouraging kids to get involved in fun activities that connect them to other kids and their own creativity can help them cope.

“Movement, a sense of community and learning new skills in a different environment,� Carter said, “can really boost a kid’s self-esteem and sense of competence.�

If these symptoms are affecting your child’s functioning at home, at school or in their relationships, it may be time to get the help of a mental health professional, experts told me. If they’re having thoughts of killing themselves or are self-harming, seek medical attention immediately.

“In general, it’s better to look at it earlier before it grows,� Markowski said. “Kids are good at hiding stuff. Sometimes we don’t know it’s a problem until it’s pretty big. Getting a professional opinion will let you know whether it’s developmental or something a bit more concerning.�

Kids can be so resilient. But they need our support, warmth and attention.

Until next week,

Laura

If what you learned today from these experts spoke to you or you’d like to tell us about your own experiences, please email us and let us know if it is OK to share your thoughts with the larger Group Therapy community. The email [email protected] gets right to our team. As always, find us on Instagram at @latimesforyourmind, where we’ll continue this conversation. See previous editions here.

More perspectives on today’s topic & other resources

In this episode of “Head-Lines,� The Times’ mental health puppet show, kids can learn more about social anxiety and what that looks and feels like. If you want to keep the conversation going, there’s an accompanying discussion guide for parents, with suggestions for how to talk with your kids about anxiety.

What to do (and not do) when children are anxious, according to the Child Mind Institute. This guide addresses the best way for parents to respond to an anxious child, how kids can learn to tolerate anxiety, and how parents can help kids stay calm in stressful situations.

The Child Mind Institute also has great resources for parents with children struggling with depression, including what to do if you think your teen is depressed, and how to help kids who are too hard on themselves.

Other interesting stuff

The implications of the debate over whether “extreme racism� is a mental illness. If extreme racism were to become accepted as a mental illness, more suspects in hate-crime cases could potentially have recourse to mount “insanity� defenses in court.

Developing nations have been serving as a proving ground for a model called community-based care, where lightly trained laypeople — someone like your grandmother, not a doctor — deliver brief mental health interventions in informal settings like homes or parks. The U.S. is taking note.