Anxiety & Depression in Kids: A Conversation with Sarah Williamson
When I wanted to reach out to someone who could speak intelligently about the prevalence of anxiety and depression in kids, the first person I thought about was Sarah Williamson. I’ve known Sarah for about eight years now. We work together at a K-8 school, and I've always been impressed by her ability to connect with kids and the insights she has about their emotional health. She has lots of wisdom to share.
Are there definitions of anxiety and depression that you’ve found particularly helpful? Can you talk about the relationship between anxiety and depression?
Anxiety and depression symptoms can sometimes be tricky to distinguish because of their commonalities. Along with some overlapping symptoms such as trouble concentrating and sleeping issues, the evidence-based treatments for each is quite similar (a combination of cognitive-behavioral therapy and medication such as SSRIs, for example, has the most research proving effectiveness in treatment).
Anxiety and depression are clinically the most common comorbid (occurring at the same time) disorders. Around 60% of those with anxiety report having some symptoms of depression.
At the most basic level, anxiety is about worry, worry, worry: worry about anything related to the near or distant future. Generally, people who struggle with depression don’t tend to fear as much. Their negative thinking is more about how things aren’t going well and the future will be “bad.”
Also, what I’ve seen with anxiety is that the crossover symptom—trouble concentrating—looks different. For example, someone with anxiety could have a nervous affect that appears more hyperactive (as in tense), and therefore they are not concentrating.
With depression, the person might not be concentrating because their affect is dulled and they’ve lost interest. It’s about searching for the meaning behind the symptoms/behaviors and the negative thoughts. It’s important for a doctor or mental health professional to evaluate.
You and I have known a lot of kids over the years who have suffered from anxiety and/or depression. It seems like that number is rising. Is this true? If so, why do you think this is happening?
We have indeed known students who have suffered from both disorders at such a young age. Not necessarily all with the clinical diagnosis, but with many symptoms.
What I’ve seen more recently is a difference in the pervasiveness and severity. I used to meet with kids who had what I would define as a normal amount of tween or teen angst, worry, fear or sadness about a situation. They would talk about it, maybe get some advice or support, and it would be based in a specific moment and they would be able to move on from there. What I see more of now is the increasing intensity of the symptoms and the repeated nature of the visits I get from kids.
This is in line with the national data for adolescents. For example, studies from college counseling offices have shown that over half of American college students report being severely overwhelmed and anxious, and over the past decade, these clinical diagnoses have risen in ages 12-17, too.
In terms of the why, it’s easiest to place blame on our digital devices, particularly smartphones. I think this is the biggest difference between when I started working with young people and now. I somewhat agree with those who blame the mood disorder increase on fear-inducing news, but I think the reason the impact of this news is so intensely negative is due to personal devices.
Our kids have online access all the time, sometimes without adults helping them to process it, and they can just go down the rabbit hole (as we can as adults too!). I think watching footage of a distant shooting tragedy and the aftermath is really traumatic for some, but I think what has been more impactful to our young students overall is their nonstop social media access.
At this age they are supposed to be making social comparisons with their peers, but these days they never get a break from it, and it can be so painful for them when they are teased online, or left out of a group text, or blocked, or see pictures of the sleepover they weren’t invited to.
They need reminders of what real face time can be (without FaceTime) in order to connect. I find it’s rare that students actually want to handle something face to face. They’d rather take to their phones, and often the social dynamic that they are managing to begin with occurred on social media. The Big Disconnect by Catherine Steiner Adair has helped me as a parent. I already need to have these conversations with my 7 year old, as her friends are getting personal devices.
Also, a lot more students are reporting sleep deprivation to me. I know they struggle with time management due to the smartphones, and text messages popping up during homework certainly doesn’t help. The child’s lack of sleep certainly leads to increased anxiety and/or depressive symptoms too.
Another phenomenon I’ve noticed is parenting styles—well-meaning parents trying to save their child from any types of hurt, and in the end not allowing them to develop skills to handle adversity. There is also part of me that hopes the rise is related to a de-stigmatization of mental health issues and perhaps more students and/or parents are seeking help. This article has some interesting ideas about why we are seeing these trends.
Are there resources for parents that will help them lessen the likelihood that their child(ren) will develop anxiety or depression? What about resources for parents trying to help their kids recover with anxiety or depression?
Lessening the likelihood requires being aware of risk factors. When dealing with anxiety and depression, it’s more about ongoing treatment and management than recovery. It’s different from your child breaking a bone. This website has two comprehensive guides, by age group, about reducing risk factors.
Reducing risk also goes back to allowing our children to experience adversity and helping them gain skills to manage their big emotions. In order to accomplish this, parents first need to gain an awareness of their own mental health, their family history, and their genetic makeup. I would recommend Parenting from the Inside Out by Dan Siegel and Mary Hartzell for help with this type of self-understanding.
Knowing our own triggers and anything related to these two diagnoses will help us be more mindful about how we interact with any of our childrens’ symptoms that might show up. (Do you tend to avoid situations? How do you overcome worries? How do you model this for your child? Do you allow them to avoid things because it’s hard to see them cry? Do you stay calm?)
After gaining more self-awareness, the second thing parents can do is trust their instincts and expertise as the person who knows their child best. The crux of any advice you’ll get in any parenting resource is to really be present for your child: listening to them, knowing them, and communicating with them.
Check in with your gut: “Wow, my preschooler seems to have far more difficulty integrating into new spaces, and/or tries to avoid them repeatedly, and it feel like it’s more severe than the other kids.” Talk about it with your pediatrician, or if they’re old enough, their school counselor, to get an understanding of what is typical or not. The earlier you seek help to address any dynamic of repeated avoidance and emotional meltdown due to worry, the better off the whole family will be.
Depression can be tricky with young kids because it can appear as anger or irritability. Being aware that a child might be acting out in anger when actually there could be a deeper sadness or hurt is helpful to keep in mind. I have noticed that it is a lot harder to talk with a parent about a child being depressed than a child being anxious. There is a lot more parental denial around depression symptoms, and unfortunately the health risks with depression are far more dangerous.
There are a ton of great books and websites specific to anxiety and depression. A friend of mine recently wrote about ideas for lessening the severity of symptoms. You can check that out here.
In sum, for anxiety it’s about the child learning to not be ruled by worry, but instead become the boss of the worry. This can be done through cognitive behavior therapy and learning how the body reacts when worried, so they can calm their nervous system through skills like mindful breathing.
I like Lynn Lyon’s work on anxiety—her website is a good resource—as is her book, Anxious Kids, Anxious Parents. One of the great distinctions she makes is how parents mean well by saying “Don’t worry kiddo, there’s nothing to be scared of” to their child whose more powerful Worry is telling them “It’s time to freak out!” The better response would be “yes, I see that your Worry is showing up and I understand why it would right now, so what are we going to do to talk back to the Worry?” Larry Cohen’s book is a great option, too: The Opposite of Worry.
The books I have found helpful for thinking about childhood depression are the following three, even though the first two of them aren’t very current. They’re still relevant, though. The third is most recent and I think most comprehensive.
Reviving Ophelia: Saving the Selves of Adolescent Girls by Mary Pipher
Real Boys: Rescuing Our Sons from the Myths of Boyhood by William Pollack
Depression and Your Child: A Guide for Parents and Caregivers by Deborah Serani
The symptoms of depression can include feelings of hopelessness, which in turn can lead to suicidal thinking or actions. So if there is any concern about your child at all related to their mood, it is always best to go immediately to the pediatrician or to a mental health professional or to an emergency room depending on the severity, to help evaluate the child.
You and I strongly believe in the importance of teaching mindfulness. Can you talk about what research studies have shown about how mindfulness can help kids cope with anxiety? With depression?
There was recently an article in Scientific American critiquing the research methods of some of the studies for mindfulness-based interventions, but even this article can’t debunk some rigorous studies that have shown promising results in helping with symptoms of anxiety, depression and pain.
There is compelling brain research—from Science Advances, for example—about the thickening of the prefrontal cortex, which involves focus and managing big emotions. I would like to see larger scale randomized research to understand more about the benefits of mindfulness that I see anecdotally.
For now, I teach mindfulness not because I believe it is a cure-all, but because it is one tool for a child’s social-emotional toolbox. I think it can be especially helpful for children who need to learn how to breath to stave off panic or anxiety related symptoms by breathing, or for children who have more explosive anger (which for kids could be a symptom of depression), or as a tool to manage stress.
For some people with low-level anxiety, having a mindfulness practice could be enough of a standalone health benefit, but for those with more severe anxiety, they would need extra support in a therapeutic setting to learn more skills to treat their symptoms.
What advice do you have for parents who want to teach mindfulness practices to young children? To teenagers?
Above all else I think it is best as a parent to have your own mindfulness practice first. By “practice” I mean something as simple as doing this when you wake up before your children know you’re awake, or before you fall asleep—even 1 to 2 minutes per day to start.
I even do some simple mantras to myself when I’m driving (“I’m breathing in, I’m breathing out”). I also do gratitude practice which I find beneficial for improving my mood to help me get unstuck if I’m perseverating.
Sometimes I do gratitude meditation out-loud with my kids for a fun activity: I say something I’m thankful for, and they say another thing, and I say another thing, and it becomes a nice recitation where the kids are learning from me about an attitude of gratitude, and we are also sneakily practicing together.
Teenagers are often surprisingly game for some mindfulness practice if the benefits are well-prefaced to them and it is offered—with a bit of lightness and sense of humor to match their skepticism—as a routine as part of class time. I find teens interact with mindfulness better at home with downloading their own apps or following their own mindfulness activities or scripts on websites, or going to their own yoga classes. Understandably, they like to be in control of their choices. There are also fun books like Sitting Still like a Frog by Eline Snel.
Do you think of mindfulness as a spiritual exercise?
Could you tell me a little about what you mean by spiritual exercise?
Sure. First, I’d define spirituality as experiencing the divine, or sensing the interconnectedness of all things. So, to me, a spiritual exercise is anything that helps you tap into this way of feeling and interacting with the world.
I personally wouldn’t venture to make a sweeping statement about mindfulness being a spiritual exercise for all who practice. I would want anyone to experience mindfulness how they experience it. For example, when I’m introducing students to mindfulness, I intentionally explain how this can be a secular practice even though it originated from Buddhist tradition, and that I’m teaching it as a secular practice. I explain to them that the most important pieces to me are about approaching situations and other people around you by paying attention to that present moment with non-judgmental curiosity and kindness.
I don’t practice an organized religion, though I grew up in a Protestant Christian household, going to church regularly. My version of spirituality is more a belief in a connection to something or someone greater than oneself. When I say “greater” I don’t necessarily mean a “higher being.” I’m not sure whether I believe in a God or not at this point in my life. I believe that faith in a God is a major source of strength for many people which I value and understand.
I do believe mindfulness is a spiritual exercise for me because when I am meditating, usually as part of my yoga practice, I think I am intentionally connecting to something other than my own ego. This connection is often in gratitude to people in my life, as well as to something less concrete, involving consideration for the miracle of the natural world that we inhabit and in which I get to walk around in my (fortunately) healthy mind and body.
Through this practice of connecting with something greater than myself, I connect more deeply with myself, and therefore I am able to be more mindful in my relationships with others, including my children.
A book I mentioned before, Parenting from the Inside Out by Dan Siegel and Mary Hartzell, has a great passage describing this approach to parenting at the beginning of the book. I found my yoga practice as a form of prenatal care with my first child, and have more recently incorporated mindfulness practice into an almost daily practice.
This was the last activity I expected to pick up in my life, as I’m quite extroverted, talkative, and hyperactive, and yet, over time, mindfulness has been a personal source of major health and mood improvements. And I think it’s as close as I come to any form of spirituality in my life for now.
Sarah Williamson is a mother to two children (ages 5 and 8) and works as a school counselor for students in grades 5-8. She began her career as a teacher and found that the relationships formed with children and families interested her the most, and when a child was struggling she wanted to learn how to help. This led her to her MSW program at Boston College, and she is now a licensed social worker (LICSW). In her free time she enjoys playing basketball, yoga, being on the water in any type of vessel, reading with her children, playing piano, and singing.