What’s Behind the Surge in Youth Anxiety?

Lindsey Culli vividly remembers the day in the fall of 2021 when she got a phone call from the counselor at her son’s Baltimore County public school alerting her that he had expressed a desire for self-harm. At the time, Calvin was a six-year-old first grader who was struggling to navigate the post-pandemic world, especially after spending his early education in front of screens.

“Calvin was one of those kids who was in kindergarten when the pandemic started,” Culli recalls. Though her son was academically high achieving, she believes that the social isolation of those years stunted his social and emotional growth. “He’s an introverted kid. He was feeling all these big feelings [at school] and he didn’t have a way to express it,” says Culli. “He was saying the most outrageous thing he could say, which terrified the guidance counselor because he started talking about self-harm.”

Naturally, this alarmed his school counselor, who took his words seriously. Thankfully, it eventually became clear that Calvin didn’t have plans to actually harm himself. “He was just kind of grasping at, ‘What is the biggest thing I can say to get somebody to pay attention because I’m not okay. I don’t know the language to talk about what’s wrong. I just know that something is.’”

Eventually, Calvin’s “big feelings” escalated to a point that Culli and Sam, Calvin’s father, decided it was time to seek professional help. Fortunately, Calvin’s school had an arrangement with a private practice therapy group that saw students during the day. His therapist diagnosed him with anxiety and began helping him learn tools to manage it.

“He started seeing a therapist that spring and it was really helpful pretty much right away,” says Culli. “[His therapist] gave him the toolbox that he needed and started putting tools in his toolbox to be able to recognize the emotions he was feeling and name them [and] work through them. That is hard when you’re an adult, but it’s especially hard when you’re only six! He’s come a really long way and it’s a testament to the therapy that he’s gotten and the people that he’s been able to work with.”

Today, Calvin is an active 10-year-old. He still struggles with anxiety—Culli thinks it is likely part of his wiring as someone who strives to be high-achieving. The difference is, when he gets those “big feelings,” he knows how to process them. Best of all, Culli has watched Calvin grow into the creative, empathetic, and thriving kid she always knew him to be.

“We named Calvin after the [comic strip] Calvin and Hobbes,” says Culli. “It turns out he’s actually a lot like the comic book Calvin! He’s very creative. He’s very bright. He’s also a really good friend. He has so much empathy, which probably hinders his mental health a little bit because he takes on other people’s feelings and emotions. I think it’s both a strength and also a challenge to be an empathetic and compassionate person in a world that can be so tough. But now he has the tools to manage it.”

Calvin’s experience with anxiety as a young child is not unique. According to the Centers for Disease Control and Prevention (CDC), about 10 percent of children between the ages of three and 17 have a diagnosed anxiety disorder. Experts contend that it’s normal for kids to experience occasional anxiety about stressful things like academics or social situations. But the National Institutes of Health (NIH) explains that anxiety becomes a disorder when it does not go away and its symptoms interfere with daily activities.

Biologically, the way our bodies experience anxiety is similar to the way we process fear. Fear keeps us safe from danger, preparing our bodies for “fight or flight.” Our heart and breathing quicken to boost oxygen flow to our brain. Our muscles tense up to prepare us to run, fight, or hide. Our minds zoom in with a laser focus on the threat to determine the best plan for safety. Anxiety is the body’s response to a perceived threat.

While this heightened state of awareness is helpful for actual danger, living in a state of high alert about unspecific future threats can be overwhelming—especially for children who may not have the tools to manage these feelings.

Krista Dhruv, LCSW-C, is an individual and family therapist and educational consultant based in Baltimore. She has served as a counselor in K 12 schools and higher education settings and has observed how anxiety presents in children of all different ages.

“Starting with our youngest kids, they might experience somatic symptoms, like belly aches, headaches, and disrupted sleep,” explains Dhruv. “It manifests physically because anxiety is in the body. It’s hormonal—cortisol and adrenaline, a hormonal response to perceived fear, metabolizes in the body. [Anxiety] also shows up as worry language: a lot of ‘what ifs’—‘What if you forget to pick me up? What if nobody wants to play with me? What if I eat something and it makes me sick?’”

Research suggests that the causes of childhood anxiety are complex. Some children may be more sensitive to strong emotions or have a biological tendency toward anxiety. For others, anxiety may develop as a reaction to a significant stressful event, like a death in the family. Environmental stressors, such as food insecurity, parents who fight or argue, or experiences of bullying, abuse, and neglect can also cause anxiety in young people.

Further, larger events and issues, such as climate change or global instability, may also impact children’s wellness—especially for older kids who may be more aware. An often-cited study conducted by the Pew Research Center indicates that more than half of teenagers are worried about a shooting happening at their school.

Other environmental factors inducing worry are, well, the environment. A recent survey published in The Lancet polled 10,000 young people across 10 countries, revealing that as many as 84 percent of respondents were worried about climate change, with 45 percent reporting that climate anxiety affected their daily lives.

Regardless of the constellation of causes behind anxiety, it is important to note that it is on the rise. A Department of Health and Human Resources report in 2022 noted that between 2016 and 2020, the number of children ages 3-17 years diagnosed with anxiety grew by 29 percent and those with depression by 27 percent.

This is important on many levels, not least of which is that a mental health condition is a risk factor for suicide, which is also on the rise among young people.

Increasingly, experts point to a growing cause of mental illness in young people: social media and phone use.  Jonathan Haidt, a social psychologist and author of The Anxious Generation: How the Great Rewiring of Childhood Is Causing an Epidemic of Mental Illness, claims that what he terms a “phone-based childhood” is to blame for a many of these unsettling youth mental health trends.

In fact, so great is the impact of social media that U.S. Surgeon General Dr. Vivek Murthy recently called on Congress to require warning labels on social media sites to communicate their potential harms, especially for the developing adolescent brain. And Australia just passed a groundbreaking ban on a social media for children 16 and under.

Haidt likens young people’s unrestrained exploration of this new virtual frontier to launching our children to the planet Mars without first doing an appropriate amount of research to realize their bodies and minds are not suited to survive this alternate planet. The research he presents in his book posits that “overprotection in the real world and under-protection in the virtual world are the major reasons why children born after 1995 became the anxious generation.” Kids’ brains are literally being rewired during their crucial early, brain-building years.

“In this new phone-based childhood, free play, attunement, and local models for social learning are replaced by screen time, asynchronous [or non-real-time] interaction, and influencers chosen by algorithms. Children are, in a sense, deprived of childhood,” explains Haidt.

Anxiety can show up as what ifs: ‘What if you forget to pick me up?’ ‘What if nobody wants to play with me?’

Dhruv agrees and has observed the impact of screen time on today’s youth. “[Social media] is kind of experience where young people are socializing and interacting, but being that they’re online, the whole body isn’t involved—it’s disembodied. Young children aren’t outside as much playing and climbing trees—maybe even spraining an ankle. Kids aren’t taking healthy risks, which are imperative to healthy development.”

“These are normative life experiences that build our resilience and develop a growth mindset,” Dhruv continues. “When most of our [socializing and recreation] is happening online, whether it is video games or through social influencers, we lose that ability to take risks, social or physical or emotional, and to really experience failure as well as success, which is part of life.”

She echoes Haidt’s ideas about asynchronous interactions: “I might text you this morning about a funny thing that my dog did and you might not text me back until 3 o’clock today with a cute little emoji, which feels good.”

But something is off: Human beings aren’t meant to communicate via delayed reaction or strictly through our laptops or phones.

“We are wired to be in community and in connection,” she says. “We should be able to read body language. If I say something and a friend grimaces, I realize I probably shouldn’t say that again, or I should check in with her about that. [With online socializing], we lose all that nuance of the human experience.”

There is, however, a silver lining to the over-sharing that is often seen on social media. Experts note that children are increasingly likely to talk about their mental health with transparency, which is steadily chipping away at the stigma of mental illness. There are additional benefits to phone use and social media. For example, many kids who may feel marginalized due to their differences can more easily find their community online.

And experts are keen to note that the phone itself is not the enemy: If used responsibly, it’s a valuable tool to help us connect and make life easier. The key is to make sure parents place limits on the amount of time kids spend on screens and the content they view.

“The one positive about social media is that it allows access for a great deal more information,” explains Chad Lennon, MD, a child and adolescent psychiatrist for Sheppard Pratt. “People are communicating more about their mental health.”

Young people are more aware of mental illness—and the resources available to help.

“What has happened over the past 10, maybe 15, years or so is a complete shift. Now what we see that most of the people coming to us for services, whether it’s in a school environment or private practice, are already coming with the diagnostic language. They’re coming with deep attunement to their emotional experience, saying specifically, ‘I have anxiety,’ or ‘I think I’m neurodivergent,’ or ‘I’ve had this many years of treatment,’” shares Dhruv.

And therapy really does help. Calvin is a perfect example. The tools his therapist gave him were the key ingredients for helping him return to the thriving and intelligent kid his parents knew him to be.

“I think therapy is very helpful for everyone, but if you have anxiety, without [therapy], it can be hard to go through daily life and not get overwhelmed or upset,” says Calvin, with a thoughtfulness and maturity that belies his years. “Therapy has helped me to be able to be in certain places or spaces and without feeling afraid or anxious. I have more friends now and I can do things I think would be fun without being overwhelmed or afraid.”

For parents of children with anxiety, sometimes it’s hard to know what they can do to help. Lennon advises the following game plan: “First, parents really need to know themselves. The best way to help your own child is if you have a sense of your own emotional regulation,” he says. “Secondly, I’m really big on helping kids develop coping skills—and I use that term very generally because really anything can be a coping skill, as long as you know it helps you reduce your anxiety. Coping skills can be anything from playing a sport, going for a walk, taking a deep breath, reading or drawing, connecting with friends, even video games can be helpful, if used properly.

“[Thirdly,] connect with someone you trust,” shares Lennon, who adds that this doesn’t necessarily need to be a therapist. “This could be a parent, aunt, uncle, or coach. Helping a child connect to someone they trust helps them realize they are not alone, which goes a long way toward reducing anxiety.”

Therapist Krista Dhruv also advises that a great starting point for finding help for school-aged children is the school counselor and/or pediatrician. “The school counselor is a great first place to go,” she says. “They don’t necessarily know your child best, but they know this age range really well and can help you understand this developmental stage and what’s normative, typical, or atypical behavior.”

The family’s pediatrician is also trained to spot an anxiety disorder or help a family understand how to best help a child. Furthermore, they can examine if there is a physical cause for anxiety, especially when a child presents with somatic complaints. Finally, there’s a practical consideration for reaching out to the pediatrician: They can provide a referral for mental health services, which in many cases makes it easier for your health insurance to defray these expenses.

Fortunately, experts agree that most children with anxiety can reduce its impact through a combination of therapy, appropriate medication, and lifestyle changes.