Anxiety and Depression in Children and Adolescents

Anxiety and depressive disorders are the principal emotional, or internalizing, disorders of childhood and adolescence. Anxiety disorders involve excessive fear or worry that is out of proportion to the situation and impairs functioning, while depression involves persistent low mood or loss of interest with associated cognitive and physical changes. Both commonly begin in the developmental period and frequently co-occur.

Definition

Childhood and adolescent anxiety disorders are conditions of excessive, persistent fear or worry causing distress or functional impairment, while depressive disorders involve a persistent depressed or irritable mood and/or loss of interest with associated changes in sleep, appetite, energy, concentration, and self-worth, arising during the developmental period.

Scope

This entry covers the definitions, developmental presentation, prevalence, and conceptual framing of anxiety and depressive disorders in children and adolescents, and their relationship to neurodevelopmental conditions. It is a reference overview of how these emotional disorders are described and studied and does not provide diagnostic criteria for individual young people or treatment guidance.

Core questions

• How are clinically significant anxiety and low mood distinguished from normal childhood worry and sadness?
• How do anxiety and depression present differently across developmental stages?
• Why do anxiety and depression so often co-occur with each other and with neurodevelopmental conditions?

Key concepts

• Internalizing (emotional) disorders
• Anxiety disorders of childhood
• Major depressive and persistent depressive disorders
• Developmental presentation (for example, irritability in youth depression)
• Comorbidity between anxiety and depression
• Continuity into adulthood

Mechanisms

Anxiety and depression in young people arise from interacting genetic, temperamental, and environmental influences, including behavioural inhibition, adverse experiences, family history, and stressful life events. Shared liability helps explain their frequent co-occurrence and the tendency for childhood anxiety to precede later depression. Neurobiological accounts implicate systems involved in threat processing, reward, and emotion regulation, while developmental context shapes how symptoms present at different ages.

Clinical relevance

Anxiety and depressive disorders are among the most common mental-health conditions of childhood and adolescence and can affect education, relationships, and long-term wellbeing, with adolescent depression carrying particular importance for later mental health. This entry describes how these conditions are conceptualised and studied; it is not a basis for diagnosing or managing an individual young person, which requires specialist assessment.

Epidemiology

A meta-analysis of community surveys estimated the worldwide prevalence of any childhood mental disorder at around 13 percent, with anxiety disorders among the most common (roughly 6-7 percent) and depressive disorders less common in childhood but rising in adolescence. Anxiety disorders tend to have an earlier onset than depression, both are reported more often in girls from adolescence onward, and the two frequently co-occur.

Evidence & guidelines

Diagnostic concepts follow DSM-5-TR and ICD-11, which classify anxiety and depressive disorders as emotional rather than neurodevelopmental disorders while recognising their childhood onset and frequent overlap with neurodevelopmental conditions. Prevalence is anchored in meta-analyses of community surveys, and clinical pathways are issued by bodies such as the UK National Institute for Health and Care Excellence and the American Academy of Child and Adolescent Psychiatry; this entry summarises framing rather than reproducing those pathways.

History

Emotional disorders of childhood were historically under-recognised, with depression in young people once thought rare. Through the late twentieth century, structured assessment and community surveys established that anxiety and depression occur in children and adolescents, often continuing into adulthood. Successive DSM and ICD editions refined their classification, including recognition that youth depression may present with irritability and that childhood anxiety frequently precedes later mood disorders.

Debates

Trends in adolescent mental health over time

Whether the prevalence of adolescent anxiety and depression, and associated service demand, has genuinely risen over recent decades or partly reflects changes in awareness, help-seeking, and measurement remains actively debated.

Key figures

• Anita Thapar
• Stephan Collishaw
• Daniel Pine

Seminal works

• thapar-2012
• polanczyk-2015

Frequently asked questions

How is childhood depression different from ordinary sadness?

Clinically significant depression involves a persistent depressed or irritable mood and/or loss of interest, lasting at least two weeks and accompanied by changes in sleep, appetite, energy, concentration, or self-worth that impair functioning, beyond the transient sadness common in childhood.

Do anxiety and depression occur together in young people?

Yes. They share liability and frequently co-occur, and childhood anxiety disorders often precede the later onset of depression, which is one reason they are considered together as emotional disorders.