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The best tools for combating anxiety in children are often within reach, experts say

The key is to continually remind children and teens that they are cared for, and to help them get back into the structure and familiar activities that give them a feeling of accomplishment. That's the advice of two experts from Mayo Clinic.

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ROCHESTER, Minn. — The pandemic pulled children and teenagers out of the very thing that keeps them healthy and happy: their lives.

That's how experts in pediatric psychology describe a current wave of young people developing depressed mood and anxiety.

"I think it's accurate to say there is an increase in anxiety and depression and in general mental health issues," says Mayo Clinic child psychologist Dr. Stephen Whiteside, a specialist in treating anxiety in children.

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Dr. Stephen Whiteside
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"Even before the pandemic there was good evidence suggesting that anxiety and depression were on the rise," he said. "In our clinic ... it certainly seems to me that we are seeing many kids who seem like they were on track before the pandemic.

"Maybe they had a tendency to be somewhat shy, or nervous, or anxious, but it wasn't particularly problematic. Only now they are coming in with more difficulty getting back into the flow of life."

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For Dr. Marcie Billings, a pediatrician at Mayo Clinic, the effect of the pandemic on the moods of children and teens is hardly a mystery, given a child's critical need to experience structure and relationships they can count on — a need the pandemic disrupted.

"Schedule and routine is really important for kids," Billings said. "With the pandemic ... Kids were waking up in their beds, sitting there, grabbing their laptop and going to school. They didn't go downstairs and have breakfast. They didn't go catch the bus. They didn't do after school activities."

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Dr. Marcie Billings
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Billings says children are ultimately resilient, however, and that while the health system is always available for mood-related challenges, it's critical that parents regularly ask their children a key question:

"How are things going for you?"

And they should ask it even if they never get a straight answer.

"If the response for three weeks is always just, 'fine, fine, fine,' they're still going to understand that you're asking them," Billings said. "And maybe on that fourth week, they're going to say, 'you know, I've had a rough day today.' It doesn't have to be an expectation that every time you're going to have a big teen talk."

She says that while parents might take a child's silence personally, if anything, it often means they care.

"One of the most common things I hear from teenagers is that they don't want to talk to their parents, because they know their parents are already stressed and they don't want to add more to their plate. As a parent that breaks my heart."

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Experts say children are not likely to verbalize that they are struggling with their feelings.

"Parents are seeing kids being more withdrawn, and not doing structured activities or unstructured activities like getting together with friends," Whiteside said. "More isolation. Wanting to be in their room. Using screens to occupy time rather than interacting with family or doing other activities."

Other signs a child may be struggling include "getting really upset by things that don't seem to outside observers as serious as the child is reacting," he said.

Billings said to watch for a change in the child's performance: "If a teenager who is typically an A student is now coming home with C's. Or a teenager or child who tries out for basketball every year decides not to do that."

Of course, children can change their interests, she says, and go through ordinary bouts of mood just like adults.

"If weeks turn into a month," Whiteside said, "or if it's disrupting functioning, so it starts to lead to being late to school, or missing school, or not getting school work done, or choosing to stay home rather than doing activities or things with the family ... then you should be more concerned it might be something more than the normal ups and downs."

For children who are distressed with anxiety or depression, professionals will often work with the family to reset the balance at home.

"We set aside some time to talk with kids as needed, but the vast majority of what we do is working with kids or teens and their parents together," Whiteside said. "Changing behavior is hard, so to have someone to remind you to do that is helpful."

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More often than not a professional intervention comes down to helping children re-establish the ordinary goals and activities that give them a sense of accomplishment.

"We usually like to start with the basics," Whiteside said. "If you're not getting enough sleep, and you're not eating enough, you're not going to feel good ... it seems like we've seen a lot of teens and kids whose fundamentals have been disrupted."

It's important as well, Billings says, to introduce children who are struggling to the benefits of helping others.

"It really builds that resiliency," she said. "Encouraging them to help around the house, to help out with things at school. Volunteer work, especially with older kids, can really give them a sense of purpose and understanding of the bigger picture of what we're all dealing with."

The world may have become more complicated, both doctors say, but the inner lives of children are often familiar.

"I would say mostly they are talking about the same things," Whiteside said. "They are worrying about safety, and about acceptance from their peers, and they are often being nervous about being alone, independent and away from their parents."

Part of structure, finally, is to structure in time for no structure.

"I sometimes ask my teenage patients, 'do you have any downtime?'" Billings said. "'Do you ever just kind of hang out, doing whatever you want, even if it's just sitting there listening to music or chatting with a friend?'"

"So in your schedule you might want to schedule some downtime," she said.

Paul John Scott is the health correspondent for NewsMD and the Forum News Service. He is a novelist and was an award winning magazine journalist for 15 years prior to joining the FNS in 2019.
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