Fall 2026 Issue

Stemming the Rising Tide of Childhood Anxiety
By Elizabeth S. Goar
Social Work Today
Vol. 26 No. 4 P. 22

Identify anxiety early to help children succeed.

Anxiety has emerged as the most common mental health condition among children, with nearly 13% of children aged 6 to 17 suffering from anxiety in 2023, an increase of nearly 51% over 2016.1 The latest National Survey of Children’s Health found the sharpest rise among adolescents aged 12 to 17, increasing by 61% from 2016 (10%) to 2023 (16.1%).2

Childhood anxiety can be viewed as a canary in the coal mine, signaling broader challenges affecting youth mental health, family well-being, and child development. It often coexists with conditions like ADHD, depression, and behavioral disorders—impacting everything from school performance and relationships to sleep and overall well-being and driving calls for wider access to mental health services for clinically complex presentations.

From a genetic predisposition to anxiety or traumatic events such as bullying or early childhood abuse, “There are a variety of potential causes of childhood anxiety, and this makes it challenging to pinpoint any one main cause,” says Whitney Willborn, LCSW, of Base-Point BreakThrough. “Different causes may change the specifics of how an individual therapist deals with a particular child. Generally, however, therapy models look to provide general strategies which have been proven to assist in the management of anxiety, which can then be tailored to the specifics of the particular case.”

Prevailing Models
Therapeutic approaches have come a long way since Freud’s ideas began shaping childhood mental health in the early 1900s, when psychoanalysis introduced the notion that early experiences and unconscious conflicts drive later psychological outcomes. By the mid-20th century, these concepts had become the dominant framework in child psychiatry, largely through the expansion of child-focused psychoanalytic work by Anna Freud and Melanie Klein.3

While earlier approaches may have become outmoded or clinically irrelevant, “the emphasis placed on the deep impact of childhood anxiety and the importance of learning in its treatment has remained influential in subsequent treatment models,” Willborn says. “CBT and other current models have increasingly centered the child themselves and encouraged a reciprocal, dialogical relationship with the therapist, marking a distinct break from earlier models which tended to focus on directing and shaping their behavior.”

Adds Jonathan Goelz, LCSW, executive director of All In Solutions, “There have been significant advancements in our understanding of anxiety. Specifically, we now view anxiety as not simply an internal process within the child, but as a systemic response involving the entire environment surrounding that child.”

For example, he says, there are various factors that may impact both the manifestation of a child’s symptoms of anxiety and their potential to receive appropriate treatment. Among these are familial stress levels, economic status/poverty, home/stability of residence, levels of racism/discrimination, exposure to violence at school/community, and attitudes/beliefs regarding mental illness.

As a result, two evidence-based approaches have emerged as the most used methods of treating childhood anxiety today: Cognitive Behavioral Therapy (CBT) and Supportive Parenting for Anxious Childhood Emotions (SPACE).

CBT “allows children to develop a better ability to recognize their anxious thinking patterns, become comfortable with feelings of uneasiness, and eventually confront/face feared situations,” Goelz says.

Children are taught to identify anxious thoughts and replace them with more realistic, balanced interpretations. Cognitive work is paired with skills for managing physiological symptoms of anxiety, including breathing strategies, grounding techniques, and gradual tolerance of uncomfortable emotions. Central components of CBT for childhood anxiety are the following:

• Exposure using a structured process called “fear ladders” that lets children face feared situations in small, manageable steps, building confidence and reducing avoidance behaviors over time.

• Incorporation of parents and caregivers, especially when anxiety affects daily routines or family dynamics, who learn how to reinforce coping skills, reduce unhelpful reassurance, and support the child’s practice of exposure tasks at home. This collaborative approach helps children generalize skills beyond therapy, strengthens family resilience, and leads to lasting reductions in anxiety symptoms.4

SPACE is a parent-focused intervention that helps caregivers reduce behaviors that inadvertently reinforce a child’s anxiety. Instead of treating the child directly, clinicians work with parents to map out anxiety-driven accommodations, teach supportive communication that blends validation with confidence, and guide families in gradually reducing one targeted accommodation at a time.

The model fits well within child welfare and family preservation contexts because it strengthens caregiver capacity, lowers household stress, and can be delivered in homes, schools, foster care, and community programs without requiring the child’s participation.

“It’s a great model because it leans into the parenting aspect of supporting the child,” says Latasha Riddick, LCSWA. “When you look at helping children [navigate] mental health, specifically anxiety environments, support has a huge [role] in that work. It’s very hard to do that in isolation with only the child. Having parents on board is very important. It also sends an … indirect but very helpful message to the child when they see that their parents are involved.”

SPACE emphasizes transparency and predictability: caregivers announce planned changes in advance and use calm, supportive statements as the child experiences distress. Because reducing accommodations often triggers short-term escalation, social workers provide ongoing coaching to help parents stay consistent and avoid reverting to old patterns.

Willborn notes that while CBT remains the prevailing model, some research has shown that SPACE may be equally effective, particularly with certain kinds of anxiety.

“Both are useful strategies which approach the core issue of anxiety in different ways, and so are best applied depending on the clinical context,” she says. “CBT generally emphasizes the development of the child’s coping mechanisms, while SPACE emphasizes the parent’s response to their child’s behavior.”

Willborn adds that while CBT and SPACE remain the most prevalent models, others such as child-centered therapy, which emphasizes the therapeutic value of play and encourages children to lead the session themselves, are also used. She says it’s best to have a variety of potential treatment methods at the ready in case one proves ineffective.

“When it comes to adopting any model, social workers should be attentive to the needs of the child and the specific sorts of anxiety that they are suffering from. There is some evidence to suggest that different treatment models may be better suited than others for specific kinds of anxiety,” says Willborn, pointing out that CBT alone or with medication can be effective in treating specific anxieties, while more diffuse or general anxieties may be better helped by looking at family dynamics. “SPACE and other models take this latter approach, as they recognize that dysfunctional family dynamics [such as] neglect or abuse, parental pressure, etc. may be contributing to the child’s condition.”

Choosing the Right Approach
What model or hybrid of models a social worker integrates into their approach to childhood anxiety should be dictated by the results of a comprehensive biopsychosocial assessment of both the child’s and family’s needs, as well as relational dynamics, strengths, preferences, developmental stage, and the available evidence for effective intervention,

“This is an example of the fundamentals of social work practice. We obtain collateral information from our client, who’s a child, and from the parent,” says Frances A. Young, LCSW, PMH-C, Bachelor of Social Work Program and Admissions coordinator in the School of Social Work at the University of Nevada, Las Vegas. It is vital to understand as much about the parents’ and child’s environment as possible, including any stress, anxiety, or trauma the mother may have experienced during or after pregnancy. “There are so many factors with anxiety. If I have a person in the postpartum period who is anxious [and] they have a partner, you now have two anxious parents trying to nurture a baby. They can’t do it fully because of their own symptoms.”

She adds, “Kids don’t know they’re intuitive at that age, but they are. They pick up on everything. They are mirroring us. Good and bad.”

Riddick emphasizes the importance of identifying not just ways to help the child manage anxiety symptoms but also what is triggering them. Rarely will there be just one trigger, she says. Trauma, social settings, phobias, family separation, and more can contribute to a child’s anxiety. Understanding what those triggers are is just as important as understanding how to counter them.

“We have to take the time to get to the root of where the anxiety is even coming from. Once we identify that, we can identify which model we should use. With a child who has a phobia or separation anxiety, exposure therapy will probably be best for them,” Riddick says. “I need to be able to gradually support them in being exposed to the setting that they’re afraid of. But if it’s trauma, that’s a whole other approach. Trauma-focused CBT may be better for that, or narrative therapy, where that child can tell their story. Or maybe it’s through drawing [or] play.”

UNLV’s Young says it’s also important to gain insights into how the child’s body reacts to anxiety. Do they experience symptoms such as heart palpitations, sweating, or shaking? Do they feel that pit in their stomach? “Somatic symptoms are real,” she says.

Having the child identify how they feel as anxiety is rising lets the therapist know how the child can tell something is wrong. This helps understand what coping skills will be most effective, especially when they must manage an anxiety episode on their own.

“Parents are fixers. They want to fix it all, make [their child] better, and be the one they run to. But if the parent is not there, how do they manage?” she explains. That’s why she starts with understanding the triggers and physical symptoms before working to determine if “we can eliminate what’s triggering you. Or is it [something like] school that we can’t eliminate? Really dig into what’s going on and teach them how to cope with stress.

“Children are very black and white in their thinking,” she adds. If they feel “they’re not perfect, it means they’re terrible. There’s no gray. We have to teach them it is okay to be in the gray, or there is a high possibility of experiencing anxiety and depression symptoms.”

Heather LaSelle, PhD, LCSW, MS, MPA, an assistant professor of social work at the University of Saint Joseph in West Hartford, Connecticut, adds that effectively implementing SPACE requires arming child welfare workers with better standardized tools and training to assess and capture anxiety symptoms. Training is also needed, as is an exploration of “whether SPACE can be effective with foster parents and parents simultaneously. This may require an adaptation so that all caregivers are trained in the same approach and intervention for children in the foster care system.”

LaSelle also points out that, in practice, decisions on the approach to a particular case are often made not on an assessment, but on location, convenience, providers’ familiarity with particular interventions or providers, established referral relationships, and local service availability.

“Within child welfare, there is also significant pressure to act quickly because of statutory timelines and documentation requirements,” she says. “As a result, youth may be referred to interventions that are readily accessible, such as CBT, because they can be initiated promptly and demonstrate that evidence-based services have been implemented.

“While timely access to treatment is important,” LaSelle cautions, “the fastest available intervention is not always the intervention that is the best clinical fit for a particular child’s or family’s needs.”

Caring for the Caregiver
Because parents and guardians play an outsized role in treating children with anxiety, it’s vital that their emotional and physical well-being is a consideration. Burnout can lead to feelings of isolation, hopelessness, and an inability to carry out consistent parenting strategies.

“I make it very simple with the parents I treat,” Young says. “It is very important to engage in self-care to stay grounded and prevent burnout in all the roles a parent carries. You need to recharge your battery, or you will burn out, intervention or not.”

Burnout concerns are heightened in the case of parents who are dealing with their own generational traumas, chronic stress, financial hardship, and competing responsibilities, as they often experience a scarcity of time and emotional resources. LaSelle shares that under these conditions, accommodating a child’s anxiety or giving in to anxiety-driven demands can become an adaptive short-term coping strategy to reduce immediate conflict and distress. However, “while these accommodations provide temporary relief, they may inadvertently reinforce anxiety over time and contribute to the maintenance of the child’s symptoms.”

Indeed, she says, a primary obstacle to implementing the SPACE model is engaging already overwhelmed caregivers and asking them to invest in a treatment approach whose benefits are realized primarily over time. SPACE often results in short-term increases in child distress and a temporary escalation of anxiety-related behavioral responses as caregivers shift behaviors and as accommodations are gradually reduced.

“For caregivers experiencing burnout, the immediate relief associated with accommodation may seem more attainable than the delayed benefits of sustained behavioral change,” says LaSelle, adding that SPACE works best when child welfare workers understand how caregiver accommodations keep anxiety going and why investing in parent engagement is essential to the model’s success.

“Validating caregiver burden and supporting caregivers through relationship-based reinforcement of their strengths and self-efficacy in parenting under the veil of child welfare involvement is essential to engagement in treatment,” she says.

Riddick says the first step to avoiding burnout is ensuring parents and caregivers are trained on proper responses, so they don’t put themselves in a position where their response inadvertently makes a situation worse. Along with education, social workers should take time to get to know parents as individuals and have respite resources ready.

“A lot of adults don’t know how to take care of themselves [or] how to set boundaries. A lot of adults don’t know how to communicate [or] how to be self-aware and identify what they need to thrive,” she says. “They overexert themselves. They say yes to everyone and everything, and they are automatically putting themselves in the position of burnout and don’t even know it. There has to be some individual work with the parent because avoiding burnout goes beyond the child; that parent has to manage their own personal life in addition to being a parent.”

A Family Affair
Judy Rudny, LCSW, founder and licensed clinical social worker at Serenity Path Therapy, agrees that avoiding caregiver burnout is “another critical piece of the puzzle.” Overwhelmed parents have trouble maintaining consistency, so ensuring they receive support “is an important part of helping children succeed.”

Beyond that, Rudny says no single approach is right for every child. CBT, SPACE, and other evidence-based models can be effective; however, the best approach depends on the child’s age, symptoms, underlying factors, and family dynamics.

“One of the biggest changes I’ve seen over the past 20 years is a greater understanding that anxiety isn’t something children simply grow out of,” she says. “We now recognize the importance of identifying concerns early, helping children develop healthy coping skills, and supporting parents so they can respond in ways that build confidence rather than unintentionally reinforcing anxiety.”

— Elizabeth S. Goar is a freelance health care writer based in Wisconsin.

SOCIAL MEDIA AND THE RISING PREVALENCE OF CHILDHOOD ANXIETY

Statistics tell the story: mental health diagnoses are increasing across the board, but especially among children and adolescents. The question is whether prevalence is rising or if awareness is reducing the stigma and leading to more diagnoses of existing cases.

“There’s a lot of research being done and some deep diving [is needed] to really try to figure that out [but] what I like to believe is that it’s a little bit of both,” says Latasha Riddick, LCSWA. “The world is evolving at such a quick pace. We have access to more [information], and we’re more vulnerable. Traditionally, we think access is a great thing. It brings equity. It helps us live better lives when we have access. But access can also be damaging.”

Social media is a prime example, exposing children and adults to wall-to-wall images that are edited, filtered, and/or enhanced or created with AI, blurring the line between reality and make-believe. It exacerbates already unrealistic beauty and wealth standards once limited to the glossy but disposable pages of magazines or television programs that could be turned off.

“Many children and teens are exposed to constant comparison, unrealistic expectations, and a steady stream of information that can contribute to anxiety,” says Judy Rudny, LCSW, founder and licensed clinical social worker at Serenity Path Therapy.

Riddick adds: “Not only are we comparing ourselves and our lives to others, but we also have more awareness of tragedies and disparities that are happening around the world. Things that we may not have even learned about [before] we can now see on social media.”

Jonathan Goelz, LCSW, executive director of All In Solutions, acknowledges the mixed messages children and adolescents receive from social media. While it offers positive opportunities for connecting individuals, it also presents challenges, including increased peer comparison, exposure to frightening content, sleep disruptions, and pressure to remain available 24 hours a day.

“Developmental research continues to evolve, and thus social workers should assess how each specific child utilizes each social media platform prior to making assumptions regarding the equal negative effects of all screen time,” he says.

A cultural component also comes into play. Whereas in the past, children were discouraged from expressing emotions—think “boys don’t cry”—social media now causes them to suppress their feelings to maintain a carefully crafted online image.

“It does not normalize a person having a weak or vulnerable moment. So, when we talk about adults who have anxiety, in many cases it started at a very young age because there was a suppression of emotions, and those emotions were not ever properly exposed or experienced or expressed,” Riddick says.

The good news is that, in part due to the oversharing nature of social media, emotions have been normalized to the point where children (and adults) are encouraged to recognize their feelings. But while people may be more open about what they’re going through, “there’s a step that we haven’t gotten to yet,” Riddick says. “Once we encourage you to express this emotion, we now have to teach you how to manage it.”

Rudny adds: “Helping families establish healthy boundaries around technology, while strengthening communication and emotional connection at home, can make a meaningful difference.”

References
1. Diggs DT, Olfson M. National trends in clinically recognized anxiety among US children and adolescents. Acad Pediatr. 2026;26(6):103357.

2. HRSA Maternal and Child Health Bureau, National Survey of Children's Health: Adolescent Mental and Behavioral Health, 2023. https://mchb.hrsa.gov/sites/default/files/mchb/data-research/nsch-data-brief-adolescent-mental-behavioral-health-2023.pdf. Published October 2024.

3. Geissmann P, Geissmann C. A History of Child Psychoanalysis. 1st ed. London, England: Routledge; 2005. https://doi.org/10.4324/9780203013700

4. Anxiety in children. Cleveland Clinic website. https://my.clevelandclinic.org/health/diseases/anxiety-in-children. Updated October 11, 2023.