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• American Academy of Child and Adolescent Psychiatry. (2021). Recommendations for Pediatricians, Family Practitioners, Psychiatrists, and Non-physician Mental Health Practitioners.
• American Academy of Child and Adolescent Psychiatry. (2017). Anxiety and Children.
• American Academy of Family Physicians. Cultural competence self-test for physicians.
• American Academy of Pediatrics. (2021). Interim Guidance on Supporting the Emotional and Behavioral Health Needs of Children, Adolescents, and Families During the COVID-19 Pandemic.
• American Academy of Pediatrics. (2021). “Where We Stand: Gun Safety.”
• American Academy of Pediatrics. (2019). Policy Statement: Mental Health Competencies for Pediatric Practice. Pediatrics, 144(5): e20192757.
• American Academy of Pediatrics, healthychildren.org. (2019). Anxiety in Teens is Rising: What's Going On?
• American Academy of Pediatrics. (2018). Policy Statement: How Pediatricians Can Advocate for Children’s Health by Collaborating with Public Health Professionals.
• American Academy of Pediatrics. (2016). Clinical Report: Mind-Body Therapies in Children and Youth. Pediatrics, 138:3.
• American Academy of Pediatrics. (2016). Clinical Report: Families Affected by Parental Substance Use. Pediatrics, 138(2):e20161575.
• American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, DSM–5.
• Anxiety and Depression Association of America. (2015). Childhood Anxiety Disorders.
• Bitsko, R. H., Holbrook, J. R., Ghandour, R. M., Blumberg, S. J., Visser, S. N., Perou, R., & Walkup, J. T. (2018). Epidemiology and Impact of Health Care Provider–Diagnosed Anxiety and Depression Among U.S. Children. Journal of Developmental & Behavioral Pediatrics, 39(5), 395-403.
• Brew, B. K., Lundholm, C., Gong, T., Larsson, H., & Almqvist, C. (2018). Familial aggregation of atopic diseases and depression or anxiety in children. Clinical and Experimental Allergy, 48(6), 703–711.
• Centers for Disease Control and Prevention. (2021). Anxiety and Depression in Children: Get the Facts.
• Centers for Disease Control and Prevention. (2018). Children’s Mental Health: Anxiety and Depression in Children.
• Centers for Disease Control and Prevention, National Center for Health Statistics. (2018). Use of Yoga, Meditation, and Chiropractors Among U.S. Children Aged 4–17 Years, NCHS Data Brief 324.
• Child Mind Institute. (2022). What to do (and not to do) when children are anxious.
• Child Mind Institute. (2018). 2018 Children’s Mental Health Report: Understanding Anxiety in Children and Teens.
• Cobham, V. E., Hickling, A., Kimball, H., Thomas, H. J., Scott, J. G., & Middeldorp, C. M. (2020). Systematic review: anxiety in children and adolescents with chronic medical conditions. Journal of the American Academy of Child & Adolescent Psychiatry, 59 (5), 595-618.
• Cohodes, E. M., & Gee, D. G. (2017). Developmental Neurobiology of Anxiety and Related Disorders. Neuroscience.
• Connolly, S. (n.d.). Anxiety Disorders in Children and Adolescents. Presentation by the director, University of Illinois at Chicago Pediatric Stress and Anxiety Disorders Clinic.
• Cornell University. (2022). What is self-injury?
• Dabkowska, M., & Dabkowska-Mika, A. (2015). A Fresh Look at Anxiety Disorders. Chapter: Risk Factors of Anxiety Disorders in Children. IntechOpen.
• Dudeney, J., Sharpe, L., Jaffe, A., Jones, E. B., & Hunt, C. (2017). Anxiety in youth with asthma: A meta-analysis. Pediatric Pulmonology, 52(9): 1121-1129.
• Essau, C. A., Lewinsohn, P. M., Lim, J. X., Ho, M. R., & Rohde, P. (2018). Incidence, recurrence and comorbidity of anxiety disorders in four major developmental stages. Journal of Affective Disorders, 228, 248–253.
• Georgetown University, Health Information Group and Bright Futures. (2019). Cultural Concepts of Distress, from Addressing Mental Health Concerns, Module 14. Mental Health: Culture, Race, and Ethnicity.
• Hoge, E., Bickham, D., & Cantor, J. (2017). Digital Media, Anxiety, and Depression in Children. Pediatrics, 140(Suppl 2):S76-S80.
• Lawrence, P. J., Murayama, K., & Creswell, C. (2019). Systematic Review and Meta-Analysis: Anxiety and Depressive Disorders in Offspring of Parents With Anxiety Disorders. Journal of the American Academy of Child & Adolescent Psychiatry, 58(1):46-60.
• Lebowitz, E. R., Marin, C., Martino, A., Shimshoni, Y., & Silverman, W. K. (2020). Parent-Based Treatment as Efficacious as Cognitive-Behavioral Therapy for Childhood Anxiety: A Randomized Noninferiority Study of Supportive Parenting for Anxious Childhood Emotions. Journal of the American Academy of Child & Adolescent Psychiatry, 59(3), P362-372.
• Lebowitz, E. R., Omer, H., Hermes, H., & Scahill, L. (2014). Parent Training for Childhood Anxiety Disorders: The SPACE Program. Cognitive and Behavioral Practice, 21(4), 456–469.
• Leeb, R. T., Bitsko, R. H., Radhakrishnan, L., Martinez, P., Njai, R., & Holland, K. M. (2020). Mental Health–Related Emergency Department Visits Among Children Aged <18 Years During the COVID-19 Pandemic—United States, January 1–October 17, 2020. Morbidity and Mortality Weekly Report (MMWR), 69:1675–1680.
• Leonte, K. G., Puliafico, A., Na, A., & Rynn, M. (2019). Pharmacotherapy for anxiety disorders in children and adolescents. Up-to-Date.
• Lindberg, L., Hagman, E., Danielsson, P., Marcus, C., & Persson, M. (2020). Anxiety and depression in children and adolescents with obesity: a nationwide study in Sweden. BMC Medicine, 18(1):30.
• Mayo Clinic (2021). Self injury/cutting.
• National Institute on Drug Abuse. (2020). Common Comorbidities with Substance Use Disorders.
• Norman, K. R., Silverman, W. K., & Lebowitz, E. R. (2015). Family Accommodation of Child and Adolescent Anxiety: Mechanisms, Assessment, and Treatment. Journal of Child and Adolescent Psychiatric Nursing, 28(3): 131-140.
• Osgood, K., Sheldon-Dean, H., & Kimball, H. (2021). 2021 Children’s Mental Health Report: What we know about the COVID-19 pandemic’s impact on children’s mental health –– and what we don’t know. Child Mind Institute.
• Pentz, J., & Simkin, D. R. (2016). The Use of Meditation in Children With Mental Health Issues. Psychiatric Times, 13/11.
• Runyon, K., Chesnut, S. R., & Burley, H. (2018). Screening for childhood anxiety: A meta-analysis of the screen for child anxiety related emotional disorders. Journal of Affective Disorders, 240:220-229.
• Scott, A. J., Sharpe, L., Loomes, M., & Gandy, M. (2020). Systematic Review and Meta-Analysis of Anxiety and Depression in Youth with Epilepsy. Journal of Pediatric Psychology, 45(2):L 133-144.
• Southammakosane, C., & Schmitz, K. (2015). Pediatric Psychopharmacology for Treatment of ADHD, Depression, and Anxiety. Pediatrics, 136:2.
• U.S. Department of Health and Human Services. (2021). Protecting Youth Mental Health: The U.S. Surgeon General’s Advisory.
• Wang, S., Sun, Q., Zhai, L., Bai, Y., Wei, W., & Jia, L. (2019). The prevalence of depression and anxiety symptoms among overweight/obese and non-overweight/non-obese children/adolescents in China: A systematic review and meta-analysis. International Journal of Environmental Research and Public Health, 16(3), 340.
• Wehry, A. M., Beesdo-Baum, K., Hennely, M. M., Connolly, S. D., & Strawn, J. R. (2015). Assessment and Treatment of Anxiety Disorders in Children and Adolescents. Current Psychiatry Reports, 17(7): 591.
• Weitzman, C. C., & Bridgemohan, C. (2019). Up to 30% of youths will develop anxiety disorders; how you can help. American Academy of Pediatrics News, Jan. 15.
• YouthSuicideWarningSigns.org. (n.d.). Healthcare Professionals: Youth Suicide Warning Signs.

Medical Definitions

The medical definitions provided in this module were adapted or obtained from the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders–Fifth Edition (DSM-5), American Psychological Association, Cambridge Dictionary, Frontiers in Psychology, Healthline.com, Indiana University, Mayo Clinic, Neuroscience, Oxford University Press, PsychCentral and the U.S. Department of Health and Human Services.

Continuing Medical Education

The Texas Department of State Health Services, Continuing Education Service is accredited by the Texas Medical Association to provide continuing medical education for physicians. 

The Texas Department of State Health Services, Continuing Education Service designates this enduring material for a maximum of 1.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Continuing Nursing Education

The Texas Department of State Health Services, Continuing Education Service is accredited as a provider of continuing nursing education by the American Nurses Credentialing Center’s Commission on Accreditation. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 contact hour(s) of Continuing Nursing Education.

Certified Health Education Specialists

Sponsored by The Texas Department of State Health Services, Continuing Education Service, a designated provider of continuing education contact hours (CECH) in health education by the National Commission for Health Education Credentialing, Inc. This program is designated for Certified Health Education Specialists (CHES®) and/or Master Certified Health Education Specialists (MCHES®) to receive up to 1.25 total Category I contact education contact hours. Maximum advanced-level continuing education contact hours available are 1.25.

Licensed Marriage and Family Therapists

The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is related to the practice of marriage and family therapy; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 hours of credit.

Licensed Professional Counselors

Up to 1.25 LPC hours may be earned at this event.

Licensed Psychologists

The Texas Department of State Health Services, Continuing Education Service is approved as a provider of professional development hours for licensed psychologists, per the Texas Administrative Code Rule §463.35 (f)(1). The Texas Department of State Health Services, Continuing Education Service has awarded  1.25 professional development hours.

Social Workers

The Texas Department of State Health Services, Continuing Education Service, the continuing education provider, ensures that the education provided is directly related to the practice of social work; and that the individuals presenting the information have the necessary experience and knowledge in the topics presented. The Texas Department of State Health Services, Continuing Education Service has awarded 1.25 hours of credit.

Certificate of Attendance

The Texas Department of State Health Services, Continuing Education Service has designated 1.25 hour(s) for attendance.

General Disclosure

One of the requirements of continuing education is disclosure of the following information to the learner:

1. Notice of requirements for successful completion of continuing education activity. To receive continuing education credit the learner must successfully complete the following activities:
   • Create a Texas Health Steps account.
   • Complete on-line registration process.
   • Thoroughly read the content of the module.
   • Complete the on-line examination.
   • Complete the evaluation.
2. Commercial Support.
   The THSTEPS Web-based Continuing Education Series has received no commercial support.
3. Disclosure of Relevant Financial Relationships.
   The THSTEPS Continuing Education Planning Committee and the authors of these modules have no relevant financial relationships to disclose.
4. Non-Endorsement Statement.
   Accredited status does not imply endorsement of any commercial products or services by the Department of State Health Services, Continuing Education Service; Texas Medical Association; or American Nurse Credentialing Center.
5. Off-Label Use.
   Using a disclosure review process, the THSTEPS Continuing Education Planning Committee has examined documents and has concluded that the authors of these modules have not included content that discusses off-label use (use of products for a purpose other than that for which they were approved by the Food and Drug Administration).

The following are policies and definitions of terms related to continuing education disclosure:

The intent of disclosure is to allow Department of State Health Services (DSHS) Continuing Education Service the opportunity to resolve any potential conflicts of interest to assure balance, independence, objectivity and scientific rigor in all of its Continuing Education activities.

All faculty, planners, speakers and authors of Department of State Health Services (DSHS) Continuing Education Service sponsored activities are expected to disclose to the Department of State Health Services (DSHS) Continuing Education Service any relevant financial, relationships with any commercial or personal interest that produces health care goods or services concerned with the content of an educational presentation. Faculty, planners, speakers and authors must also disclose where there are any other potentially biasing relationships of a professional or personal nature.

Glossary of Terms

Conflict of Interest: Circumstances create a conflict of interest when an individual has an opportunity to affect Continuing Education content about products or services of a commercial interest with which she/he has a financial relationship or where there are any other potentially biasing relationships of a professional or personal nature.

Commercial Interest: Any entity producing, marketing, re-selling, or distributing health care goods or services consumed by, or used on, patients.

Financial Relationships: Those relationships in which the individual benefits by receiving a salary, royalty, intellectual property rights, consulting fee, honoraria, ownership interest (e.g., stocks, stock options or other ownership interest, excluding diversified mutual funds), or other financial benefit. Financial benefits are usually associated with roles such as employment, management position, independent contractor (including contracted research), consulting, teaching, membership on advisory committees or review panels, board membership, and other activities for which remuneration is received or expected. Relevant financial relationships would include those within the past 12 months of the person involved in the activity and a spouse or partner. Relevant financial relationships of your spouse or partner are those of which you are aware at the time of this disclosure.

Off Label: Using products for a purpose other that that for which it was approved by the Food and Drug Administration (FDA).

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