How to Help a Child With Anxiety and Depression: What the Research Says

Anxiety and depression frequently
occur together in children and adolescents —
and when they do, the combination
is more challenging to navigate than
either condition alone. Research finds
that approximately fifty percent of
children with an anxiety disorder
also have depression — and that
the combination produces greater
impairment, greater distress, and
requires more comprehensive support
than either condition in isolation.

This article covers what the research
shows about anxiety and depression
in children — how they are related,
what the combination looks like,
and what parents can specifically
do to support a child experiencing both.

How Anxiety and Depression
Are Related in Children

Research on the relationship between
anxiety and depression in children
finds a complex, bidirectional connection:

Anxiety frequently precedes depression.
Research on the developmental
course of childhood anxiety and
depression — including longitudinal
work by Brady and Kendall —
finds that anxiety typically
develops before depression in
children and adolescents, with
depression often emerging as
a consequence of the chronic
stress and impairment that
untreated anxiety produces.

The mechanism is well-researched:
chronic anxiety — the sustained
experience of fear, avoidance,
and threat — is exhausting.
Over time, the repeated experience
of anxiety, the accumulated
avoidance of valued activities,
and the erosion of confidence
and self-efficacy that chronic
anxiety produces can give rise
to depression.

They share common risk factors.
Research on the shared etiology
of anxiety and depression —
including work by David Barlow
on the unified protocol for
emotional disorders — finds
that anxiety and depression
share significant genetic, temperamental,
and environmental risk factors.
The same temperamental trait —
negative affectivity, the tendency
to experience negative emotions
intensely — is a risk factor for both.

They amplify each other. Research
on comorbid anxiety and depression
finds that the two conditions
amplify each other’s effects —
the depression makes the anxiety
harder to manage, the anxiety
makes the depression more persistent,
and the combination produces
greater functional impairment
than either alone.

What Anxiety and Depression
Together Look Like in Children

Research on the presentation
of comorbid anxiety and depression
in children identifies several
characteristic patterns that
distinguish this combination
from either condition alone:

Pervasive withdrawal. The anxious
child avoids specific feared
situations. The depressed child
withdraws from activities they
previously enjoyed. The child
with both may show pervasive
withdrawal — avoiding both
feared situations and previously
enjoyed activities — leaving
little in their daily life
that feels safe or pleasurable.

Hopelessness about anxiety.
Research on comorbid anxiety
and depression finds that depression
adds a quality of hopelessness
to anxiety that makes it significantly
harder to treat: the depressed-anxious
child not only fears the situation
but believes that nothing will
help and that things will
not get better. This hopelessness
significantly reduces motivation
to engage with treatment.

Low energy combined with high
arousal. The physiological state
of comorbid anxiety and depression
is particularly uncomfortable —
the low energy, fatigue, and
slowed processing of depression
combined with the high arousal,
tension, and hypervigilance
of anxiety. Research finds
this combination particularly
distressing and disruptive to functioning.

Negative self-concept with
threat focus. Depression produces
negative self-evaluation — “I
am worthless, unlovable, a
failure.” Anxiety produces threat
focus — “the world is dangerous
and I cannot cope.” Together
they produce a child who feels
both worthless and threatened —
a particularly painful combination.

Significant sleep disruption.
Research on sleep and mental
health finds that both anxiety
and depression independently
disrupt sleep — and that comorbid
anxiety and depression produces
particularly significant sleep
difficulty, with downstream
effects on mood, energy, concentration,
and anxiety management capacity.

School refusal and academic decline.
Research on school functioning
and comorbid anxiety and depression
finds significantly higher rates
of school refusal and academic
decline in children with both
conditions than in those with
either condition alone.

What the Research Shows Helps

Seeking professional support —
early and proactively. Research
on comorbid anxiety and depression
in children consistently finds
that the combination requires
professional assessment and
support — both because the
combination is more complex
than either condition alone
and because the hopelessness
of depression makes self-directed
improvement significantly harder.

The most evidence-based intervention
for comorbid anxiety and depression
in children is cognitive behavioral
therapy — adapted for the specific
combination. Research finds
CBT effective for both conditions
simultaneously, particularly
when the treatment addresses
both the avoidance of anxiety
and the withdrawal and hopelessness of depression.

Medication may be considered
for moderate to severe presentations —
in consultation with a child
psychiatrist or pediatrician.
Research on the treatment of
comorbid anxiety and depression
finds that for moderate to
severe presentations, the combination
of CBT and medication produces
better outcomes than either alone.

Maintaining connection and warmth.
Research on parental support
and child mental health recovery
consistently finds that the
quality of the parent-child
relationship is one of the
strongest predictors of recovery —
a warm, stable, available parent
is one of the most powerful
therapeutic resources available.

For the child with anxiety
and depression, this means:
Staying genuinely connected —
not withdrawing in response
to the child’s withdrawal.
Expressing genuine warmth
and love — consistently, even
when the child is difficult
to reach.
Being available without pressuring
— the open door, not the push through it.

Behavioral activation — gentle
reengagement with valued activities.
Research on depression treatment —
particularly behavioral activation —
finds that the most important
behavioral intervention for
depression is the gradual reengagement
with activities that provide
pleasure, mastery, or meaning.
For the depressed-anxious child,
this means:

Identifying activities that
previously brought pleasure
or engagement.
Gently, gradually re-introducing
these activities — one at
a time, at the child’s pace.
Not waiting for motivation
to return before reengaging —
research finds that action
typically precedes motivation
in depression, not the other way around.

Addressing sleep. Research
on sleep and mental health
finds that sleep disruption
both results from and contributes
to anxiety and depression —
and that improving sleep quality
significantly improves both conditions.
Consistent sleep schedule,
screen-free bedtime routine,
and the sleep hygiene practices
supported by research are
an important component of support.

Physical activity. Research
on exercise and mental health —
including meta-analyses by
John Ratey at Harvard — finds
that regular physical activity
produces significant improvements
in both anxiety and depression
in children and adolescents —
through effects on cortisol,
serotonin, neuroplasticity,
and self-efficacy. Even small
amounts of regular physical
activity — a daily walk, a
brief exercise routine — produce
measurable improvements in mood and anxiety.

Monitoring safety. Research
on comorbid anxiety and depression
and suicide risk finds elevated
risk in adolescents with both
conditions — particularly when
accompanied by hopelessness.
Parents of adolescents with
comorbid anxiety and depression
should be aware of warning
signs and should not hesitate
to seek emergency support
if their child expresses thoughts
of self-harm or suicide.

If your child expresses any
thought of self-harm or suicide —
take it seriously immediately.
Contact your pediatrician,
a mental health professional,
or a crisis line. In the
United States, the 988 Suicide
and Crisis Lifeline is available
by calling or texting 988.

What Does Not Help

Minimizing or dismissing the
combination. Research on parental
response to child mental health
and treatment outcomes finds
that dismissing the severity
of comorbid anxiety and depression —
“you’ll be fine,” “just cheer up,”
“everyone feels anxious sometimes” —
increases shame, reduces help-seeking,
and does not produce improvement.

Pushing too hard, too fast.
Research on depression and motivation
finds that pushing a depressed
child to engage with activities
or challenges before they have
adequate support in place increases
distress rather than building resilience.
Gentle, graduated reengagement
with adequate support is significantly
more effective than urgent pushing.

Reducing all demands. Research
on depression and behavioral
withdrawal finds that complete
removal of all demands — however
kindly intended — maintains
and deepens depression by
reducing the behavioral engagement
that recovery requires. The
balance is between adequate
support and gradual reengagement —
not between pushing and complete accommodation.

Try This This Week

Practice 1 — The Connection Practice
What it is: A deliberate
daily investment in genuine
connection with your child —
maintaining the relationship
that research finds most predictive of recovery.

How to do it: Once each day,
find one genuine moment of
connection with your child —
entirely separate from any
therapeutic or corrective agenda:

A brief, warm physical connection.
A shared activity — however small.
A genuine expression of love:
“I love you. I’m here.
Whatever you’re going through,
we’re going through it together.”
A moment of genuine humor or lightness if possible.

Keep it genuine and non-pressuring —
not contingent on the child’s mood or engagement.

Why it works: Research on
parental support and child
mental health recovery consistently
finds that maintained parental
warmth and connection — through
the most difficult periods —
is one of the strongest predictors
of recovery from both anxiety
and depression.

Practice 2 — The One Activity Reengagement
What it is: A gentle, gradual
reengagement with one previously
enjoyed activity — applying
behavioral activation principles
to support depression recovery.

How to do it: Together with
your child, identify one activity
that previously brought pleasure
or meaning — however small:

A brief walk together.
A previously enjoyed game or creative activity.
Time with a pet.
A simple shared meal preparation.

Introduce it gently — once
this week. Do not pressure.
Do not require enjoyment.
Simply create the opportunity.

Why it works: Research on
behavioral activation and depression
finds that gradual reengagement
with pleasurable or meaningful
activities — even when motivation
is low — produces genuine
improvements in mood over
time. Action precedes motivation
in depression — the reengagement
creates the mood improvement,
not the other way around.

Practice 3 — The Safety Check-In
What it is: A regular, warm
check-in that includes a direct,
gentle safety question — maintaining
the parental awareness of the
child’s safety that comorbid
anxiety and depression requires.

How to do it: Once a week —
in a calm, connected moment —
as part of a natural conversation:

“I want to check in with
you about how you’re really doing.
Not just the surface — but
how things feel inside.”
[Listen genuinely.]
“Sometimes when people are
feeling really low and really
anxious, they have thoughts
about hurting themselves or
not wanting to be here.
Has that happened for you?”

If the answer is yes — take
it seriously immediately and
seek professional support.

Why it works: Research on
suicide risk and parental awareness
finds that direct, calm questions
about safety — asked in the
context of genuine connection —
do not increase risk and significantly
increase the likelihood of
disclosure. The Safety Check-In
maintains parental awareness
in a warm, non-alarming way.

The Bottom Line

Anxiety and depression together
in a child are not simply
two conditions added together.
They interact, amplify each
other, and produce a level
of suffering and impairment
that requires comprehensive,
professional support alongside
the most important resource available —
a parent who stays warm,
stays connected, and stays present.

The research is clear: early,
professional, evidence-based
support produces significantly
better outcomes than delayed
or inadequate support. The
combination is treatable —
with CBT, with appropriate
medication where indicated,
with behavioral activation,
and with the sustained parental
warmth that no treatment replaces.

If you are concerned about
your child — trust your instinct
and seek professional assessment.
Early support is always better
than waiting.

And if your child is struggling —
tell them what the research
consistently finds to be true:
this is treatable, this is
not their fault, and they
are not alone.

Sources

Brady, E. U., & Kendall, P. C.
(1992). Comorbidity of anxiety
and depression in children and adolescents.
Psychological Bulletin,
111(2), 244–255.

Barlow, D. H., et al. (2011).
Unified Protocol for Transdiagnostic
Treatment of Emotional Disorders.
Oxford University Press.

Ratey, J. J., & Hagerman, E.
(2008). Spark: The Revolutionary
New Science of Exercise and the Brain.
Little, Brown.

Kendall, P. C., & Hedtke, K. A.
(2006). Cognitive-Behavioral Therapy
for Anxious Children: Therapist Manual.
Workbook Publishing.