National Trends in Clinically Recognized Anxiety Among US Children and Adolescents.
Level 3 - non-randomized controlled study
Repeated nationally representative cross-sectional survey without longitudinal individual follow-up
PubMed 42341870 · doi:10.1016/j.acap.2026.103357
What was done
This was a repeated cross-sectional analysis of the 2016–2023 National Survey of Children's Health examining a nationally representative sample of 223,178 non-institutionalized US youth aged 6 to 17 years (51.1% male; 26.4% Hispanic, 4.7% non-Hispanic Asian, 13.7% non-Hispanic Black, 49.3% non-Hispanic White). The authors evaluated annual rates and adjusted prevalence ratios (aPRs) of caregiver-reported, clinician-diagnosed anxiety across demographic subgroups and severity levels (moderate, severe), using multivariate logistic regression to identify correlates and co-occurring mental health conditions.
What was found
Across the entire period, 10.0% of children had anxiety (4.5% moderate, 1.0% severe). Anxiety prevalence increased from 8.2% in 2016 to 12.8% in 2023 (aPR 1.63; 95% CI, 1.53–1.75), while severity distributions remained stable. Increases were significantly larger among girls (aPR 1.85; 95% CI, 1.69–2.03, P < .001) and adolescents aged 12 to 17 years (aPR 1.76; 95% CI, 1.63–1.91, P < .001) compared to boys and younger children (ages 6 to 11). Anxiety rose across most racial and ethnic groups without a significant interaction between sex and race/ethnicity over time. Among youth with anxiety, 70.1% had at least one co-occurring mental health condition—most commonly ADHD (38.8%), depression (35.1%), and behavioral problems (32.0%)—which correlated with greater anxiety severity.
Why it matters
This study provides national surveillance data showing a marked post-2016 increase in pediatric anxiety diagnoses, driven largely by adolescent females. It underscores that most affected youth present with complex multimorbid psychiatric profiles requiring expanded clinical services.
Limits
Outcomes relied entirely on caregiver recall of clinician diagnoses rather than direct structured clinical assessments or validated diagnostic instruments. The cross-sectional design cannot track individual symptom trajectories or establish causality. The survey excludes institutionalized populations and cannot differentiate whether rising rates reflect true increases in incidence, changes in diagnostic screening practices, or shifts in healthcare-seeking behavior.