Anxious Kids: Five Questions with Jennifer Freeman, PhD

Anxiety is one of the most common mental health disorders among children and adolescents. The US Centers for Disease Control and Prevention reports that in the US, anxiety of varying degrees affects 14 to 30 percent of children between the ages of 3 and 17 years old. A 2021 study in the Journal of the American Medical Association Pediatrics indicated that the prevalence of youth anxiety doubled during the pandemic.

Jennifer Freeman, PhD, is the director of the Pediatric Anxiety Research Center (PARC) at Bradley Hospital and professor (research) of psychiatry and human behavior at The Warren Alpert Medical School of Brown University. Her research interests are in child and adolescent anxiety disorders, with special focus on obsessive-compulsive disorder (OCD), cognitive behavioral family interventions, and developing new training and service models that provide high-quality, evidence-based care outside the office. She offers a perspective on pediatric anxiety disorder research and care.

A Perspective on Pediatric Anxiety Disorder Research and Care

How do we distinguish between anxiety symptoms that are a normal and expected part of development and anxiety that is pathological and requires treatment?

That’s the million-dollar question that most people ask when it comes to thinking about when anxiety symptoms need more care and a specialist. Anxiety is totally normal, but when it interferes with doing the expected things that a child should be doing in their life, from socializing with other kids to eating, sleeping, grooming or leaving the house/their parents, it may be time to do something. It’s important to recognize if this behavior is different from the child’s normal experience, or if it has been lasting over a longer period of time.

Are there fundamental differences in the types of anxiety that determine the type of treatment needed or are the overarching similarities more important?

I think the overarching similarities are more important when it comes to thinking about these types of disorders because of the treatment. The best treatment or at least the biggest core component of all treatments for anxiety is exposure therapy, a specific kind of cognitive behavioral treatment. It is less about the specific name of the diagnosis and more about what is the child’s core fear. That’s what is causing the impairment.

PARC has grown from a team of two to a multidisciplinary team of 45 researchers and clinicians and is nationally recognized for its programs that treat children with OCD and other anxiety disorders. What are its core principles and approaches?

We focus on researching new treatments and delivering these evidence-based treatments through a number of different outpatient and partial hospital programs. A core focus of the partial programs is to address the needs of those children for whom outpatient treatment is not enough. There are a lot of barriers to getting better with an hour a week of treatment. This program pools our many resources – psychiatrists, psychologists, bachelor’s level staff, group therapy, medication management, and intensive family and individual therapy. And, we include home visits. We treat anxiety where it lives. This gives us a much better reach to our patients and families.

As a devoted and accomplished researcher in the field, what are the most pressing questions in pediatric anxiety disorders or OCD that need clinical research to provide answers?

A key area is treatment augmentation for children who are at the most severe ends of the spectrum, many of whom do not respond well to traditional treatments whether behavioral or psychopharmacological. At PARC, we are thinking about other augmentative treatments and behavioral strategies that we can add, including non-invasive brain stimulation. My own research is primarily focused on improving access to care. I am thinking a lot about how we can get high quality effective treatments for anxiety beyond our hospitals and academic medical settings to treat kids in the communities in which they live. 

Lastly, what is the outlook for the overall pediatric anxiety landscape?

We need to train more people in exposure therapy in order to gain the skills to treat anxious pediatric patients. We really need to think about the diversity of the samples of children that are included in research. The traditional, randomized, controlled trials that have been done in anxiety and OCD are quite limited in terms of racial, ethnic, and gender diversity of children and adolescents and this needs to change.

Learn more about the Pediatric Anxiety Research Center