CBD and its Usage to Treat Anxiety in School-Age Children: What Parents Need To Know

Acknowledging An Increasingly Stressful Reality

The demanding and hectic nature of modern-day life contains a formidable amount of stress-inducing circumstances. As engaging, hard-working members of society, we accept stress as a necessary component of life; we embrace it even. However, efforts to meet financial and social needs have engendered rising stress levels in the general population. Just as we cannot afford to ignore a spreading disease, we need to address what some experts have called a stress epidemic.

Stress is deviously contagious; as it permeates adult psyches, the effects trickle down to younger generations. Today’s college-bound students experience greater expectations and high amounts of pressure. According to UCLA researchers, 41% of the incoming college freshman class reported feeling overwhelmed in 2016, a drastic increase from 18% in 1985 and 29% in 2010. The American College Health Association found even higher levels, reporting 50% in 2011 and a staggering 62% in 2016.

While some may not consider stress itself a cause for concern, excessive amounts can lead to health issues and disorders that have very tangible consequences. As postulated by a CNN article, data from the Centers for Disease Control and Prevention (CDC) indicates that stress-related conditions and diseases, such as suicide, heart disease, obesity, and diabetes, have been on the rise for decades.

Furthermore, stress-related conditions, such as anxiety and depression, have become increasingly evident within the teen population. Whether that denotes an escalation of discernible cases or an improved ability to recognize them, the evidence is perturbing. One potential causal factor is earlier introductions to social media. As a result, the arms of peer pressure have extended, adding depth to the pool of available peers.

A less explored but equally concerning area of study suggests that stress may have epigenetic consequences. High amounts of stress in expectant mothers may impact genes involved in stress response and system dysregulation. Which begs the question, if stress disorders can be “inherited,” how will increased stress levels within the population impact the generations to come?

While statistics paint a grim picture, there is hope hidden within the numbers. Controlling income equality and investing in human development may combat increasing problems in adolescent and youth populations. Tackling the causes may prove challenging; however, providing resources for dealing with symptoms like anxiety is realistic and undoubtedly helpful in curbing the epidemic.

As stressors evolve, so do our strategies for dealing with them. CBD may be a plausible aid for anxiety, but, as with any drug, it’s essential to consider all angles before administering it—especially to children who are still developing.

What Is Anxiety In Children?

Despite our best efforts, it is impossible to avoid stressful situations entirely. Thus, feeling and dealing with anxiety is a valuable life skill and a critical part of human development. Children endure varying degrees of pressure as they grow up, particularly when facing daunting or unfamiliar circumstances.

Anxiety is normal; young children may even experience prolonged phases of heightened anxiety. However, if they fail to outgrow such fears or worries and deviate from typical stress levels, they may have an anxiety disorder that can cause lasting harm when left untreated.

Anxiety disorders in children are associated with impaired academic and social function, with half of all lifetime disorders emerging by age 11. Moreover, people with childhood anxiety disorders are predisposed for ongoing anxiety issues as well as other mental health disorders.

Types of Anxiety Disorders
Generalized Anxiety Disorder (GAD)

GAD is characterized by excessive and exaggerated anxiety about everyday life. It starts in childhood, and women are twice as likely to be affected.

Obsessive-Compulsive Disorder (OCD)

OCD involves recurring thoughts or sensations that compel repetitive actions or compulsions. The average age of onset is 19; however, one-third of adults with OCD experienced their first symptoms during childhood.

Panic Disorder

Recurring, episodic panic attacks indicate a panic disorder. An attack can manifest in emotional and physical symptoms, including chest pain, heart palpitations, and dizziness.

Posttraumatic Stress Disorder (PTSD)

With PTSD, specific triggers bring back memories of past trauma, eliciting intense physical and emotional distress. PTSD is also characterized by avoidance behavior.

Separation Anxiety Disorder

Children with a SAD become excessively anxious when separated from their parents. As a result, they often experience nightmares and may feel unable to attend school or events without their parents present.

Social Anxiety Disorder

Also called social phobia, people with this disorder become irrationally anxious, fearful, and self-conscious when faced with everyday social interactions. Social anxiety disorder typically begins around age 13 and affects 6.8% of the U.S. population.

Selective Mutism

Selective mutism is characterized by an inability to speak in public or social settings. The severe anxiety disorder starts in early childhood and typically does not dissipate without treatment.

Specific Phobias

An irrational fear of an object or situation is called a specific phobia. Common examples in children include the dark, heights, insects, and enclosed spaces. They are persistent and can infiltrate daily life depending on the phobia.

You can learn more about different types of anxiety disorders on the Anxiety & Depression Association of America (ADAA) website.

Symptoms of Anxiety Disorders

Since anxiety and stress commonly exist at manageable levels, it can be challenging to distinguish between normalcy and disorder. Even more confounding, anxiety disorders can present differently from person to person. For instance, some children may appear visibly stressed or worried, while others act irritable or angry.

Anxiety symptoms include
  • Problems with sleeping
  • Fatigue
  • Jitteriness
  • Headaches
  • Stomachaches
  • Nervous sweats
  • Difficulties concentrating
  • Improper eating habits
  • Tense posture
  • Fidgeting
  • Crying
  • Being excessively clingy

Children with anxiety disorders are also prone to hiding their problems, making it difficult for parents to recognize symptoms and get the proper help. Thus, encouraging an open and supportive home environment can be vital to identifying a disorder early. If you suspect that your child may be suffering from an anxiety disorder but are having trouble discussing it with them, seek a professional opinion.

There’s feeling a weight on your chest, and there’s the feeling of 16 people sitting on top of each other on your chest. As soon as I’d wake up, it was absolute dread.

Jillian, 16-year-old girl suffering from social anxiety and emetophobia
Jillian, 16-year-old girl suffering from social anxiety and emetophobia
Prevalence Of Anxiety In School-Age Children

Anxiety disorders are more common among younger populations than many people would like to believe. In fact, they are the most common mental health disorder experienced by children and young adults. According to ADAA, one in eight children has an anxiety disorder, and 25.1% of children ages 13–18 are affected.

In addition, the CDC reports that 7.1% of children aged 3–17 have been diagnosed with anxiety, approximately 4.4 million children in the United States. Furthermore, evidence suggests that prevalence is increasing, with diagnosed cases among children aged 6–17 rising from 5.5% in 2007 to 6.4% in 2011–2012.

As if dealing with an anxiety disorder wasn’t stressful enough, they are often accompanied by co-occurring conditions such as:

  • Depression
  • Eating disorders
  • ADHD
  • Learning disabilities
  • Substance abuse

Co-occurring disorders are not only difficult to deal with individually, but also tend to increase the severity of each disorder’s symptoms. Due to their close relation, co-occurring conditions are best treated in conjunction with one another. However, such programs are rare and underdeveloped due to a lack of researched-based understanding in the field.

Expert Interview

Prof. Paul Amminger, MD, PhD

Prof. Amminger's research spans traditional high-risk research in schizophrenia to cutting-edge intervention studies in the onset phase of psychosis and affective disorders.

Prof. Paul Amminger, MD, PhD
Professor of Youth Mental Health at the Centre for Youth Mental Health, The University of Melbourne
What were the remarkable outcomes observed in the pilot study using cannabidiol (CBD) as an anxiety treatment for young people?

The Cannabidiol Youth Anxiety Pilot Study found that young people with treatment-resistant anxiety had an average 42.6% reduction in anxiety severity and impairment following 12 weeks’ treatment with cannabidiol. The young people had fewer panic attacks and could do things which they were previously unable to do like leave the house, go to school, participate in social situations, eat at restaurants, take public transport or attend appointments by themselves.

With the current frontline treatments for anxiety appearing to only work in about half of the patients, how does CBD compare as a treatment option for young individuals with anxiety disorders?

The problem with current frontline treatments for anxiety – CBT and selective serotonin reuptake inhibitor (SSRI) antidepressant drugs – is that they only work in about half of the people who try them. Anxiety disorders are very common so that leaves a large number of young people untreated, struggling with symptoms and developing secondary conditions, for instance depression and substance use disorders.

There are often concerns about potential side effects or even addiction when introducing a new treatment, especially for young people. Can you comment on these concerns in relation to cannabidiol use?

It’s important to stress that cannabidiol does not induce any significant side effects or lead to the emergence of any neurological or psychiatric manifestations. Cannabidiol is non-intoxicating and doesn’t contain tetrahydrocannabinol (THC) so it doesn’t cause alterations in thinking and perception, it doesn’t make you ‘high’ and it’s not addictive. In fact, cannabidiol has been used to treat addictive behaviours in other research trials and can reduce some of the adverse and intoxicating effects of THC.

Given the promising results of your pilot study, what are your plans for future research to further investigate the potential benefits of CBD for treating anxiety in young people?

An open-label pilot study is limited by its design. To see a treatment effect in the treatment-resistant group is encouraging, but it could still be a placebo effect. The next step is a randomised controlled trial, which is the gold standard to test a new intervention. Such a trial needs to be done in a much larger group – around 200 to 250 young people – to enable us to say with some certainty that there is, or is not, real treatment benefits and effects.

What Is CBD And What Is It Used For?

CBD and THC interact with the body via the endocannabinoid system (ECS), which has three primary components: endocannabinoids, receptors, and enzymes. Endocannabinoids are similar to phytocannabinoids, the difference being that they’re produced by the body rather than found in plant life. So far, experts have identified two key endocannabinoids (anandamide and 2-arachidonoylglyerol), which the body produces as needed to keep internal functions running properly.

Crucially, the ECS helps regulate a broad range of physiological processes, including:

  • Sleep
  • Mood
  • Appetite
  • Digestion
  • Metabolism
  • Energy levels
  • Intestinal fortitude
  • Blood pressure
  • Immune activity
  • Bone density, remodeling, and growth
  • Muscle formation
  • Glucose metabolism
  • Liver function
  • Pain
  • Inflammation
  • Memory
  • Stress
  • Skin and nerve function
  • Reproduction and fertility

Unlike endocannabinoids and THC, CBD is unable to bind to the CB1 and CB2 receptors. Hence, scientists are unsure how CBD actually works. Some presume that it prevents endocannabinoids from breaking down, increasing their effect on the body. Others believe that it binds to a receptor they have yet to discover.

In nearly all pathological conditions, the endocannabinoid system fails to function correctly. By modulating the endocannabinoid system and preventing dysregulation, phytocannabinoids may help combat diseases and encourage healing processes.

The Therapeutic Characteristics Of CBD For Treating Anxiety

According to Harvard Health Publishing, CBD is commonly used to manage anxiety and may help with insomnia. Though many of the details are unknown, the general understanding is that CBD communicates with the nervous system to reduce heightened states of fight or flight.

A 2015 study reviewed 49 preclinical, clinical, and epidemiological cases and found substantial evidence supporting CBD as a treatment for multiple anxiety disorders. However, findings were based on putting healthy subjects under duress and measuring the impact of CBD on the body’s anxiety response. Healthy individuals may not respond to CBD treatments in the same way as those with anxiety disorders. The study acknowledged that further research, specifically clinical trials, is needed to verify efficacy and establish treatment plans.

Overall, current evidence indicates CBD has considerable potential as a treatment for multiple anxiety disorders, with need for further study of chronic and therapeutic effects in relevant clinical populations.

Cannabidiol as a Potential Treatment for Anxiety Disorders (09/04/2015)
Cannabidiol as a Potential Treatment for Anxiety Disorders (09/04/2015)
Effectiveness For Children With Anxiety

A commonly referenced study of a 10-year-old with PTSD found that CBD oil reduced her insomnia and helped combat feelings of anxiety. The journal article indicated several key findings, including:

  • The benefits of CBD in the case of PTSD likely stem from its anxiolytic and sleep-inducing effects.
  • CBD may block anxiety-induced rapid eye movement during altered sleep.
  • Animal studies also support CBD as a treatment for anxiety.

My granddaughter’s behaviors are definitely better being on the CBD. Her anxiety is not gone, but it is not as intense and she is much easier to be around. She now sleeps in her own room most of the time, which has never happened before.

Grandmother of 10-year-old case study subject
Grandmother of 10-year-old case study subject

Though research is promising and CBD may likely help with anxiety disorders, comprehensive knowledge is currently unavailable. Such setbacks are even more apparent when children are involved, as adequately controlled clinical trials are still ongoing and have yet to provide conclusive evidence.

Is CBD Safe For Consumers?

Most sources seem to agree that CBD doesn’t pose a safety threat when used either medically or recreationally. In fact, it’s even been postured as perfectly safe for adults. According to the World Health Organization, “CBD is generally well tolerated with a good safety profile.”

The 2018 World Health Organization’s Expert Committee on Drug Dependence Fortieth Meeting, Cannabidiol (CBD) Critical Review Report concluded:

  • In humans, CBD exhibits no effects indicative of any abuse or dependence potential.
  • CBD has been demonstrated as an effective treatment of epilepsy in several clinical trials.
  • There is preliminary evidence that CBD may be a valuable treatment for numerous medical treatments.

While research is promising, testing is still in the early stages. As an upcoming field, the absolute certainty of the safety or efficacy of CBD products is impossible.

What About For Children And Teenagers?

While CBD is likely safe for adults, the jury is still out when it comes to children. Emerging evidence seems to suggest that CBD may also be safe for children; however, parents are advised to err on the side of caution.

I don't suggest that anyone under age 21 use marijuana regularly. It's also not clear what the appropriate CBD dose is for children, and more research is needed in this area.

Dr. Donal Levy, medical director at the Osher Clinical Center and assistant clinical professor of medicine at Harvard Medical School
Dr. Donal Levy, medical director at the Osher Clinical Center and assistant clinical professor of medicine at Harvard Medical School

Unfortunately, research regarding CBD’s efficacy and applications is still in its infancy, slowed down by barriers caused by marijuana’s Schedule I classification. Outside of Epidiolex (prescription medication for severe forms of epilepsy), CBD products are not FDA-approved or regulated. Moreover, CBD products may contain varying amounts of THC, which has intoxicating properties with dangerous consequences, including addiction, and should never be administered to children.

The biggest problem is there’s a lot that we still need to know, especially in kids. . . .In regards to treating mental health disorders in children and adolescents, there’s a lack of evidence to support its use.

Dr. Paul Mitrani, clinical director at the Child Mind Institute
Dr. Paul Mitrani, clinical director at the Child Mind Institute
Potential Dangers Associated With CBD Consumption
  • 1

    Clinical vs General Consumption: During clinical trials, CBD is typically administered orally as a capsule or dissolved in an oil solution. However, CBD is available to consumers in many different forms. It stands to follow that research results may not extend to general consumption due to how the administration method may directly impact effects.

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    Inconclusive Research: Though research suggests that CBD is indeed safe for consumption, a lot of information concerning the details remains unknown. For instance, not much is understood about the amount of CBD delivered to the brain, especially when different methods of consumption have varying rates of delivery. Additionally, the lack of research in a relatively new field means that very few people are familiar with proper dosing.

     

     

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    Lack of Regulation: Lab testing isn’t mandatory for CBD products in every state, and they can contain harmful ingredients other than CBD. With no reliable certifications or guidelines, it’s near impossible for consumers to verify the safety of certain products. CBD products are also readily available to the masses online and contain a wide range of CBD concentrations. Such products are entirely unregulated, making it difficult for parents and other consumers to know for sure what ingredients they have.

     

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    Content Inconsistencies: Furthermore, a JAMA study revealed that labeling inaccuracies among CBD products led to them having more or less CBD than stated. The study also observed that mislabeled amounts of high THC content could produce intoxication or impairment, especially in children.

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    Tolerance: Not enough research has been conducted into the possible long-term side effects of CBD consumption. For instance, there is some concern that children may develop a tolerance, worsening conditions (such as problems with sleeping) when CBD treatment is unavailable or stopped.

  • 6

    Adverse Side-effects: CBD consumption may produce significant side-effects, including restlessness and inconsistent sleep. Drugs often affect people differently, and you should always keep an eye out for dangerous reactions.

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    Interactions: There are always risks involved with CBD consumption. Even with safe, high-quality products, consumers run the risk that an ingredient may interact poorly with other medications being metabolized in the liver. Thus, parents should never give their children CBD products if they are taking other medications without first consulting a doctor.

How Legal Is The Use Of CBD?

There have been continual advances toward legalizing cannabis products and CBD, but full legality remains a grey area. Along with dissonance between federal and state law, the source of CBD muddies the waters. For example, CBD products derived from hemp have a higher concentration of CBD, while marijuana has a higher concentration of THC. And while hemp is federally legal, marijuana is not.

CBD from hemp
  • Federally legal as long as products contain less than 0.3% THC
  • Some states restrict possession of hemp-derived CBD
CBD from marijuana
  • Federally illegal
  • Legal under some state laws

Understanding the difference between hemp and marijuana is crucial for abiding by federal and state laws. You can learn more about the specifics of state medical marijuana laws on the National Conference of State Legislatures website.

It's kind of ironic. With marijuana, we have got the federal government saying 'No' and a bunch of states saying 'Yeah, it's OK'—but with hemp, the feds say 'Yeah, it's OK,' but we still have some states saying it's not.

Sarah Lee Gossett Parrish, cannabis industry attorney
Sarah Lee Gossett Parrish, cannabis industry attorney
Is It Legal to Give CBD To Children?

All CBD products can contain some amount of THC, which is entirely illegal to give to children. Thus, providing children with CBD products may be considered illegal and morally ambiguous at best, especially when inaccurate labeling makes it difficult to determine how much THC a product actually contains. Take note, there are numerous cases in which Child Protective Services have been involved under accusations of child endangerment.

Some states where cannabis is decriminalized have also voted to protect parents and medical professionals who give their children hemp-derived CBD. For instance, school nurses in Colorado can legally treat students with non-smokable medical marijuana just like other prescription medications, so long as the student has a marijuana card and written permission from their parents and the school principal.

Advice For Parents Of Children With Anxiety Disorders

Children with anxiety disorders often experience feelings of shame and isolation. As a parent, you should start by validating and acknowledging their symptoms. Above all, make it undeniably apparent to them that they are not alone in dealing with their struggles, and you are with them every step of the way.

Typically, anxiety disorders are addressed with behavioral therapy. Multiple types of behavioral therapies are proven scientifically effective and are, therefore, the first-line treatment. However, figuring out an optimal treatment strategy can be challenging, as what works may change from person to person, depending on specific symptoms.

The top 3 types of therapy for treating anxiety
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    Cognitive-behavioral therapy (CBT) - Gain an understanding of thinking patterns and identify and replace negative thoughts and behaviors with positive ones. Flesh out unrealistic thoughts and learn skills and techniques to reduce anxiety.

     

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    Acceptance and commitment therapy (ACT) - Cope with unwanted thoughts, feelings, and sensations with strategies that utilize acceptance and mindfulness.

     

  • 3

     

    Dialectical behavioral therapy - Examine how to deal with intense negative emotion and conflict by taking responsibility for problems.

     

Therapy and prescription medication are often used simultaneously. For instance, major research studies have found that a combination of CBT and an antidepressant was more effective for children ages 7–17 years old than either treatment alone.

Theoretically, CBD can be used in conjunction with therapy for similar results. As therapy seeks to address underlying psychological issues leading to anxiety, CBD can help treat the physical symptoms.

My panic attacks started when I was eight years old. I would get really shaky and sweaty. I would hyperventilate and feel like I was getting smothered to death, like my lungs had closed up. My mother took me to see a psychologist, and it helped a lot. I can travel again and do things that a normal teenager can do. My family has seen a big difference, too.

Breanna, age 15
Breanna, age 15
How to Help Your Child With Their Anxiety in 5 Steps
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    Open up a dialogue - If you suspect that your child may be struggling with anxiety-related issues, start by having an honest discussion with your child. Your initial approach can shape your future conversations, so try to prioritize your child’s comfort. Embrace a non-judgemental, non-combative attitude that encourages them to speak their mind and reveal their innermost struggles. Let them know that the conversation is open-ended and that they can come to you for help at any time.

     

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    Identify symptoms and possible disorders - When speaking with your child, take mental note of their symptoms and piece together a picture of what they might indicate. Once you have a comprehensive idea of what your child is going through, conduct additional research about specific health conditions that match their symptoms. Keep an eye out for detailed information regarding relevant symptoms and treatments.

     

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    Set up an appointment with a professional - Finding the right therapist is crucial to the success of your child’s treatment. Conduct a search for a qualified, educated individual who also specializes in anxiety and working with children. Sometimes children can be put off if they have difficulty meshing with their therapist, discouraging them from opening up and seeking advice. As with all close relationships, it may take time to build trust and create vulnerability. Look for a professional who prioritizes creating a safe and inviting environment. Keep in mind, you may not find success with the first therapist you try. In such cases, assure your child that they will eventually find the right fit and to maintain hope.

     

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    Discuss the possibilities - Once you find the right fit, you’re ready to start the treatment process. The therapist will likely begin with a general evaluation to gauge your child’s situation. If they ask you for information, do not hesitate to describe all the potential symptoms you have observed in your child’s behavior. Honesty is truly the best policy. If progress is lacking or if their therapist suggests supplemental medication, ask them what they think of CBD and if it might be a viable option for your child’s condition. Don’t be afraid to get a second opinion if necessary.

     

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    Research brands and products (if applicable) - If it turns out that CBD could help your child, make sure you conduct research with due diligence. Collect information from multiple sources and do not trust retailers who have a vested interest in selling you products. Instead, talk to a cannabis-informed doctor who can provide you with pertinent information and monitor your child’s physical condition.

     

Should You Use CBD to Treat Your Child’s Anxiety?

Using CBD to treat children with anxiety disorders shows promise in terms of efficacy and safety; however, much is still unknown about potential hazards and correct dosages. Even more concerning is the lack of federal guidelines for CBD products, making it difficult for consumers to know exactly what they are ingesting. Thus, while CBD may be a plausible aid, it’s essential to be as informed as possible to avoid doing more harm than good.

If you choose to follow the CBD route for treatment, keep in mind that administering any drug can have adverse side effects. Stay attentive over time, and keep an eye on your child to see how the treatment is affecting them. Even when effective, CBD is not a magic fix. It is best used in conjunction with lifestyle changes and behavioral therapy to address the underlying issues. Before administering CBD to your child, you need to understand not only the risks and benefits, but also the nature of their specific anxiety disorder.

Conclusively, if your child is suffering from mild anxiety, engage in behavioral therapy and avoid using any form of drugs, including CBD. Cannabis research has a long way to go in regards to CBD and children. However, if your child suffers from an anxiety disorder that impacts their ability to function daily, consider CBD as an alternative to psychopharmaceuticals that are more dangerous and often have harmful side effects. Most importantly, supporting and staying abreast of recent and upcoming research or studies is the best way to make informed decisions when it comes to the mental and physical health of your child.

A lot of times people think CBD is a cure-all, and it's not," Dr. Chin says. "You should also have a healthy lifestyle with plenty of exercise and good nutrition—CBD is not going to fix everything.

Junella Chin, osteopathic physician and medical cannabis expert
Junella Chin, osteopathic physician and medical cannabis expert

Purchasing CBD Products, What You Should Know

  • Labeled products that allow you to see exactly how much THC they contain.
  • An FDA disclaimer. (Avoid any companies that claim to cure diseases.)
  • Warning text.
  • A batch number.
  • Third-party testing results.

The safest method of consuming CBD is orally (as a tablet or chewable) or tincture (a concentrated liquid). For CBD oil, you can check out our StayHonest product reviews, specifically our selections for anxiety and stress.

Resources For Parents

Sources

  • https://adaa.org/understanding-anxiety/facts-statistics
  • https://doi.org/10.33552/ANN.2019.05.000610
  • http://dx.doi.org/10.1037/pas0000570
  • https://doi.org/10.5041/RMMJ.10386
  • https://jamanetwork.com/journals/jama/fullarticle/2661569
  • https://www.nhs.uk/conditions/anxiety-disorders-in-children/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4355945/https://adaa.org/understanding-anxiety/co-occurring-disorders
  • https://parents.au.reachout.com/common-concerns/everyday-issues/stress-and-teenagers
  • https://www.developmentalscience.com/blog/2019/5/7/our-teens-are-more-stressed-than-ever
  • https://healthyfamilies.beyondblue.org.au/age-6-12/mental-health-conditions-in-children/anxiety
  • https://kidshealth.org/en/parents/anxiety-disorders.htmlhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4604171/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3662600/
  • https://paradigmtreatment.com/anxiety-teens-young-adults/social-media-addiction/
  • https://www.webmd.com/vitamins/ai/ingredientmono-1439/cannabidiol-cbd
  • https://www.health.harvard.edu/staying-healthy/cbd-products-are-everywhere-but-do-they-work