Frank Ezzo, Ph.D., ABPP, LLC, Author at Behavioral Wellness Group

ANXIETY IN KIDS AND TEENS

Frank Ezzo, Ph.D., ABPP, LLC — Wed, 22 Jul 2026 13:43:51 +0000

We all have worries and stress in our lives. Anxiety in young children at specific times in development is normal. For example, between the ages of about 8 months to preschool years (4-5) healthy kids may show intense distress at times of separation from their parents or other people they are close to. Young children may have short-lived fears, such as fear of the dark, storms, animals, or a fear of strangers. Worries, fears, and stress can become an anxiety disorder for children and teens when the fears interfere with their lives for more than four weeks. Children and teens might become more withdrawn, avoid certain activities- even resist going to school, be more irritable, have outbursts of crying or temper tantrums, and complain about feeling sick. Children and teens might be on edge, looking for perceived dangerous situations to avoid and consequently be tense and on guard.

How prevalent is anxiety in children and teens?

Data collected from 2021-2022 in Ohio determined that almost 12% of Ohio children, ages 3-17 had anxiety.¹ The Center for Disease Control (CDC) data from 2022-2023 found that an anxiety disorder was found in 2.3% of children ages 3-5, 9.2% of children 6-11, and 16% of children 12-17.²

What are the types of anxiety in children and teens?

Separation Anxiety Disorder: As referenced earlier, separation anxiety (not disorder) is a normal developmental phase. Separation Anxiety Disorder is extreme and continues beyond the typical developmental period. Kids may be worried about parents or other family members and have difficulty going to school or being away from home or may have difficulty falling asleep. If your child shows extreme distress with separations that is a sign to seek professional help.

Specific Phobias: Fear when in danger is good, fear helps us to survive. Specific phobias are extreme fears that are out of proportion with an actual threat of danger. A thunderstorm becomes a fear of a tornado, or any other circumstance that becomes catastrophized and blown out of proportion. For example, an intense fear of insects, a fear of elevators, escalators. Sometimes a child or teen will say “What if” this or that happens.

Social Anxiety: This is an intense fear of being judged or rejected in social situations. A child may avoid interacting with others at school or have a hard time speaking to people.

Generalized Anxiety Disorder: This is excessive worry or fear about a range of different things that happen in daily life. A child worries about the future more than other children.

Panic Disorder: A panic disorder is a type of anxiety that also has intense physical symptoms like a racing heart, dizziness, feeling like they can’t breathe. A panic “attack” can come without warning and can go away within minutes to hours.

What can I look for if I think my child has anxiety?

Some kids will say what they are afraid of: “I don’t want to go to school because the teacher might call on me in class?”
Worry and/or cries more than other kids
Complaints about being sick; upset stomach, headaches
Trouble sleeping, nightmares, does not want to sleep alone
Restless, jittery
Anger easily
Difficulty focusing
Shaking
Refusing to go to school
Uses the bathroom a lot

What causes anxiety?

Some kids are just more sensitive and might have a hard time coping with change. These kids may have a biological or family tendency to be anxious. Anxiety can also develop after stressful life events such as:

Death of someone close to them
Moving to a new house or school
Poverty: getting enough to eat, difficulty having a safe place to live
Parents who fight and argue, or separation/divorce
Abuse/neglect, bullying

Are there complications from anxiety?

Children with an anxiety disorder are at greater risk for depression and substance use disorders later life. There is also a higher risk for self-harm and suicide.

What can I do as a parent?

The 3-3-3 Rule: Name 3 things you can see. Name 3 things you can hear. Move 3 body parts. This strategy incorporates multiple senses, distracts from the thoughts causing anxiety, and grounds the child in the present moment. Make this playful, practice when not anxious.
Daily exercise
A safe and supportive home and school environment
Good sleep habits
Well balanced meals
Monitor screen time and social media
Teach meditation and breathing techniques: Here are some free apps:

Anxiety Free: iCan Hypnosis – Developed by hypnotherapist Donald MacKinnon, this app is designed to use self-hypnosis to help teach techniques for relaxation and altering subconscious thoughts.
Sanvello* – Designed to be used in conjunction with therapy, this app teaches deep breathing and behavioral exercises. Users learn how to identify negative thinking patterns and replace them with positive ones. It focuses on the cause of anxiety and personalizes itself using voice recordings.
Panic Relief*– This easy-to-use app uses evidence-based coping tools to help calm and safely move through a panic attack. Coping tools include muscle relaxation, rest, breathing and more.
Self-Help Anxiety Management*– This app for older teenagers and adults focuses on mindfulness, or self-awareness. It helps users understand the causes of their anxiety and aids in monitoring them. It focuses on anxious thoughts and behaviors, and provides exercises to deal with them and private reflection.
MindShift* – This app for adolescents and young adults teaches basic skills to manage anxiety disorders. It also helps manage performance anxiety, test anxiety and perfectionism. Users can choose among the coping strategies and “favorite” the methods that work for them. It also features a “Chill Out” tool, which uses breathing exercises, mental imagery and mindfulness. “Quick Tips” are included to assist with anxiety in the moment.
Stop, Breathe & Think- Another mindfulness-driven app, Stop, Breathe & Think uses the foundational methods of meditations. This app allows users to track feelings before and after meditation and view yoga videos. The goal is to offer the chance and skills to breathe and think. Meditations are goal-oriented and constructed to help users calm down.
Live OCD Free*– For children and adults with OCD, this app is designed to help aid cognitive behavioral treatment. It includes ERP (exposure response prevention) exercises and reminders, and offers personalization.
Breathe2Relax*– This is an app, by the National Center for Telehealth & Technology, teaches breathing techniques to manage stress. The pace can be personalized for what is most relaxing to the user and includes a map to track personal progress. It helps manage fight-or-flight responses during panic attacks, aids in mood stabilization and anger control.
Calm – Combining mindfulness and meditation to manage anxiety symptoms, this app is noted for its serene interface. It uses relaxing sounds and guided meditations to help the user stay calm.
7 Cups – This app functions as a confidential therapy chat room, allowing the user to talk about problems causing stress or panic, and connect with others dealing with anxiety disorders. It also has hundreds of mindfulness exercises and licensed therapists available.

What about professional help?

There are two main ways to treat child and teen anxiety: cognitive behavior therapy and medication therapy. Both of these treatments may work on their own, but they work better together; “pills don’t teach skills.”

The Behavioral Wellness Group has “one stop shopping” for help with your child or teen. We have therapists skilled in treating kids with anxiety, prescribers for medication, and if needed, an Intensive Outpatient Program (IOP) for Adolescents. Here is the link to our practice.

WEBSITE: https://behavioralwellnessgroup.com/

ADOLESCENT MENTAL HEALTH IOP: https://behavioralwellnessgroup.com/intensive-outpatient-programs/adolescent-iop/

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¹“Ohio Child Mental Health Project: Factors contributing to child and youth mental health struggles.” Health Policy Institute of Ohio, July 2025.

²Child and Adolescent Health Measurement Initiative. (2022-2023). National Survey of Children’s Health. Data Resource Center for Child and Adolescent Health supported by the U.S. Department of Health and Human Services, Health Resources and Services Administration (HRSA), Maternal and Child Health Bureau (MCHB).

Frank R. Ezzo, Ph.D., ABPP, LLC
The Behavioral Wellness Group
8224 Mentor Ave #208 Mentor OH 44060
P: 440 392 2222 #852 F: 440 565 2349
fezzo@behavioralwellnessgroup.com
www.behavioralwellnessgroup.com

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Is Childhood and Teen Depression Different than Adult Depression?

Frank Ezzo, Ph.D., ABPP, LLC — Thu, 09 Jul 2026 15:42:01 +0000

Yes. Depression often looks different in children and teens than it does in adults. In addition to sadness, loss of interest in activities, and withdrawal, children and teens may show intense irritability, anger, unexplained physical symptoms, sleep or appetite changes, or behavioral acting out. Symptoms can also differ between younger children and teens. Younger children may complain of headaches or stomachaches, refuse to go to school, become clingier with a parent, or have sudden severe tantrums or defiant behavior. In teens, depression may appear as social isolation, poor school performance, fatigue, or sudden changes in friendships. Although teens may withdraw from family, they may still spend time with a few close friends. High-risk behaviors, such as substance use or self-harm, can also be important warning signs.

How prevalent is depression in children and teens?

While depression was often seen as an adult problem, according to the Centers for Disease Control (CDC) based on data from 2022-2023, an estimated 4% of children between 3 and 17 years old have been diagnosed with depression (3% of males and 6% of females). If teen years are only taken into consideration, according to the National Institute of Mental Health 20.1% of the U.S. population aged 12-17 have had at least one episode of major depression. Depressive episodes were higher in females (29.2%) compared to males (11.5%).

What to watch for:

Behavior changes that last persistently for at least two weeks
Mood changes like sadness, feeling “sluggish,” irritability, anger
Loss of pleasure in previously enjoyed hobbies and activities
Insomnia or sleeping too much, chronic lack of energy
Excessive self-criticism or statements of worthlessness: “I can’t do anything right.”
Persistent hopeless or helpless attitude
Suicidal thoughts or self-harm (cutting)
Dramatic changes in grooming
Unusually erratic or impulsive behavior
Appetite changes: weight loss or weight gain
Preoccupation with song lyrics, books, poetry, or art that suggest that life is meaningless
Physical, digestive complaints

Teenage blues vs. Depression

A good rule of thumb to determine whether a teen is suffering from typical teenage moodiness or something more is to look at how their moods are affecting daily functioning in school, with friends, and family relationships. If you notice a drop in grades, increased isolation-doesn’t want to hang out with friends, spends most of his/her time in their room away from family, there is a cause for concern. A teen who is sad or moody but not really depressed will still go out with friends or participate in activities. If your child is feeling down most of the day for more than 2 weeks and is withdrawing from social relationships and activities he/she once enjoyed, depression could be to blame.

Risk factors for childhood and teen depression

Having issues that negatively impact self-esteem, such as obesity, peer problems, long-term bullying or academic problems
Having been the victim or witness of violence, such as physical or sexual abuse
Having other mental health conditions such as anxiety, attention-deficit hyperactivity disorder
Having a learning disability
Having certain personality traits such as low self-esteem. Or being overly dependent, self-critical or pessimistic
Being gay, lesbian, bisexual, or transgender in an unsupportive environment
Having a parent, grandparent or other blood relative with depression, or other behavioral health or substance use problems
Having a family member or relative who died by suicide
Having a family with major communication and relationship problems
Having experienced recent stressful life events, such as parental divorce, parental military service, death of a loved one, break up of a romantic relationship

Need help?

The Behavioral Wellness Group can help with evidence based individual and family therapy as well as an Intensive Outpatient Program for Adolescents:

www.behavioralwellnessgroup.com/intensive-outpatient-programs/adolescent-iop/

Our practice also has medication management for child and teen depression if needed.

Call us for an Intake Consultation at 440-392-2222 to help determine how we can best help your child/teen and family. their financial sacrifices, even if you have student loans, family are making sacrifices for your future.

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TIPS FOR COLLEGE STUDENTS

Frank Ezzo, Ph.D., ABPP, LLC — Mon, 29 Jun 2026 13:37:57 +0000

Preparing for college is an exciting milestone, but the transition from high school to higher education requires a shift in how you manage your time, money, and personal well-being. A successful college journey requires proactively establishing good habits: building structured routines, mastering practical life skills (like laundry and simple cooking), and actively advocating for yourself by using campus resources like office hours and tutoring centers.

The transition to college can be streamlined by categorizing your preparation into actionable, day-to-day strategies.

📚 Academic & Study Habits

Treat study as a full-time job: In college, you may only be in class for about 15 hours a week, but you are expected to spend roughly 35 hours studying outside of class. Treat this out-of-class time as a scheduled job. Most college students report studying about 10 to 17 hours per week. However, professors and the U.S. Department of Education expect students to dedicate roughly 2 to 3 hours outside of class for every 1 credit hour, which translates to a recommended 30 to 45 hours per week of total out-of-class study time for a full-time, 15-credit schedule.
Actual study time varies widely depending on your major, the nature of your classes, and whether you work.
The Academic Rule of Thumb: According to the CollegiateParent guide, you should budget 2 hours of study time for every 1 unit of a humanities or non-science course, and 3 hours for every 1 unit of a science course.
STEM vs. Humanities: Students in Engineering, Nursing, or Physics typically study longer—often 20 to 30+ hours a week—while those in certain Humanities or Education majors can average 10 hours or fewer.
Community Consensus: On platforms like Reddit, students acknowledge a massive discrepancy between faculty expectations and real-world study habits. Many note that heavy-reading classes or STEM lab work drastically push up their hourly totals, while other lighter seminar classes barely require any outside studying at all.
Always attend class & sit up front: Sitting in the first three rows keeps you engaged and helps your professors learn your face and name.
Utilize office hours: Your professors’ office hours are the ultimate “cheat code”. Going to ask questions, even if you don’t need help, is how you build relationships that lead to recommendations, research opportunities, and internships.
Avoid all-nighters: Cramming and pulling all-nighters are highly correlated with burnout and poor academic performance. Break large research papers and projects into smaller, manageable chunks.

🕒 Time Management & Organization

Adopt a scheduling tool: Whether you prefer a paper planner, Google Calendar, or the Notion app, map out your syllabi, deadlines, and study blocks the first week of the semester.
Prioritize active studying: Simply re-reading notes or highlighting your textbook is largely ineffective. Test your knowledge using Quizlet flashcards, summarize chapters in your own words, or explain difficult concepts to a classmate.

💳 Financial & Life Skills

Learn the basics before you leave: Make sure you are comfortable doing your own laundry, maintaining a bank account, and preparing a few simple meals before moving to campus.
Find student discounts: Shopping with an active university email can save you a significant amount on subscriptions, software, and gear.
Review legal and medical paperwork: Talk to your family about getting a Healthcare Proxy/Medical Power of Attorney, a HIPAA release form, and FERPA Waiver to ensure they can help you if an emergency arises while you are away at school.

🤝 Social & Campus Life

Go to the activities fair: The best way to make friends and build a community is by attending your school’s student organization or activities fair during orientation week. Join a few things, then narrow your focus to 1 or 2 core groups.
Communicate with roommates: Address living and cleaning expectations early. Set ground rules so that your dorm remains a comfortable and safe study and sleep space.
Friends: Make new friends by being honest, helpful, and supportive. These friendships will last a lifetime. Take romantic relationships slowly, don’t lose sight of a balance between academic responsibilities and romantic relationships. If a relationship ends, try to end it in a friendly manner. I advise not jumping from one romantic relationship to another. Your reputation is important.
Greek life: I favor fraternities and sororities that emphasize community service and not “partying.” Don’t follow the crowd; be an independent thinker and evaluate choices carefully.
Need more support: If extra mental health support is needed contact the college counseling center. Also, The Behavioral Wellness Group has a College Wellness Intensive Outpatient Program. https://behavioralwellnessgroup.com/intensive-outpatient-programs/college-mental-health-iop/

Family Life

As a college student you are semi-independent, sort of a transition into adulthood. Be respectful to your family and have gratitude for their financial sacrifices, even if you have student loans, family are making sacrifices for your future.

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Is There a Youth Mental Health Crisis?

Frank Ezzo, Ph.D., ABPP, LLC — Mon, 15 Jun 2026 14:00:19 +0000

The data is compelling that there is a Youth Mental Health Crisis. The Centers for Disease Control (CDC), The World Health Organization (WHO), the United States Department of Health and Human Services, and professional organizations like the American Academy of Child and Adolescent Psychiatry, and the American Psychological Association all agree that children and high school students who are feeling sad and hopeless increased significantly over the last ten years.

Adolescent mental health was already worsening prior to the COVID-19 pandemic. A troubling pattern of suicidal thoughts and behaviors are increasing for many high school students with female and LGBTQ+ students at greater risk for persistent feelings of sadness and hopelessness.

But what about my child? Mental health is shaped by several factors: biological factors, including genes and brain chemistry; environmental and life experience factors such as poverty, losses, school stress, peer relationships/bullying, adverse child events often referred to as ACES (neglect, abuse, and other trauma-related events), parental divorce and interparental conflict.

How do I know my child is experiencing mental health struggles? Look for changes in behavior, lifestyle, friends: sleeping more/more difficulty sleeping, appetite changes, mood changes from becoming more withdrawn to more irritable, drop in grades at school, does not want to participate or enjoy activities that they used to enjoy or participate in.

What to do? Have open and honest conversations with your child/teen; listen instead of reacting, model this with your own behavior by talking about emotions and problem-solving strategies. Encourage connections with friends and family, monitor the amount of time spent on/with social media, video games, and other technologies. Provide a stable and predictable home environment, model stress management and problem solving.

How do I know my child/teen has a mental health problem or is just being a teenager? The acronym FIND can be helpful.

F=Frequency of concerning behaviors and moods/how often are they, 1-2 times a month or
more days than not;
I=Intensity of emotions and behavior, are reactions to stress, rules/limits, changes out of
proportion to the event;
N=Number of problem behaviors observed (irritability/anger, withdrawn, appetite, sleep);
and
D=Duration, how long have these changes been going on?

Need Help? Call The Behavioral Wellness Group at 440-392-2222 to talk with one of our Intake Specialists. We will listen to your concerns, ask some questions, and help you match with one of our mental health providers.

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TOURETTE’S DISORDER AND TICS

Frank Ezzo, Ph.D., ABPP, LLC — Mon, 08 Jun 2026 13:30:07 +0000

• Tics are uncontrolled body movements or vocal utterances

• Tics are most common in children with an estimated 20% of kids experiencing transient tics that clear up on their own. Tics that last less than a year fall under the category of “Provisional Tic Disorder.”

• Tics often improve with age and experts suspect brain maturation plays a role.

• About 10 to 15% of people with Tourette’s Disorder display inappropriate utterances of obscenities or slurs.

• A parent who becomes upset or distressed over their child having tics and might cut them slack by saying “You don’t have to do your homework tonight” only reinforces the tics.

• Reassuring parents and kids that tics are not dangerous medical condition and they will see improvement with age gives parents and children hope.

Behavioral Treatment for Tics

• Behavioral Treatment called Cognitive Behavioral Intervention for Tics (CBIT) is the gold standard of treatment. There are three components: 1. Learn to become more self-aware of tics and the preceding urge that sometimes arises before the tics; 2. Help learn a competing response, which makes the tic more difficult. For example, if the tic involves jerking your head back, a competing response would be to tuck your chin, straighten your neck, and hold that position; 3. Figure out what situations tend to make tics worse or to reinforce them and change the circumstances.

• TicHelper is an on-line self-help version of CBIT that walks kids and families through the intervention

• About half of kids and most adults who try CBIT do not respond or partially respond, therefore an alternative approach is Exposure and Response Prevention (ERP). This involves learning to tolerate the urge to tic-exposing yourself to situations that may trigger tics and learning to relax with deep breathing and progressive muscle relation.

• Mindfulness exercises and distress tolerance practices are part of mindfulness. Using images such as the urge to tic as an ocean wave and let the wave crest and collapse on the shore. Tics increase with excitement and stress and improve with calm, focused activities.

• People with chronic tics have an overconnected corticostriatal sensorimotor circuit that links the cortex to deep motor structures in the brain. They also have underactive inhibitory circuits and overactive limbic circuits. Interventions like CBIT helps strengthen the prefrontal inhibitory circuits.

• Tics can appear alongside other disorders such as obsessive-compulsive disorder (OCD) or Attention Deficit Hyperactivity Disorder (ADHD). A thorough diagnostic session is necessary to identify other coexisting diagnoses. Anxiety disorders can worsen tics, as well as depression. Life stressors can worsen tics, for example, a difficult Calculus Class, transitioning to college or a job, a divorce, being bullied.

• Lifestyle: exercise, good sleep habits, daily routines—things that you can control.

Source: Monitor on Psychology. June 2026. Stephanie Pappas. Pages: 33-37.

Another source: Nix your tics! Eliminate Unwanted tic symptoms” A how-to-guide for young people (2^nd ed.) B. Duncan McKinlay.

One last comment. We may suggest a referral for medication, but will leave specific medication recommendations to the expertise of the Prescriber.

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