Teen Anxiety

Today's topic is anxiety in childhood and adolescence or, how to make the "boogey man" go away. In actuality, anxiety disorders are pretty common among children and adolescents. According to National Institute of Mental Health estimates, each year 13 percent of our young people suffer from anxiety.

Of course everybody, including every child, experiences some anxiety some of the time. This goes with the normal ups and downs of life. Basically, normal anxiety may be distressing, but it is typically not disabling. Disabling anxiety causes a disruption of essential everyday activities, like home and family, school, or socializing and play. When the various symptoms are severe enough or cause enough disruption, then we may diagnose an anxiety disorder and, depending upon its causes and characteristics, select treatments that are likely to help.

What are the main anxiety disorders that affect children and teens?

There are several that I think are important to discuss. The first one chat comes up is the one that we usually see first in our kids — Separation Anxiety Disorder. As many as 4 percent of children and adolescents suffer from Separation Anxiety Disorder, being unable to part with a parent or the safety of home without excessive worry and distress. Accompanying thoughts include fears that family members will be killed, get lost, or not return to them or that they will be taken away. They may complain of nightmares, stomachaches, or be unable to fall asleep alone. This can result in reluctance to go to school or other places and can make it difficult to form necessary social relationships outside of the family.

A second condition is called Generalized Anxiety Disorder, or GAD. In Generalized Anxiety Disorder, the major symptoms are excessive anxiety and apprehension about events or activities. Checklist items include, restlessness, fatigability, poor concentration, irritability, tension, and sleep difficulties. In adult studies we find about 5 percent of the population qualify for a GAD diagnosis, and over half of adults with GAD had it during childhood.

A third and common childhood anxiety is called Social Phobia, involving anxieties related to being in public with other people, especially in anticipation of being the object of attention or scrutiny. "Performance anxiety" is a variation of this condition. The child or adolescent may initially seem shy or dislike new situations, complaining of fears of embarrassment, humiliation, acting stupid, and so on. When faced with exposure to a socially feared situation, he or she freezes up and attempts to avoid or get out of the situation. Research findings suggest a 4 to 5 times' increase in adult Social Phobia when it was initially diagnosed during childhood. Although as many as 20 percent of individuals express fear of speaking in public, far fewer — about 2 percent qualify for a diagnosis of a phobic disorder.

What causes childhood anxiety disorders and how can we help?

Some anxiety disorders seem to be related to exposure to stressful events, losses, or traumas. Some conditions appear more commonly in very close knit families, as is the case with Separation Anxiety. Some anxiety seems to be at least partially learned from parents who may suffer from anxiety disorders and sometimes model ineffective styles for coping. Finally, there's increasing evidence of neural network problems, for example, in OCD research, where some areas of the brain may be more sensitized in anxiety sufferers.

The assessment of anxiety is sometimes more difficult with children, who are less verbal and articulate about their internal states. So we have to watch their behavior and physical expressions and listen for signs of anxiety in their stories or other verbal communications. Anxieties can be revealed as much by avoidant and compliant behavior as it can by hand-wringing or complaints of headaches or a child pretending he or she would rather stay home than go to a party or a sleep-over.

There are several effective methods for treating all these anxiety disorders in young people. First, a lot of anxiety is learned or the result of mislabeling and over-reacting, so I recommend that treatment be initially focused to assist kids to reassess their experiences to encourage a more positive self-interpretation. The second step is to teach relaxation skills, so that young people can learn how to modify their own mental states by breathing and muscle relaxation strategies. A third strategy employs social problem solving: learning how to identify and diffuse anxious situations — the latter approach works better for teens, but can be modified for youngsters. Finally, there are an increasing number of medications designed for adults but found to be useful in child psychiatry. I know that there's a lot of controversy going on about prescribing adult meds for children, but in some instances and with careful monitoring it might help.

What can parents do?

As parents, we can begin by re-examining our own attitudes and ways of coping with fears and anxieties in our lives. We can accept that we teach by example as well as by our words. We can let our children know that we also experience moments of fear and that we are successful getting through them because we believe in ourselves and that we know that fear and anxiety are transient states. Words of reassurance and sharing stories of successful coping show our young people that we believe in their emerging ability to face the uncertainties of life.

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