Anxiety in TeenagersAnxiety in Teenagers

*Developed by the Center for School Mental Health

(http://csmh.umaryland.edu) in collaboration with

the Maryland School Mental Health Alliance.

Facts about AnxietyFacts about Anxiety• Anxiety disorders are among the most common mental,

emotional, and behavioral problems to occur

• About 13 of every 100 children and adolescents ages 9 to 17 experience some kind of anxiety disorder

• Girls are affected more than boys. About 50% of children and adolescents with anxiety disorders have a 2nd anxiety disorder or other mental/behavioral disorder

• Anxiety disorders may coexist with physical health conditions as well

Brief DefinitionBrief Definition• Anxiety is a general feeling of Anxiety is a general feeling of

apprehension or worry and is a normal apprehension or worry and is a normal reaction to stressful situations reaction to stressful situations

• Red flagsRed flags should go up when the should go up when the feelings become excessive, thoughts feelings become excessive, thoughts become irrational and everyday become irrational and everyday functioning is debilitated functioning is debilitated

• Anxiety disorders are characterized by Anxiety disorders are characterized by excessive feelings of panic, fear, or excessive feelings of panic, fear, or irrational discomfort in everyday irrational discomfort in everyday situationssituations

Production of fear and anxietyProduction of fear and anxiety

• Using brain imaging and neurochemical Using brain imaging and neurochemical techniques several parts of the brain have techniques several parts of the brain have been identified as key in the been identified as key in the production of fear and anxietyproduction of fear and anxiety

• Two main components involved are the Two main components involved are the amygdala and the hippocampusamygdala and the hippocampus

– AmygdalaAmygdala- Emotional memories are stored - Emotional memories are stored here and alerts brain that a threat is present here and alerts brain that a threat is present

– HippocampusHippocampus- Encodes specific threatening - Encodes specific threatening events into memories events into memories

How Anxiety is ManifestedHow Anxiety is Manifested

• Students may feel a sense of dreadStudents may feel a sense of dread

• Have fears of impending doomHave fears of impending doom

• Experience a sense of suffocationExperience a sense of suffocation

• Anticipation of unarticulated Anticipation of unarticulated catastrophecatastrophe

• Loss of control over their breath, Loss of control over their breath, swallowing, speech, and coordinationswallowing, speech, and coordination

• Somatic ComplaintsSomatic Complaints

Types of Anxiety DisordersTypes of Anxiety Disorders

• Generalized Anxiety Disorder (GAD)Generalized Anxiety Disorder (GAD)– GAD results in students experiencing six months or GAD results in students experiencing six months or

more of persistent, irrational and extreme worry, more of persistent, irrational and extreme worry, causing insomnia, headaches, and irritability. causing insomnia, headaches, and irritability.

• Post-Traumatic Stress Disorder (PTSD)Post-Traumatic Stress Disorder (PTSD)– PTSD can follow an exposure to a traumatic event such PTSD can follow an exposure to a traumatic event such

as natural disasters, sexual or physical assaults, or the as natural disasters, sexual or physical assaults, or the death of a loved one. Three main symptoms: reliving death of a loved one. Three main symptoms: reliving of the traumatic event, avoidance behaviors and of the traumatic event, avoidance behaviors and emotional numbing, and physiological arousal such as emotional numbing, and physiological arousal such as difficulty sleeping, irritability or poor concentration. difficulty sleeping, irritability or poor concentration.

• Panic DisordersPanic Disorders– Characterized by unpredictable panic attacks, which are Characterized by unpredictable panic attacks, which are

episodes of intense fear, physiological arousal, and episodes of intense fear, physiological arousal, and escape behaviors. escape behaviors. Common symptomsCommon symptoms: heart : heart palpitations, shortness of breath, dizziness and anxiety palpitations, shortness of breath, dizziness and anxiety and these symptoms are often confused with those of a and these symptoms are often confused with those of a heart attackheart attack..

• Specific PhobiasSpecific Phobias– Intense fear reaction to a specific object or situation Intense fear reaction to a specific object or situation

(such as spiders, dogs, or heights) which often leads to (such as spiders, dogs, or heights) which often leads to avoidance behavior. The level of fear is usually avoidance behavior. The level of fear is usually inappropriate to the situation and is recognized by the inappropriate to the situation and is recognized by the sufferer as being irrational sufferer as being irrational

Disorders continued….Disorders continued….• Social Phobia

– Extreme anxiety about being judged by others or behaving in a way that might cause embarrassment or ridicule and may lead to avoidance behavior.

• Separation Anxiety Disorder– Intense anxiety associated with being away from

caregivers, results in youths clinging to parents or refusing to do daily activities such as going to school.

• Obsessive-Compulsive Disorder (OCD)– Students may be plagued by persistent, recurring

thoughts (obsessions) and engage in compulsive ritualistic behaviors in order to reduce the anxiety associated with these obsessions (e.g. constant hand washing).

ComorbidityComorbidity

• Comorbid diagnoses of depressive Comorbid diagnoses of depressive disorders, ADHD, and other anxiety disorders, ADHD, and other anxiety disorders are common in anxiety patients. disorders are common in anxiety patients.

• Symptoms that may appear to be ADHD:Symptoms that may appear to be ADHD:– Restlessness, feeling keyed up or on edgeRestlessness, feeling keyed up or on edge– Difficulty concentrating, mind going blankDifficulty concentrating, mind going blank– IrritabilityIrritability– Clinically significant distress or Clinically significant distress or

impairment in social or academic areasimpairment in social or academic areas

Comorbidity continued….. Comorbidity continued…..

• Adolescents with substance use Adolescents with substance use disorders (SUD) especially exhibit a disorders (SUD) especially exhibit a high prevalence of psychiatric high prevalence of psychiatric problems compared to the general problems compared to the general population population

• Many teens (as well as adults) Many teens (as well as adults) believe that drugs and alcohol may believe that drugs and alcohol may alleviate anxiety and stressalleviate anxiety and stress

Effective Ways to Treat AnxietyEffective Ways to Treat Anxiety

• Cognitive-behavioral treatment( young Cognitive-behavioral treatment( young people learn to deal with fears by modifying people learn to deal with fears by modifying the ways they think and behave)the ways they think and behave)

• Relaxation techniquesRelaxation techniques

• Biofeedback (to control stress and muscle Biofeedback (to control stress and muscle tension)tension)

• Family therapyFamily therapy

• Parent trainingParent training

• MedicationMedication

Effects of AnxietyEffects of Anxiety

• School failure School failure

• Absenteeism Absenteeism

• Classroom disruption Classroom disruption

• The inability to complete basic tasksThe inability to complete basic tasks

• Family stress Family stress

• Impaired social relationshipsImpaired social relationships

Strategies for Dealing with Strategies for Dealing with Anxious StudentsAnxious Students

• Because transitions and separation are frequently Because transitions and separation are frequently difficult for children with anxiety disorders, difficult for children with anxiety disorders, accommodate student’s late arrival and provide extra accommodate student’s late arrival and provide extra time for changing activities and locations.time for changing activities and locations.

• Recognize that often it is a youth’s anxiety that Recognize that often it is a youth’s anxiety that causes him or her to disregard directions, rather than causes him or her to disregard directions, rather than an intentional desire to be oppositional. an intentional desire to be oppositional.

• Develop a “safe” place where the youth can go to Develop a “safe” place where the youth can go to relieve anxiety during stressful times or provide relieve anxiety during stressful times or provide calming activities. calming activities.

• Encourage the development of relaxation techniques Encourage the development of relaxation techniques that can work in the school setting. Often these can that can work in the school setting. Often these can be adapted from those that are effective at home. be adapted from those that are effective at home.

• Work with a child regarding class Work with a child regarding class participation and answering questions on the participation and answering questions on the board, understanding that many anxious board, understanding that many anxious youth fear answering incorrectly.youth fear answering incorrectly.

• Encourage small group interactions and Encourage small group interactions and provide assistance in increasing competency provide assistance in increasing competency and developing peer relationships.and developing peer relationships.

• Reward the student’s efforts. Reward the student’s efforts. • Provide an organized, calming, and Provide an organized, calming, and

supportive environment. supportive environment. • For maximum effectiveness, foster feedback For maximum effectiveness, foster feedback

from youths about these interventionsfrom youths about these interventions

Strategies continued…..Strategies continued…..

• It is important for behaviors to be It is important for behaviors to be reinforced at home as well as in reinforced at home as well as in school therefore parents should be school therefore parents should be involved in the treatment processinvolved in the treatment process

Resources for EducatorsResources for Educators• PsychCentralPsychCentral

http://psychcentral.com/disorders/anxietyhttp://psychcentral.com/disorders/anxiety

• National Institute of Mental Health National Institute of Mental Health

http://http://www.nimh.nih.gov/HealthInformation/anxietymenu.cfmwww.nimh.nih.gov/HealthInformation/anxietymenu.cfm

• Anxiety Disorders Association of AmericaAnxiety Disorders Association of America

http://http://www.adaa.orgwww.adaa.org//

• NYU Child Study Center NYU Child Study Center http://www.aboutourkids.org/aboutour/articles/sub_abushttp://www.aboutourkids.org/aboutour/articles/sub_abuse.htmle.html

• DSM-IV Diagnosis in the Schools(2002) ~~ Alvin E. DSM-IV Diagnosis in the Schools(2002) ~~ Alvin E. House House

*Developed by the Center for School Mental Health (http://csmh.umaryland.edu)

in collaboration with the Maryland School Mental Health Alliance