Anxiety in Adolescents

1. Anxiety in Adolescents Julie Ryan, M.A. & Carrie Masia, Ph.D. NYU Child Study Center NYU School of Medicine

2. Facts about Anxiety Disorders • Anxiety is the most prevalent problem in children and adolescents • Begins early • High co-occurrance of anxiety disorders, and with depression • Persistent when untreated • Risk for negative long-term consequences when untreated

3. Consequences of Anxiety in Youth • Personal: low self-concept, feelings of helplessness, somatic complaints, delayed progress in meeting developmental tasks • Academic: concentration and attention difficulties, falling behind in school, difficulty participating in class • Social: difficulty initiating or sustaining friendships • Familial: increased family stress, fighting, struggles

4. Why is it difficult to identify anxiety in youth? • Children often do not disclose problems to parents or school personnel • Families may not view anxiety as serious • Externalizing problems identified more easily: internalizing disorders are often overlooked

5. Anxiety Disorders in Teenagers • Social Anxiety Disorder (Social phobia) • Obsessive Compulsive Disorder • Separation Anxiety Disorder • Generalized Anxiety Disorder • Panic Disorder • School refusal

6. Social Anxiety Disorder (Social phobia) • Fear of public humiliation, negative evaluation, or embarrassment • Intense fear of social and performance situations • Fear embarrassing themselves or be negatively evaluated • Fears situations such as: • unstructured interactions with peers • initiating conversations • performing in front of others • inviting others to get together • Eating in front of others

7. Social Anxiety Disorder (Social phobia) • Minimal interaction and conversation with peers • Appears isolated and on the fringes of the group • May sit alone in the library or cafeteria, hang back, • Excessive shyness • Difficulty with public speaking, reading aloud, being called on in class, gym class – may impair grades • Anticipation of a social event may provoke a panic attack

8. Generalized Anxiety Disorder • Excessive and uncontrollable worry about school, grades, performance, future, family, health, finances • "What if" concerns that span far into the future • Physical symptoms: headaches, stomachaches, inability to unwind/relax • Difficulty concentrating, always thinking what's next • Low risk-taking; Need for reassurance and approval for small steps

9. G.A.D. - More Worries • Perfectionism, fear of making mistakes, unrealistic, unfavorable assessment of their grades, abilities • Over-responsibility: if disaster happens that it's their fault • Negative news that happens to others, fears will happen to them; everything is contagious by association: divorce, illness, car accidents, food poisoning • Sleep difficulties, irritability, fatigue

10. Obsessive Compulsive Disorder • Obsessions are recurrent, intrusive, uncontrollable thoughts, images, or urges that result in anxiety and discomfort • Typically these thoughts, images, and urges are resisted • Compulsions are behaviors that are performed to suppress the obsessions and reduce the anxiety and discomfort, providing relief • Some common types of compulsions: • Cleaning or Washing • Checking rituals • Repeating a phrase a specific number of times

11. Panic Disorder • Experience of unexpected panic attack (i.e., a false alarm) • Symptoms- e.g. heart racing, difficulty breathing, dizziness, sweating, trembling, fear of loosing control or “going crazy” • Develop anxiety, worry, or fear about having another attack or its implications • Symptoms and concern about another attack persists for one month or more • Can sometimes lead to Agoraphobia – a fear or avoidance of situations/events associated with panic

12. Specific Phobias • Extreme and irrational fear of a specific object or situation • Markedly interferes with one's ability to function • May recognize fears are unreasonable, but go to great lengths to avoid the feared object or situation Types of phobias • Blood-injury-injection phobia (e.g., getting blood taken, needles) • Situational phobia – (e.g., planes, subways) • Natural environment phobia – (e.g., heights, storms) • Animal phobia – (e.g., dogs, snakes, spiders) • Other phobias – Do not fit into the other categories (e.g., fear of choking, vomiting)

13. Separation Anxiety Disorder • Worry about harm of self or parent, often leads to school refusal • Excessive distress when separated from their parent. Often they will beg or please for their parent to stay. • Their worry center around harm befalling themselves or attachment figures (being kidknapped, parent in accident) • Sometimes child refuses to go school or to camp • They can be fearful to be alone at home or to walk alone • Nightmares with theme of separation • Complaints of physical symptoms when separation occurs or is anticipated

14. School Refusal • Refuse to attend school and/or have trouble remaining in class an entire day OR Rarely miss school but attend with a lot of distress. • Separation anxiety • Worry • Withdrawal • Shyness, social anxiety • Depression • Fears • Repeated Reassurance seeking • Physical complaints • Complaints about teacher or peers • Sleep disturbance • Temper outbursts • Verbal or physical aggression • In younger children • Clinging, Crying or whining before school • Delaying in dressing/preparing for school

15. Anxiety and the School Setting • Many Aspects of the School Setting May Induce Anxiety • Separation from Family • Social Interaction • Social Evaluation • Performance Evaluation • Potential Threats

16. The Nature of Anxiety Disorders • Three components • Behavioral • Cognitive • Physiological I am going to fail the test

17. THE FOUR Ds • Disproportion--Excessive and well out of proportion to the context or situational trigger • Disruption--Interferes with ability to function or with quality of life • Distress—Burdensome and bothersome • Duration– Consistent over a period of time

18. Parents and Teachers-Reinforce but don’t rescue • Encourage child to solve his or her problems. Have child generate a list of ways to handle concerns. Assist child with choosing realistic and helpful ways to solve a problem • If you solve the problem, child is prevented from learning to manage stress on his or her own • When child does something you like, tell him or her!

19. Tips for Teachers • Keep an eye out for anxiety symptoms • Refer the student to get more help • Peer-pairing for anxious youth or new students • Subtle reinforcement for socially anxious youth • Systematic ignoring and attending • Focus on problem solving: Socratic method

20. Treatments for Anxiety • Therapies • Family therapy • Cognitive Behavioral therapy • Interpersonal Psychotherapy • Group and Individual therapy • Medication