A child and adolescent psychiatrist explains how to spot the symptoms and support teens with anxiety.
From friendships to family dynamics, extracurriculars to exams, teens have a lot on their plates. When anxiety is added to the mix, daily life can begin to feel overwhelming. Dr. Kathryn L. Jones, a child and adolescent psychiatrist at Virginia Treatment Center for Children, helps children and teens struggling with anxiety and offers some insight into why it happens, what they’re feeling and how to help.
7 questions and answers about anxiety with child and adolescent psychiatrist Dr. Kathryn L. Jones
How common is anxiety among teens, and does it seem to be increasing?
Anxiety is extremely common among teens…and everyone else. When I’m teaching medical students about anxiety, I tell them to look to their right, to their left, to the front of the room (where I’m lecturing), to the back of the room and in the mirror, and they will surely see multiple individuals with anxiety.
As with many psychiatric diagnoses, anxiety is likely not increasing in terms of absolute numbers. We’re more likely to recognize the symptoms and to call what we are feeling or what we observe in others to be anxiety. We’re also more likely to seek help and medical attention, in no small part because stigmatization of mental health diagnoses has decreased over time, particularly with movie stars, musicians and influencers sharing their experiences with a plethora of mental health disorders, including anxiety.
What factors contribute to anxiety in teens?
Genetics (whether parents and other relatives struggle with anxiety) and temperament (how a child sees the world and their level of comfort exploring it) are examples of intrinsic, biological and psychological factors that can predispose a child to become an anxious teen.
Extrinsic or environmental factors are also significant. We live in a highly connected, fast-paced, information-rich and information-skewed world, with decreasing amounts of privacy. In contrast, our nervous systems evolved in a different environment with different threats, where anxiety might have kept us alive in dangerous situations. We also live in a constantly changing world socially, culturally and geopolitically; one where we have or believe we have decreasing amounts of control over what will happen to us.
What are some indicators that a teen’s anxiety and stress are more than what may be considered typical for someone their age?
A key indicator that a teen's anxiety or stress is disproportionate to their age, stage of development or situation is that the anxiety is interfering with multiple domains of their life – family relationships, friendships, academic performance, self-esteem. Sometimes we’ll see teens regress in their development, becoming more child-like, clingy and fearful in an effort to convey the extent of their anxious distress. Other teens may mask anxiety out of fear of ridicule for being perceived as weak.
For boys and male-identifying teens in particular, anxiety may present as anger and aggression, which makes sense when we think about culturally bound ideas about masculinity. It can be more comfortable and anxiety-relieving to be angry than to feel scared, stressed and overwhelmed.
Are there other conditions that can contribute to a teen’s anxiety?
There are medical conditions that can be associated with increased anxiety, or that can give physical symptoms indistinguishable from those caused by a primary anxiety disorder. These include hyperthyroidism (when your thyroid gland makes too much thyroid hormone), certain cardiovascular and pulmonary conditions (angina, heart attacks, uncontrolled asthma) and ingestions (too much caffeine or energy drinks).
Some of the medications psychiatrists prescribe for depression and attention-deficit hyperactivity disorder can also increase the risk of developing anxiety, including stimulant medications (Concerta, Adderall, etc.) and anti-depressants (Wellbutrin, Prozac, Effexor, etc.)
If a teen doesn’t verbalize it, what are some signs they may be struggling with anxiety?
Warning signs a child or teen is struggling with anxiety include:
- Increased isolation – not spending time outside of their bedrooms when at home, not wanting to leave the house
- Avoiding certain activities or places, such as school
- Changes in mood or behavior – increased irritability, shorter temper, more emotionality and tearfulness, regression with more child-like presentation
They may not even be aware that they’re acting differently, and may need parents or other trusted adults to point the changes out in a loving, curious, nonjudgemental way.
How can a parent help a teen who struggles with daily anxiety?
If your teen struggles with chronic anxiety, the first and best intervention is being present, listening and validating their feelings. You may need to help them name the emotion; sometimes it can be helpful to ask where in their body they feel discomfort when anxious so they can start to make the connection between the physical sensation and the emotional state.
Some kids and teens find expressions of physical affection, such as hugs or back rubs, to be soothing and supportive, while others dislike this so intensely that it can make their anxiety worse. Try offering physical touch, while respecting their bodily autonomy.
Some teens need more than emotional support and psychological safety to manage their anxiety. In these cases, we know that cognitive behavioral therapy, or CBT, is extremely effective. It focuses on identifying relationships between thoughts, feelings and behaviors – and making changes to respond in more effective ways. CBT can often be more effective than medications, although the combination is often most helpful for reducing symptoms and improving quality of life. If CBT is not available or the structure isn’t working, any kind of therapy where there is a positive therapeutic relationship is better than nothing at all. Therapists may also provide insights as to whether a medication might be helpful for the child's function and their ability to participate in and learn from therapy.
How about anxiety related to a specific event, such as a test or performance?
Performance and test-taking anxiety are extremely common subtypes of anxiety, as are phobias (like fear of flying, heights or frogs – my personal phobia). Therapy with exposure response prevention, or ERP, is an effective treatment for this. The therapist helps the child or teen practice tolerating the feelings of anxiety under the fear-producing conditions so they can practice coping skills and call upon them in the future.
There is also a role for medications that are not scheduled for every day, but might be taken 30 minutes before giving a presentation or sitting down to take an exam. We recommend these medications be used sparingly as some can become habit-forming and cause greater problems down the road than the anxiety itself.
Admitting to anxiety can be a scary step to take for any child or teen, and it's up to us as adults to be supportive and not stigmatize seeking help.