Adolescence

Currently adolescents make up 16 per cent of the world’s population.  That equates to 1.3 billion adolescents worldwide (UNICEF, 2022a).  Adolescence is the developmental growth between childhood and adulthood (Csikszentmihalyi, 2021).  It is defined as anyone aged between 10 and 19 years of age (Csikszentmihalyi, 2021).  During the transition from childhood to adolescence, teenagers experience puberty, producing hormonal changes effecting emotional, physical, social and psychological growth (Raising Children Network, 2021b).  They are beginning to find independence, develop their own identity and form new relationships (CDC, 2021e).  With adolescence comes exploration and risk taking.  Teens experiment with alcohol and drugs, becoming sexually active, experiencing mood and metal health disruptions, questioning authority and disengaging from school (ReachOut, 2022a). In today’s society, anxiety is a frequently diagnosed mental health factor among teens.

According to the National Institutes of Health, nearly 1 in 3 of all adolescents ages 13 to 18 will experience an anxiety disorder (McCarthy, 2019). These numbers have been rising steadily; between 2007 and 2012, anxiety disorders in children and teens went up 20% (McCarthy, 2019).

Anxiety

Anxiety triggers the fight or flight response when individuals are faced with challenging, stressful and intimidating situations (Lyness, 2022).  The body is overwhelmed by tense feelings of dread, a person’s heart begins to race and they may find it difficult to physically, emotionally, psychologically and cognitively manage the situation (Health Direct, 2020a).  Anxiety can have an adverse effect on the development of teenagers schooling, socialisation and ability to function in everyday life (Healthdirect, 2020b). Anxiety underpins many disorders such as phobias, separation, social panic, Obsessive Compulsive Disorder (OCD), Post traumatic stress disorder (PTSD) and Generalised Anxiety Disorder (Healthline, 2018).  Each disorder involves similar symptoms, apprehension and avoidant behaviours (Wicks-Nelson & Israel, 2015).

Phobia is the fear of something that may pose little or no threat (Lewis, 2020).  Phobias include but are not limited to, the fear of heights, animals, blood and flying (MentalHealth.gov, 2022).  Separation anxiety disorder is one type of anxiety disorder. This form of anxiety is described as a feeling of extreme distress when a child is away from their parent or guardian. There are two kinds of separation, normal separation and separation disorder.  Separation disorder is more intense with the child unable to participate in normal activities, becoming anxious at just the thought of being away from their parent and becoming physically sick, often missing school (Helpguide, 2022).  Social anxiety is the fear of being judged or scrutinised negatively for doing or saying things, and acting anxious in social settings such as public speaking, meeting and engaging with new people, going out in public, speaking to adults and being placed in new situations or environments (Kids Helpline, 2022).  This fear can play a negative factor in building relationships, participating in educational learning and future employment and careers (Kids Helpline, 2022).

Panic attacks produce strange and unknown feelings and thoughts.  Teenagers struggle to manage this disorder and suffer from symptoms such as shortness of breath, disorientation, chest pain, racing heart, sweating and shaking. Teens who experience panic attacks will begin to avoid people, places and situations, therefore disengaging in life (Star & Lockhart, 2021). OCD is pattern based obsessive-compulsive behaviours based on anxiousness and fears (Mayo Clinic Staff, 2020).  Its repetitive cycled actions cause further distress and anguish.  OCD interferes with normal functioning and daily life (Mayo Clinic Staff, 2020). People who witness or experience a stressful or traumatic situation can develop PTSD (Torres, 2020b).  PTSD causes intrusive thoughts such as flash backs, avoidance, mood alterations and the inability to regulate emotions and outbursts. (Torres, 2020b). PTSD can negatively affect a person’s whole way of life from everyday activities, family engagement, to functioning in today’s society (Torres, 2020b).  General anxiety is known as having no set or specific type of diagnoses (Wicks-Nelson & Israel, 2015).  Like the other forms of anxiety, it is linked to excessive fear, worry and apprehension.  Individuals with anxiety are perfectionists who set high standards, seek constant reassurance and display nervousness in almost all new, social and unstructured situations (Wicks-Nelson & Israel, 2015).

Evidence of Symptoms 

Risk factors associated with teenage anxiety disorders include, physical, mental and emotional abuse, witnessing or experiencing trauma, long term serious health conditions, excessive worrying (family, school and home life), mental health disorders (depression), misuse of drugs and alcohol and genetics (Mayo Clinic, 2018).  Anxiety, stress and excessive worrying have a negative impact on the adolescents working memory and their cognitive abilities (Rapgay, 2019).  Working memory assists in making decisions, learning new tasks and setting goals.  Cognitive processes such as being focused, attentive, shifting from one task to another and updating information relies heavily on the working memory (Rapgay, 2019).  Research shows that anxiety damages the adolescent’s cognitive processes and memory leading to adverse effects (Rapgay, 2019).  Anxiety limits the person’s ability to separate responsibility and threats therefore they are unable to complete everyday tasks (Rapgay, 2019).  Cognitively they struggle to concentrate, are irrational, always think the worst and lose the ability to make competent decisions (Valley Behavioural Health, 2022).  

Social anxiety is common in the adolescent years.  Teens who have family history of anxiety, suffer bullying, family trauma or abuse, are shy, or have the added pressure of social awkwardness associated with a mental health condition such as Autism (Autism Spectrum Australia, 2022), can find it difficult to function socially, emotionally and physically in daily life (Mayo Clinic Staff, 2021). Socially teenagers feel they are negatively being judged, become oversensitive, embarrass easily, struggle to engage in conversations and overthink the social situation or event leading to heightened physical and emotional responses (Mayo Clinic Staff, 2021). Physically and emotionally they experience hyperventilation, racing heart, nightmares, fatigue, headaches, insomnia and the constant feelings of being sick (nausea) (Mayo Clinic Staff, 2021).  Teenagers are unable to regulate their thoughts formulating an intense dislike to socialisation, relationship building and interaction’s altogether (Mayo Clinic Staff, 2021).  Behaviourally, teenagers become disengaged, irritable, heightened and turn to substance use to control unwanted thoughts.  They begin to show signs of avoidance, refusal, oppositional and aggressive behaviours. These are inbuilt coping mechanisms controlling the teen’s situation and undesirable thoughts and feelings (Miller, 2022a).  They are overwhelmed and consumed by stress, fear and panic, and therefore retaliate in order to escape.

When undertaking anxiety assessments and diagnoses we are guided by the tripartite theory.  The tripartite theory identifies the comorbidity within the symptoms addressing behaviour, cognitive and physiological responses (Buckby et al., 2008). Assessment must be developmentally appropriate, culturally sensitive and environmental factors taken into consideration when assessing (Wicks-Nelson & Israel, 2015).  Data can be untaken via clinical interviews (Structured interview), Self-reporting Instruments (MASQ Multidimensional Anxiety Scale for Children), direct observation (behavioural and environmental issues) and Physiological Recordings (e.g. heart rate, blood pressure) (Wicks-Nelson & Israel, 2015).

Impact on the Individual and Interactions

Anxiety impacts socialisation, relationships, schooling and home life.  Adolescents who suffer anxiety live in a world of constant fear, worry and obsessive thoughts (AACAP, 2022).  These symptoms become overwhelming and can lead to further mental health problems, substance abuse, self-harm and suicidal feelings (AACAP, 2022).  As noted before, anxiety has many different forms but produce many of the same symptoms.  Symptoms include panic, flashbacks, trouble sleeping, inability to self-regulate, shortness of breath and nausea (Cleveland Clinic medical professional, 2020).  These symptoms are triggered by stress, environmental factors and genetics (Cleveland Clinic medical professional, 2020).  Anxiety impacts teenager’s ability to form relationships, engage in school and actively participate in family life (AACAP, 2022).   Anxiety develops risky behaviours, mood disruption and questioning of adult authority (AACAP, 2022). Teenagers begin to withdraw, turn to substance abuse, aggression and undesirable behaviours to overcome the storm and stress of adolescent anxiety (AACAP, 2022). This behaviour has a negative knock on effect in schooling (truant, disengaged), social interaction (fear of separation, judgement, withdrawn) and family (self-harm, moodiness) (Epstein et al. 2020).  Some factors that trigger anxiety at school and home are negative socialisation (bullying) the pressure of doing well academically, separation (home/parents), sleep disorders, learning disabilities, trauma, abuse, divorce in the family, substance abuse and the hormonal changes of puberty (Klein & Geng, 2021).

Suggested Intervention

Cognitive Behavioural Therapy (CBT) is a common and effective form of treatment when treating anxiety disorders in adolescents (Raising Children Network, 2021a).  CBT guides teenagers to develop an understanding of their condition and challenges their anxious behaviours (Raising Children Network, 2021a).  Guidance officers, counsellors and psychologists use CBT to help teenagers overcome fears, establish coping strategies and understand how to regulate their feelings and emotions during heightened situations (Wicks-Nelson & Israel, 2015).  CBT provides adolescents with the cognitive ability to identify their symptoms and signs of anxiety, plan and overcome situations and self-reflect (Wicks-Nelson & Israel, 2015).   The therapy is constructed using strategies such as to role playing, exposure therapy (faced with fear) and begin to form relaxation techniques (breathing) to instil the different skills needed when successfully functioning in everyday life (Wicks-Nelson & Israel, 2015).