Adolescence

Adolescence is the time period between childhood and adulthood where individuals undergo a unique phase of development. This stage is commonly recognised as being a time of rapid change with significant physical and psychological progress occurring. Cognitive, behavioural and social challenges often arise as a result of these transformative developments. Cognitive development during adolescence allows individuals to perceive the world in new ways through improvements in critical thinking skills. This ability, alongside a new capability of exploring multiple perspectives, can prove challenging as an understanding of the complexity of the world is formed. Social growth occurs and an increased importance on peer relations grows, resulting in potential challenges with friendship dynamics and romantic relationships. Teenagers today have increasingly complex lives with pressure arising from multiple directions. Stress is further compounded by anxieties about school work and decision making about further education and career options. Significant physical changes also occur during adolescence with increases in height, weight and strength (Raising Children Network, 2021b). Changes to skin, sexual organs, hair and sweatiness also transpire (Raising Children Network, 2021b). Individuals develop at different rates, which can be a stressor for adolescents as they may feel different to their peers depending on when these changes occur for them. Additionally, physical changes can result in fatigue and mood disruptions due to hormonal fluctuations. While these challenges are common to the majority of adolescents, further obstacles can occur depending on the risk and protective factors relevant to each individual. Contextual factors, such as socio-economic standing, neighbourhood characteristics, family cohesion and health, can have further implications for adolescent wellbeing and development.

Anxiety

Anxiety is a mental health disorder characterised by excessive anxiety and worry (American Psychiatric Association [APA], 2013a). This disorder involves a strong negative response to threatening situations, though these situations may sometimes be imagined (Essau & Ollendick, 2013). Additionally, people with anxiety find it difficult to control their worry and it subsequently can be impairing to their lives (APA, 2013a). A 2015 survey conducted by the Australian Government Department of Health revealed that 6.9% of all children and adolescents suffer from some form of anxiety disorder (Lawrence et al., 2015). To be diagnosed with an anxiety order, undue anxiety must be present more days than not within a six-month time period (APA, 2013a). Anxiety disorders fall into several categories including social phobia, separation anxiety disorder, generalised anxiety disorder and obsessive-compulsive disorder.

Experiencing some anxiety in life is a normal part of the human condition. However, when the anxiety is outside of normal parameters it can impact development and be detrimental to various areas of an individual’s life. An indicator that a mental health disorder is present is when the duration and magnitude of a person’s anxiety does not correlate to the real threat of a situation (Essau & Ollendick, 2013). Additionally, there is reason for concern when anxiety arises in average everyday situations or when it lasts for long periods of time (Essau & Ollendick, 2013). Intervention may be required to help individuals overcome anxiety. Interventions are particularly important when children and adolescents are suffering from anxiety as the disorder can lead to lasting negative developmental consequences (McKay & Storch, 2011).

Depending on the type of anxiety, the worry can be caused by a variety factors. One of the common triggers for anxiety is the fear of social situations where embarrassment might occur. This is particularly pertinent for adolescents in the school environment. Teenagers are especially sensitive to how they believe they are being perceived by others and can often feel overly scrutinised. Elkin (1967) described this phenomenon as adolescents conceptualising an ‘imaginary audience’ that judges their every move. A result of social anxiety may be school refusal and withdrawal from social activities. Another root of anxiety can be excessive worry concerning particular events or activities. Anxiety has implications on physical health and can lead to fatigue and irritability. Adolescent anxiety can have repercussions not only on an individual’s development, but can also lead to stressful relationships within the home context.

Evidence of Symptoms 

Anxiety can be identified in an adolescent through several different notable symptoms in cognitive, physical and behavioural functioning. Diagnosing anxiety is beyond the scope of a Guidance Officer (GO), though they may collect anecdotal reports from the individual, parents and teachers in order to refer a student to a General Practitioner. Additionally, a GO might conduct a Conners (CBRS) assessment, which gives insight into behavioural, social and academic issues (Conners, 2008). This assessment is useful in gathering information to assist in the diagnosis process.

One of the cognitive indicators of anxiety is excessive worrying in relation to activities or events that don’t typically warrant such a response. Worry is defined as thoughts and beliefs about potential difficulties that may occur in the future (Barlow, 2002). Furthermore, feeling anxious for long periods of time, or chronically, is another cognitive symptom of anxiety disorders. People with anxiety are often afraid of the uncertainty that the future holds. Additionally, they worry that they will not be able to cope in situations. During moments of fear or panic, cognitive capability is diminished and a strong physiological response can occur (Essau & Ollendick, 2013).

While anxiety stems from cognitive patterns it can also have physical and behavioural ramifications. Individuals who suffer from anxiety often feel easily fatigued. Insomnia is a common implication of anxiety, which further exacerbates exhaustion (Abrahams, 2021). Tiredness can also be a result of a post-anxiety crash, where the adrenaline from the body’s fight or flight response runs out (Abrahams, 2021). On the other hand, another physical symptom of anxiety is restlessness or feeling constantly on edge (APA, 2013a). Physical symptoms can also include headaches, feeling weak, stomach aches and nausea (Mayo Clinic, 2018). In fear invoking instances, individuals with anxiety can experience sweaty palms, increased heart rate and rapid breathing (Essau & Ollendick, 2013). Anxiety can be identified in adolescents through behavioural presentation. The most common behavioural symptom of anxiety is avoiding the fearful stimuli or situation (Essau & Ollendick, 2013). For adolescents, this avoidance can correlate to school refusal. Irritability, angry outbursts and reduced interest in previously pleasurable activities are also behavioural symptoms of anxiety.

Impact on the Individual and Interactions

The presentation of anxiety can have clear developmental consequences for children and adolescents if left untreated (McKay & Storch, 2011). Social anxiety often occurs in adolescents as identity development and the desire for peer acceptance are significant life concerns. School refusal is a common repercussion that stems from anxiety and this avoidance behaviour is detrimental to academic and social growth. Anxiety may prevent a young person from adequate socialisation and limit opportunities to establish age appropriate behaviours and emotional development. Furthermore, anxiety disorders have been linked to low self-esteem and an increased likelihood of depression (Maldonado et al., 2013). Additionally, studies have shown that adolescents with anxiety are more likely to be lonely and have poor social skills (Essau & Ollendick, 2013). Anxiety during adolescence is also a predictor of post-school unemployment and indicates a decreased likelihood of pursuing tertiary education (Essau & Ollendick, 2013).

Suggested Interventions

An Individual Support Plan (ISP) is a useful intervention for adolescents suffering from anxiety, particularly if school refusal is involved. An ISP outlines a student’s educational goals alongside strategies and resources required to achieve these goals (Queensland Government, 2018). A common strategy for students with high anxiety around attending school is to implement a flexible arrangement where the student only attends part days or certain days of the week. Increasing an individual’s exposure to situations that evoke anxiety in short amounts has been shown to decrease anxiety in the long term as the person realises that the fear is unwarranted (Essau & Ollendick, 2013). Academic progress is also monitored through the ISP to ensure that the student’s anxiety is not interfering with educational outcomes. The ISP will also notify teachers that flexible learning modes may be required, such as access to content online. It may also outline issues for teachers to be aware of, for example to avoid calling on the student in front of their peers to reduce anxiety inducing situations.

Participating in The Brave Program (The Brave Program, 2020), an online psychological program for adolescents who experience anxiety, is another beneficial intervention. The program’s foundations are in Cognitive Behaviour Therapy and results indicate that 80% of children are free from their anxiety by the completion of the course (The Brave Program, 2020). CBT involves altering how a person thinks about their fear and works towards increasing exposure and learning relaxation and coping strategies to counter it (McCarthy, 2019). The course involves one online session each week for the duration of ten weeks, which is a simple and flexible mode of delivery for anxious teens. BRAVE also includes parent sessions to educate families on how to best support their child, which results in an added protective factor for the individual.