Adolescence

Early and mid-adolescence is the age bracket between approximately 11 and 18 years (Gilmore & Meersand, 2014) which is universally characterised by major biological, cognitive, social, and contextual changes (Larson & Sheeber, 2009) thus, adolescence is a highly active time of development for young people. As the adolescent brain and body develops and changes, so too does their interaction with those within their immediate and extended environment. These factors combine to create a myriad of never before experienced challenges (Gilmore & Meersand, 2013) that vary enormously in duration and intensity across individuals (Arnett, 1999). Adolescents begin seeking autonomy from their parents while investing concerted effort into their peer group and romantic relationships which may result in conflict with parents (Gilmore & Meersand, 2013). Similarly, in their pursuit of self-identity and individuation, adolescents may experiment through sexual encounters, hair and fashion styles and challenging previously held beliefs (Kinsman, 2014). Cognitive development sees the emergence of executive function, complex decision-making, and self-regulation in the adolescent (Kinsman, 2014). As mastery of these newly acquired skills is evolving, youth still grapple with the competence to negotiate unknown circumstances with ease (Larson & Sheeber, 2009).

Anxiety

While the Diagnostic and Statistical Manual 5 identifies multiple anxiety disorders affecting adolescents (American Psychiatric Association, 2015), it is beyond the scope of this report to discuss these conditions individually. Instead, adolescent anxiety will be addressed generally.

Anxiety is a disorder that affects approximately 10% of the adolescent population, making this mental health condition the most common among this age group (Kinsman, 2014). Anxiety can be defined as the physical and emotional preparedness that occurs in anticipation of a situation perceived as dangerous (Pine & Klein, 2015). It is when the intensity, duration and frequency of anxiety is serious and misaligns with the individual’s development that further assessment for possible intervention should be prioritised to avoid immediate or longer-term negative outcomes (Huberty, 2012).

Huberty (2012) describes several attributes common to young people who experience anxiety. Firstly, youth who experience anxiety are known to feel more deeply worried about a broad range of circumstances that appear unremarkable to their peers. In a school environment, these students may be referred to as “drama queens” by their same age peers and at home as “my little worrier” by parents (Kinsman, 2014). Secondly, repetitious thoughts invade the cognitive space required to concentrate and perform learning tasks resulting in a student who appears distracted or lacking effort. Thirdly, anxious adolescents anticipate negative outcomes which serves to perpetuate the anxiety cycle. Finally, a “threat attributional bias” (p. 30) means adolescents who are anxious assign threat to more situations than would their non-anxious peers.

Evidence of Symptoms 

Anxiety causes significant difficulty with concentration, memory, problem-solving and attention to tasks (Huberty, 2012). These problems are known as cognitive distortions and cognitive deficiencies (Kendall, 1992, as cited in Huberty, 2012). Distortions occur when incoming information is interpreted incorrectly through the lens of the anxious youth resulting in skewed thinking (Huberty, 2012). According to Read et al. (2013), three kinds of cognitive distortions are evident in youth with anxiety, (1) catastrophising is evident when anxious young people assign calamitous consequences to a potential situation that their non-anxious peers would not; (2) overgeneralising becomes obvious when adolescents expect poor results across other situations, and (3) personalising occurs when a young person takes responsibility for undesirable outcomes when blame cannot be attributed to them. Equally, deficiencies result from impairment in academic functioning as anxiety impedes the ability of the adolescent to process information (Huberty, 2012). A student’s decreased capacity for attention to tasks and instructions mean they are unable to discern relevant material and cues (Pine, 2011) that is vital for the synthesis of information and application of higher order thinking skills. Reduced concentration impairs the individual’s ability to formulate a correct response to teacher questions (Kinsman, 2014) which may lead teachers to describe these students as day dreamers when they consistently appear off-task and unresponsive (Huberty, 2012). Not surprisingly, extended and persistent periods of trouble engaging with many elements of learning tasks lead to further perpetuation of anxious thoughts reinforcing their own school failure (Huberty, 2012).

The most common behavioural indicators of adolescent anxiety are easily observable by parents, teachers, and clinicians (Huberty, 2012). These can be categorised as voluntary and involuntary and are deliberately or unavoidably undertaken by adolescents, respectively (Huberty, 2012). It is not unusual for an anxious adolescent to avoid, retreat or withdraw from activities or events where they anticipate a negative outcome, just as it is reasonable that hyperarousal may cause unintentional movement (Huberty, 2012). Both result in behaviours that may be misinterpreted as disinterested, lazy, or present as though they lack regulatory skills (Huberty, 2012).

Adolescents with anxiety frequently identify social situations as potentially distressing. Research has empirically proven the value of peer socialisation to healthy adolescent development (Steinberg & Morris, 2001) yet some teens fear this interaction and proactively work to avoid it. Consequently, these adolescents raise their risk of poor social outcomes as avoidance preventing opportunities to build confidence which in turn increases the chance of social rejection by peers (Ollendick & Ishikawa, 2013). In complex school social environments requiring small group interactions and assessment performances, anxious children are interpreted as being “socially inept, incapable or disinterested” (Huberty, 2012, p. 45). Moreover, this school dynamic has implications for learning outcomes where anxious students avoid leading groups and difficult tasks and instead seek easier options where they avoid volunteering or asserting themselves appropriately (Huberty, 2012).

Educators are warned not to dismiss the physiological symptoms of anxiety in adolescents (Kinsman, 2014) as they are an indicator of the high level of distress currently being experienced (Huberty, 2012). Flushed skin, while a sign of increasing anxiety, is likely to be a source of embarrassment (Huberty, 2012). In addition, headaches, stomach pain, high pulse rate and muscle tension may result in further medical investigation (Huberty, 2012).

Impact on the the Individual and their Interactions

Adolescents who experience anxiety are subjected to short, and potentially long-term detrimental impacts of the condition which highlight the need for prompt identification, assessment, and intervention. The immediate effects may include irritability, erratic behaviour, rapid speech, perfectionism, withdrawal, oversensitivity, and a failure to complete tasks (Huberty, 2008, as cited in Huberty, 2012). These characteristics significantly limit opportunities for productive interactions with peers which are essential in developing friendships at this age leading to acceptance by peers (Ollendick & Ishikawa, 2013). This is supported by the finding that anxious teens identify as lonelier and present with a deficit in social skills in comparison to their non-anxious peers (Strauss et al., 1989) as well as enduring social isolation from their cohort (Strauss et al., 1989). Likewise, parents and other significant adults in an adolescent’s life have a role to play in responding to the needs of an anxious youth. If parents or teachers react negatively to these behaviours, it only serves to further perpetuate the already distorted beliefs of the teen (Ollendick & Ishikawa, 2013).

The long-term effects of experiencing anxiety as an adolescent are concerning. When compared to their non-anxious peers, adults who were diagnosed as anxious during their youth are less likely to live independently or access further education (Woodward & Fergusson, 2001). Moreover, it was identified that anxiety in adolescence reduced the likelihood of attending university while raising the chance of parenthood at a young age (Woodward & Fergusson, 2001). Studies have demonstrated that an anxiety diagnosis increases workplace absenteeism with 35% of participants identifying the disorder as a significant contributor for being unable to attend their place of employment (Wittchen et al., 1998).

Suggested Interventions

Schools are perfectly positioned to deliver whole school programs that target the specific needs of the student population. Evidence supports the use of a tiered system of intervention as it is structured to address potential issues in a proactive manner through to unique challenges experienced by individuals (Shores, 2009). For those universal programs at Tier I accessible to all students (Shores, 2009), the Guidance Officer is integral in planning for the school-wide delivery of this intervention. Social-emotional development in children should be a priority for schools with the implementation of interventions that promote social-emotional learning among students (Iizuka et al., 2013). The FRIENDS for Life program (Australia Institute of Family Studies, n.d.) is an example of one evidence-based program that has been developed from an individual student strength-based perspective that promotes resilience when teaching about interactions between contexts by “actively involving students, families, teachers and schools in the intervention process” (Iizuka et al., 2013, p. 522).

Tier II supports are for approximately 15% of the student body who continue to experience mild or moderate difficulties or have been identified as at risk, despite the implementation of Tier I programs (Shores, 2009). For youth with anxiety, the efficacy of Computer-based Cognitive Behavioural Therapy (CCBT) has demonstrated results on a par with clinician delivered therapy (Wuthrich et al., 2013). This style of therapy is advantageous as it is easily accessible to adolescents, reduces treatment cost and stigma, and can free up guidance time, however users are cautioned that it may threaten the strength of the therapeutic alliance and limits custom responses to individual need (Wuthrich et al., 2013). In this instance, the Guidance Officer would investigate all options and proceed only with an empirically proven and well-evaluated support.

For approximately 5% of students, further intensive intervention is required at the Tier III level. The Guidance Officer may be nominated as the case manager and will be instrumental in developing a student plan in accordance with the Supporting students’ mental health and wellbeing procedure (Department of Education, 2021b). If specialist treatment is required through a clinical care provider, (Department of Education, 2021b) the Guidance Officer will work collaboratively with this specialist and the school team to develop a cohesive approach to intervention for the student.