Adolescence

Adolescence is a time of massive change. Everyone progresses through this developmental stage at different rates but all young people experience physical, cognitive, social and emotional changes (Kelly et al., 2017). One of the challenges facing health professionals and educators is that some of the changes and behaviours that develop in adolescence may be mistaken for mental illness and the symptoms of mental illness may be masked by the changes that occur during this stage of development (Kelly et al., 2017). Therefore, counsellors must understand the key changes and challenges that occur during adolescence to ascertain the best intervention for the young person they are supporting.

Physical Changes

Puberty causes significant changes to occur in a young person’s body. Kelly et al. (2017) states the following facts relating to physical changes:

• in Australia, the typical age of onset is 11-15years
• both male and females increase in height and weight
• the voice deepens
• growth of facial and body hair
• many young people have difficulties with pimples or acne
• increase in testosterone in males
• increase in estrogen in females
• start of menstruation for females
• increase in sexual thoughts and feelings which may lead to sexual experimentation

With all these changes it is understandable that an increased concern about personal appearance occurs. A young person may feel embarrassed and self-conscious if they are developing at a different rate to their peers (Geldard et al., 2019).

Cognitive Changes

The way an adolescent thinks about themselves, others and the world changes during adolescence. Kelly et al. (2017) highlights the following cognitive changes:

• movement from concrete ways of thinking to more abstract, analytical and critical ways of thinking
• brain is undergoing dramatic changes and part of the brain that is responsible for decisions making can take the whole of adolescence to develop
• use more reasoning and logic to solve problems
• analyse and critique things they see and hear
• formulate beliefs about what is right and wrong
• make long term plans
• think about the meaning of life
• develop spiritual and religious beliefs
• devise ethics and justice ideas
• question authority, rules and norms
• become passionate about causes (world poverty/animal cruelty)
• debate topics of interest
• sometimes intolerant of others
• take risks and make poor decisions

The reader can appreciate the volume of change occurring can result in positive and negative thought processes.

Social Changes

The biggest social change to occur during adolescence is the movement away from family and parents to an orientation toward friends. Kelly et al. (2017) proposes the following social developmental challenges during adolescence:

• learning to resolve conflict harmoniously
• manage pressure from peers
• thinking about future adult roles
• devise career identity
• experiment with looks and styles
• what young people find normal can be frustrating for parents
• finding which identity suit them best
• experimentation with romantic relationships
• gender identity experimentation

Emotional Changes

Many emotional changes occur during adolescents. Kelly et al. (2017) outlines the emotional challenges as:

• greater intensity of emotional states
• quicker emotional reactions
• an argument with a friend can quickly lead to a screaming match
• make emotionally charged statements such as vowing to never to speak again to a friend
• romantic attractions can quickly become infatuation
• emotional functions of the brain react quickly which contributes to poor decision making

The result of these emotional changes can mean that an adolescent is more likely to take risks, be impulsive and look for ways of having fun without thinking through the consequences (Kelly et al., 2017).

After considering the physical, cognitive, social and emotional challenges it is evident that processes need to occur if these challenges are to be handled with success. Unfortunately, the onset of mental illness peaks during adolescence which means that as well as being a time of psychological maturity it is also a time of psychological susceptibility (Kelly et al., 2017). The following will detail the impacts of adolescent anxiety and suggest an intervention.

Anxiety

Anxiety disorders are among the most common disorders faced by adolescents (Wicks-Nelson & Israel, 2015).  To a certain degree it is normal to worry and feel anxious at times. Anxiety can motivate an individual and help get energy to combat challenges. However, when excess anxiety isn’t connected to a challenge and is getting in the way of day-to-day activities, the quality of a person’s life gets affected (Reachout, 2022a). This is when an adolescent or the people in their life would seek assistance.

The Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; APA, 2013b) defines seven anxiety disorders seen in adolescence: generalized anxiety, social anxiety, separation anxiety, panic disorder, agoraphobia, specific phobia and selective mutism (Garcia & O’Neil, 2021). According to Garcia and O’Neil (2021) the three most common adolescent anxiety disorders are generalized anxiety disorder (GAD), social anxiety disorder (SAD) and separation anxiety. This research states that these disorders can be comorbid with each other and with other disorders such as eating disorders, depression, and attention deficit/hyperactivity disorders. General information relating to anxiety disorders retrieved from the DSM-5 is described next.

Evidence of Symptoms

Anxiety disorders include disorders that share features of persistent and excessive worrying that last more than six months and interferes with daily activities such as school. According to the DSM-5 (APA, 2013b) the situation that induces the anxiety may be different but some of the behaviours can be similar. These are feeling restless or on edge, fatigue easily, irritability, difficulty concentrating, pervasive avoidance behaviours, panic attacks and overestimating danger. Anxiety can impact on daily functioning.

Anxiety affects an adolescent’s cognition. Kelly et al. (2017) describe cognitive symptoms as a person’s mind going blank or racing, reduced concentration and memory, indecisiveness, confusion and vivid dreams. As a result this would impact not only day to day living but classroom learning, behaviour and assessment.

Anxiety may cause an adolescent to behave differently. For example, avoidance of situations, compulsive or obsessive behaviour, social situations become stressful, disturbed sleep and increased alcohol or drug use. These maladaptive behaviours can lead to isolation, loneliness and secondary health issues.

Anxiety affects the social aspects of an adolescent’s life. An adolescent may avoid situations that make them feel anxious such as travelling on public transport, going to school and meeting new people (Reachout, 2022b). As a result, school performance and friendship circles can be negatively impacted. For people who are unfamiliar with symptoms of anxiety, they may seem strange and as a result some behaviours may cause school disciplinary action or stigmatising attitudes from others. These consequences are not helpful to a young person with anxiety.

The most widely used method of assessing anxiety in adolescence is self-report instruments (Wicks-Nelson & Israel, 2015). A guidance officer can administer the Achenbach System of Empirically Based Assessment to assess competencies, strengths, adaptive functioning, behavioural, emotional and social problems (Achenbach System of Empirically Based Assessment, 2022). This data could then be forwarded to mental health professionals to be used to better understand and diagnose disorders. Severe cases require clinical interviews and direct observations by mental health doctors.

Impact on the Individual and Interactions

An adolescent can find it difficult to control the worry and to keep worrisome thoughts from hindering everyday tasks (APA, 2013a). This can have impacts on their home, school and peer interactions. The home environment could be the first place that anxiety symptoms are noticed. At home a teen may:

• complain about physical symptoms to avoid going to school
• be tearful in the morning not wanting to attend school
• express concern that homework is never done well enough
• want continual reassurance from parents
• be irritable or touchy when interacting with parents
• spend lots of time getting ready for social occasions to decide at the last minute not to attend

These impacts at home can cause conflict within family relationships and worry for parents.

Impacts within the school environment have implications for an anxious adolescent. Here Kelly et al. (2017) describes that an anxious young person may:

• be shy, well-behaved and fearful of asking questions
• require extra teacher time and need a great deal of reassurance
• failure to hand in work and assessment due to perfectionism
• complain of a sudden onset of headaches or stomach ache if required to do oral presentations or exams

All these descriptions impact school achievement and school attendance.

Adolescents value their friendships and the connection it brings.  However, Kelly et al. (2017) explains that peers of a young person with anxiety may witness them:

• only spending time with a few close friends and avoid socialising in groups
• using alcohol or drugs at parties to make it easier to mix
• leaving social occasions early
• not speaking up due to embarrassment

All these presentations make it hard for the young person to be assertive and thus they may get taken advantage of or go along with risk-taking behaviour suggested by peers. With all these impacts on the individual, symptoms would start to be noticed and communicated to support networks such as doctors and school counsellors. One support strategy that could be implemented will be discussed below.

Suggested Intervention

The first-option in the treatment for adolescent anxiety is psychotherapy (Garcia & O’Neil, 2021).  One type of psychotherapy is cognitive-behavioural treatment (CBT). Some of the CBT therapeutic strategies have been proven successful in treating anxiety disorders (Wicks-Nelson & Israel, 2015). CBT strategies would be useful for a guidance officer to teach an anxious student.

Developing an Individual Support Plan (ISP) would be a priority task for a Guidance Officer working with a student with anxiety. This plan is jointly constructed with the student and parents.  It would be documented as a support provision for the student. The ISP could contain goals and strategies based around cognitive-behavioural skills suggested by Lusk and Melnyk (2013). These are:

• self-awareness – identifying the thoughts, behaviours and feelings when anxious
• self-esteem and positive self-talk
• goal setting and problem-solving strategies
• stress and coping
• emotional and behavioural regulation
• effective communication, personality and communication styles
• barriers to achieving goals
• healthy lifestyle plan – food groups, physical activity, influences of feelings on eating
• identifying people and places that are emotionally supportive when in crisis
• identifying professional help outside of school who can help such as Kids Helpline, Beyond Blue and Headspace

The student would select a small manageable set of goals and strategies to implement and at the next ISP review session new goals would be set. The Guidance Officer would case manage the ISP prioritising regular check-ins with the student, parents and relevant outside agencies (General Practitioner, mental health professionals and social workers) to keep up with progress and current states.