Adolescence

Adolescence is a critical developmental stage that involves various challenges and experiences. The large age range between approximately 11 to 21 years involves more prominent challenges in the different stages of adolescence than others. Research suggests adolescence is the most challenging developmental lifespan period providing the physiological, biological, psychological changes endured. Childhood experiences also play a key role in shaping the transition to adolescence, and consequently the transition to adulthood, therefore the challenges associated with this key developmental period and their impacts should be considered. Stereotypical adolescent behavioural challenges involve impulsivity, conflict with peers and parents, emotional turbulence, norm-breaking, risk-taking, recklessness, and anti-social behaviour (Geldard et al., 2019). Although not all research suggests this is the case for all adolescents, their natural desire for independence and autonomy (Smith, 2015) can lead to potential behaviour challenges. Secondly, significant challenges can arise through adolescents’ social development and experiences as their sense of identity, security, values are often questioned, increasing their overall sensitivity, reactivity and vulnerability (Silverberg, 2020). Social media can also provide grounds for further insecurity through challenges such as bullying, unhealthy comparison, warped reality and addiction (Smith 2015), all closely associated with psychological problems. Most significantly, adolescents experience considerable cognitive challenges due to higher levels of abstract reasoning, and distorted perceptions of themselves, others and situations (Smith, 2015). Mental health problems such as anxiety, are considered to be continually rising for this demographic and present more in adolescents comparatively with other life stages (Helseth et al., 2016). This may be attributed to these stress-inducing cognitive and environmental changes.

Anxiety

Anxiety is considered one of the most common and prevalent psychological disorders in childhood and adolescence (Kim-Cohen et al., 2003), affecting up to one in five youth (Butterfield et al., 2021). Studies show that that anxiety is a serious problem that when experienced through key developmental periods such as adolescence, can have significant impacts on social and academic functioning, and longer-term consequences (Cartwright-Hatton, 2006). Furthermore, adults with anxiety disorders report the onset of their disorder in childhood or adolescence (Kim-Cohen et al., 2003) suggesting it is a mental health issue that can last into adulthood. Although anxiety is a feeling all individuals experience at times, it becomes a disorder when the frequency and severity interferes with daily functioning, such as concentration, socialising or finding enjoyment (Department of Health, 2020). The various types of anxiety adolescents may experience are social anxiety, phobias, panic disorder, agoraphobia or separation anxiety. These may present in different ways such as restlessness, physical symptoms, heightened self-consciousness and sensitivity, irrational negative thoughts, pre-empting unrealistic negative outcomes, avoidance, withdrawal, lack of concentration and sleep difficulties (Department of Health, 2020). The impacts of some of these symptoms can be detrimental to the wellbeing and development of teenagers, as they can severely impact on their daily functioning, relationships and perception of self (Silverberg, 2020). Within the school environment, a decrease in concentration, motivation and enjoyment, in conjunction with hyper-sensitivity and negativity, can significantly affect academic performance and relationships with teachers and peers. Within a home environment, depending on the type of anxiety experienced, family attachments can be impacted through increased conflict, withdrawal and negative thought patterns (Silverberg, 2020).

Evidence of Symptoms

Anxiety is one of the most prevalent psychological disorders amongst youth (Butterfield et al., 2021). However, dependent on the type of anxiety experienced by an adolescent and the individual themselves, evidence of anxiety can present differently. From a cognitive perspective, anxiety disorders are broadly associated with neural hypersensitivity and a heightened response to negative stimuli in the brain networks that impact emotional responses and processing (Butterfield et al., 2021). Studies have shown that adolescents suffering with anxiety demonstrate excessive emotional reactivity which can further lead to poor psychosocial functioning (Butterfield et al., 2021). Individuals within this age bracket experience biological changes impacting on cognition and therefore typically possess higher levels of abstract reasoning, affecting their perception of situations, themselves and others. Consequently, stimulating negative thought patterns of critical questioning of their role in society, their personal beliefs and self-esteem, adolescence is considered a risk period for anxiety (Butterfield et al., 2021).

Throughout this developmental lifespan period, youth experience emotional vulnerability whilst navigating new social challenges, more complex peer and romantic relationships and often conflict with family members (Silverberg, 2020). These challenges are paired with adolescents maturing, increasing awareness of social evaluation, and heightening self-consciousness. Therefore, if young people are not provided with support and protective factors to enhance emotional resilience and more logical thought patterns, unhealthy mental cognitions can manifest contributing to an anxiety disorder. Traditionally from a cognitive view, anxiety has been related to hypervigilance and attention bias; either towards or avoidance of perceived threat, and therefore impacting on how an individual may behave. Avoidance or overanalysing of negative stimuli may increase the way an adolescent internalises negative thoughts, presenting as anti-social behaviours or withdrawal (Butterfield et al., 2021). This can appear as absent-mindedness, lacking concentration, ignoring or avoiding interactions due to re-occurring negative thoughts about themselves, their environment, the past or future, or other individuals. According to Di Blasi et al. (2015), impaired self-image has been closely associated with high levels of social anxiety. However, this may not be the case for all types of anxiety or for all individuals and can often present in externalising behaviours. Hall’s (1904) Storm and Stress Theory (Casey et al., 2010) suggests that adolescents experiencing significant emotional turbulence and mental health issues may engage in risky and reckless behaviour, displaying impulsivity, rebellion, norm-breaking, and potentially harmful behaviour (Geldard et al., 2019). Maintaining their innate desire for autonomy (Smith, 2015) and search for identity (Sullivan, 2003), adolescents can also present with anxiety through externalised overt behaviours, creating more conflict with peers, parents, and society, and consequently further impacting on development and wellbeing. As a result of these various behaviours, negative social and academic impacts can present for adolescents. Peer aggression and social phobia can present in youth suffering anxiety which are both behaviours closely linked to social impairment, poor academic achievement, substance misuse, and increased risk of depression (Storch et al., 2005).

Professionals such as psychologists and Guidance Counsellors must not only understand these complex mental health issues from varied perspectives but be able to identify these signs and symptoms in young people in order to provide support and intervention. Data collection is one key method involved in this process. There are common methods of data collection used in schools and clinics such as observations, interviews or consultation with involved stakeholders, individual or family counselling, and conducting formal assessments, scales and reports. Functional Behaviour Assessments (FBA) are commonly used within schools as an initial data collection method. Psychometric assessment tools may be utilised such as the Severity Measure for Social Anxiety Disorder (Craske et al., 2013), the Social Experience Questionnaire (Crick & Grotpeter, 1996), the  Social Anxiety Scale for Adolescents (La Greca et al., 1988) , and The Generalised Anxiety Disorder 7 item scale (Spence, 2017). Personality inventories and assessments may also be useful in identifying risk factors and the likelihood of anxiety in adolescents. A combination of data collection methods would be beneficial for professionals to accurately assess an individual’s circumstances, behaviours, and cognitions in order to provide adequate support and intervention strategies.

Impact on the Individual and Interactions

As adolescence is broadly considered a challenging time for any individual, anxiety can create additional negative impacts on a teenager, in all aspects of their life. For an individual suffering with anxiety, daily experiences, emotions and cognitions can be further heightened causing hypersensitive reactions to perceived negativity (Butterfield et al., 2021). Stereotypical adolescent experiences such as peer or parent conflict, challenges at school (Geldard et al., 2019) along with biological factors heightening self-consciousness and social awareness (Silverberg, 2020), can be exacerbated to unhealthy emotional responses and cognitions due to anxiety. Something that may occur to both a non-anxiety suffering adolescent and an individual with anxiety could result in vastly different reactions, externally and internally. An individual displaying resilience, healthy cognitions, effective communication skills and processing, pro-social behaviour (Fu et al., 2017) and positive self-image has the ability to endure adversities and further develop through adolescence into adulthood. However extreme poor self-image, lack of confidence or autonomy, and internalising behaviours can result in clinical anxiety (Di Blasi et al., 2015) impacting on an individual’s emotional regulation, academic performance and key relationships that all negatively affect development (Tariq et al., 2021).

Suggested Interventions

Guidance Counsellors can provide many strategies and intervention methods to address anxiety and the impact it has on adolescents through this life stage and beyond (Queensland Guidance Counselling Association, 2019). In order to do so effectively, thorough awareness of key signs, symptoms and impacts is required. Possible interventions may include counselling, parental support, CBT methods such as mindfulness, or whole-school wellbeing programs. Strength-based parenting directly relates to reduced impacts of anxiety and increased school engagement (Cartwright-Hatton, 2006)  therefore family involvement is beneficial. However, as there are many forms of anxiety and ways young people may respond to stimuli (Healthdirect, 2020b), development of an Individualised Support Plan would enhance the level of support for an individual adolescent. This allows for personalised support and intervention, considering the uniqueness of their personality, cognitions, behaviours, family, environment, cultural background, and specific circumstances. Evidence suggests that robust social networks enhance quality of life (Rice et al., 1993), increasing academic success and future employment prospects (Smith, 2015), therefore intervention with peers such as group counselling or school-wide mental health programs is advised. As adolescents place high value on peer relationships, it is recommended to use an individual’s social network as the commencement point for intervention. Furthermore, harnessing group-driven engagement (Rice et al., 1993) offers potential for more sustainable, long-term positive impacts (Smith, 2015) for the individual and their peers. This is also highly beneficial for Guidance Counsellors to make further observations of the adolescent, witnessing peer interactions and monitoring progress, to ensure adequate intervention is provided.