Anxiety in Teenagers *Developed by the Center for School Mental Health (http://csmh.umaryland.edu) in collaboration with the Maryland School Mental Health Alliance.

Facts about Anxiety Anxiety disorders are among the most common mental, emotional, and behavioral problems to occur About 13 of every 100 children and adolescents ages 9 to 17 experience some kind of anxiety disorder Girls are affected more than boys. About 50% of children and adolescents with anxiety disorders have a 2nd anxiety disorder or other mental/behavioral disorder Anxiety disorders may coexist with physical health conditions as well Read over facts about anxiety.

Brief Definition Anxiety is a general feeling of apprehension or worry and is a normal reaction to stressful situations Red flags should go up when the feelings become excessive, thoughts become irrational and everyday functioning is debilitated Anxiety disorders are characterized by excessive feelings of panic, fear, or irrational discomfort in everyday situations

Production of fear and anxiety Using brain imaging and neurochemical techniques several parts of the brain have been identified as key in the production of fear and anxiety Two main components involved are the amygdala and the hippocampus Amygdala- Emotional memories are stored here and alerts brain that a threat is present Hippocampus- Encodes specific threatening events into memories

How Anxiety is Manifested Students may feel a sense of dread Have fears of impending doom Experience a sense of suffocation Anticipation of unarticulated catastrophe Loss of control over their breath, swallowing, speech, and coordination Somatic Complaints Read through symptoms of anxiety and answer any questions. People who present with somatic complaints are presenting symptoms that are caused by mental processes rather than immediate physiological causes (e.g., someone may “fake” being sick to get out of an anxiety-provoking situation).

Types of Anxiety Disorders Generalized Anxiety Disorder (GAD) GAD results in students experiencing six months or more of persistent, irrational and extreme worry, causing insomnia, headaches, and irritability. Post-Traumatic Stress Disorder (PTSD) PTSD can follow an exposure to a traumatic event such as natural disasters, sexual or physical assaults, or the death of a loved one. Three main symptoms: reliving of the traumatic event, avoidance behaviors and emotional numbing, and physiological arousal such as difficulty sleeping, irritability or poor concentration. Read through different types of anxiety disorders. You may want to begin by saying that you will be defining the following disorders: Generalized Anxiety Disorder, Post-Traumatic Stress Disorder, Panic Disorders, Specific Phobias, Social Phobia, Separation Anxiety Disorder, and Obsessive Compulsive Disorder.

Panic Disorders Characterized by unpredictable panic attacks, which are episodes of intense fear, physiological arousal, and escape behaviors. Common symptoms: heart palpitations, shortness of breath, dizziness and anxiety and these symptoms are often confused with those of a heart attack. Specific Phobias Intense fear reaction to a specific object or situation (such as spiders, dogs, or heights) which often leads to avoidance behavior. The level of fear is usually inappropriate to the situation and is recognized by the sufferer as being irrational

Disorders continued…. Social Phobia Extreme anxiety about being judged by others or behaving in a way that might cause embarrassment or ridicule and may lead to avoidance behavior. Separation Anxiety Disorder Intense anxiety associated with being away from caregivers, results in youths clinging to parents or refusing to do daily activities such as going to school. Obsessive-Compulsive Disorder (OCD) Students may be plagued by persistent, recurring thoughts (obsessions) and engage in compulsive ritualistic behaviors in order to reduce the anxiety associated with these obsessions (e.g. constant hand washing).

Comorbidity Comorbid diagnoses of depressive disorders, ADHD, and other anxiety disorders are common in anxiety patients. Symptoms that may appear to be ADHD: Restlessness, feeling keyed up or on edge Difficulty concentrating, mind going blank Irritability Clinically significant distress or impairment in social or academic areas Comorbidity - the presence of one or more disorders (or diseases) in addition to a primary disease or disorder. Sometimes anxiety masks itself in symptoms that would lead you to a different diagnosis. Read through ADHD example…explain that although these symptoms lead you to think that the client presents with ADHD, the client may instead present with an anxiety disorder or may be displaying both. The key is to determine which disorder is the primary disorder.

Comorbidity continued….. Adolescents with substance use disorders (SUD) especially exhibit a high prevalence of psychiatric problems compared to the general population Many teens (as well as adults) believe that drugs and alcohol may alleviate anxiety and stress Substance use also seems to be linked with anxiety.

Effective Ways to Treat Anxiety Cognitive-behavioral treatment( young people learn to deal with fears by modifying the ways they think and behave) Relaxation techniques Biofeedback (to control stress and muscle tension) Family therapy Parent training Medication Biofeedback is a treatment technique in which people are trained to improve their health by using signals from their own bodies. It is used to help tense and anxious clients learn to relax.

Effects of Anxiety School failure Absenteeism Classroom disruption The inability to complete basic tasks Family stress Impaired social relationships You may want to see if your audience can come up with some effects of anxiety that they have witnessed and then provide them with the list of possible effects.

Strategies for Dealing with Anxious Students Because transitions and separation are frequently difficult for children with anxiety disorders, accommodate student’s late arrival and provide extra time for changing activities and locations. Recognize that often it is a youth’s anxiety that causes him or her to disregard directions, rather than an intentional desire to be oppositional. Develop a “safe” place where the youth can go to relieve anxiety during stressful times or provide calming activities. Encourage the development of relaxation techniques that can work in the school setting. Often these can be adapted from those that are effective at home. You may want to explain a little about relaxation in the classroom…teach students to breathe in slowly through the nose, and out through the mouth as if they were filling up a balloon with air and then letting it out. Children should breathe in to the count of 5, and out to the count of 5 which means “Breathe in, two, three, four, five, and out, two, three, four, five” (at a rate of about one count per second); Adolescents should breathe in and out to the count of 8 and have them take 3 normal breaths in between deep breaths.

Reward the student’s efforts. Work with a child regarding class participation and answering questions on the board, understanding that many anxious youth fear answering incorrectly. Encourage small group interactions and provide assistance in increasing competency and developing peer relationships. Reward the student’s efforts. Provide an organized, calming, and supportive environment. For maximum effectiveness, foster feedback from youths about these interventions Reward students efforts with praise, small prizes, stickers, calls home, etc. Use whatever will motivate them!

Strategies continued….. It is important for behaviors to be reinforced at home as well as in school therefore parents should be involved in the treatment process Teachers and parents should keep in close contact about child’s progress.

Resources for Educators PsychCentral http://psychcentral.com/disorders/anxiety National Institute of Mental Health http://www.nimh.nih.gov/HealthInformation/anxietymenu.cfm Anxiety Disorders Association of America http://www.adaa.org/ NYU Child Study Center http://www.aboutourkids.org/aboutour/articles/sub_abuse.html DSM-IV Diagnosis in the Schools(2002) ~~ Alvin E. House

the Maryland School Mental Health Alliance *Developed by the Center for School Mental Health (http://csmh.umaryland.edu) in collaboration with the Maryland School Mental Health Alliance