“Is my child’s anxiety ‘normal’?”

Knowing when to seek help for your teenager’s anxiety

Today’s teenagers face a staggering array of challenges: navigating complex social dynamics, coping with changes to their bodies, competing for college admissions, dealing with parental expectations, and more – all under the ever-present gaze of social media. So it’s no surprise that feeling anxious is a big part of many teenagers’ experience.

As parents, we expect our teenage children to experience anxiety sometimes. But how do we know when it makes sense to seek help for our teen, versus assuming that “they’ll outgrow it?” What do we do when our child’s anxiety seems to be more than just a passing feeling? And if we think our child may need help, how do we find the right treatment?

This article provides an overview of anxiety disorders in teens, with an eye toward providing you with answers to these important questions.

Feeling anxious is both normal and beneficial

Anxiety is an emotion that we all experience in our lives. As adults, we recognize its symptoms, such as feelings of tension and fear, worried thoughts, and physical symptoms such as shortness of breath, sweating or a rapid heartrate. These symptoms are typically triggered by a perceived threat.

Anxiety is a normal and helpful response to danger: it puts us into a mentally and physically alert state, preparing us to deal with the challenge at hand. Our ancestors’ anxiety helped them navigate an often-hostile environment: the “fight or flight” response triggered by their anxiety was exactly what was needed to fend off attacks from predators. In the modern age, anxiety still serves a valuable purpose. For example, the anxiety you feel in advance of an upcoming presentation is often the alert you need to be adequately prepared.

Anxiety disorders: when anxiety become persistent and intrusive

Sometimes people experience a level of anxiety that feels out of proportion to the actual threat. For example, while many teens feel nervous about starting high school, for some the fear becomes so great that it impacts the ability to function. The preceding summer may be ruined by persistent worry. They may shut down emotionally and verbally in their classes. Some may even try to avoid school all together.

When recurring, persistent feelings of anxiety start limiting a teenager’s functioning in one or more areas of life, it may signify the presence of an anxiety disorder.

“Anxiety disorder” is the term mental health professionals use to describe a group of conditions including panic disorder, generalized anxiety disorder, agoraphobia, social anxiety disorder, separation anxiety disorder, and selective mutism.
While reading this list of scary-sounding illnesses may make any parent anxious, it’s important to know that anxiety disorders are both extremely common and highly treatable.

So which is it: “normal” anxiety or an anxiety disorder?

This question can best be answered by meeting with a mental health professional. But it can be difficult for a parent to know when their child’s anxiety issues warrant a consultation. Below are several questions, the answers to which may help inform your decision:

  • As a parent, are you adjusting your behavior to accommodate your child’s anxiety?
  • Is your child’s world getting smaller because they are avoiding things?
  • Does your child complain regularly about physical symptoms such as stomach pain, headache, or fatigue?
  • Has there been a sudden change in school attendance, punctuality, sleep habits, hygiene, or grades?
  • Does your child seem more emotional, sensitive, defensive, or easily frustrated?

If you answered “yes” to one or more of these questions, I suggest reaching out to a counselor or therapist to conduct an assessment.

For example…

Below are three examples of typical cases of teen anxiety that we encounter in our practice. In each case, I’ve provided my assessment of whether a professional evaluation is warranted.

Example 1: “My 13-year-old daughter gets extremely anxious before every math exam, obsessing about it for days in advance. Her anxiety peaks on exam days, and the relief she experiences post-exam is palpable. In spite of her nervousness, all of her exam grades have been A’s and B’s.”

Assuming she isn’t reporting any other significant incidents of anxiety, this case doesn’t appear to be an anxiety disorder. While the student experiences discomfort, she is able to perform on the exams and her anxiety doesn’t linger after the test is done. While she might benefit from learning some relaxation techniques, professional help doesn’t seem warranted.

Example 2: “Our son is a sophomore in high school. While he’s always been somewhat nervous in social situations, he recently stopped attending any social functions with friends or classmates. He claims to be happier staying home, doing his schoolwork and watching videos online.”

While this student claims to be happy just staying home, his complete withdrawal from social life is a red flag. This boy’s life has gotten smaller as a result of his fear. When anxiety starts limiting significant aspects of a teenager’s world, as is the case here, then I suggest speaking with a mental health professional.

Example 3: “For several years, our daughter has had her sights set on attending an Ivy League college. Her grades are outstanding as are her extracurricular activities. But her fear of standardized tests has caused her to put off taking the SAT exam three times. Now she’s talking about only applying to schools that don’t require SAT scores.”

Unlike our first example – in which the student was able to effectively take tests in spite of her fear – this teenager’s anxiety has led her to avoid taking an important exam and thus severely limited her choice of colleges. As in our second example, anxiety is making the student’s world smaller. Thus I would suggest meeting with a mental health professional who can help determine if an anxiety disorder is present.

Finding the right treatment for your teenager’s anxiety

The good news about anxiety disorders is that effective treatment is available.

Cognitive Behavioral Therapy (CBT) has proved to be particularly effective in treating anxiety disorders, especially when the treatment involves exposure therapy. Exposure therapy is designed to increase the teen’s anxiety in a controlled environment. Through this exposure, the patient becomes desensitized to the source of their fear. This enables them to face their fear with greater confidence.

When evaluating treatment options, I advise parents to seek out an anxiety specialist who utilizes exposure therapy. Good places to find such therapists are the websites of the Anxiety Disorder Association of America (adaa.org) and the Association for Behavioral and Cognitive Therapies (abct.org).

It pays to be a smart consumer when searching for treatment for your teen’s anxiety. To that end, here are a few questions to ask when interviewing therapists:

  • What role does Cognitive Behavioral Therapy (CBT) play in your approach? (You will want a therapist that makes extensive use of CBT.)
  • Do you use exposure therapy in your treatment? (Look for a therapist that answers “yes” and can explain how they utilize this approach.)
  • Does treatment for anxiety typically include spending time outside of the office? (Exposure therapy works most efficiently when done both inside and outside the office, so you’re looking for a “yes” response.)
  • How do you measure progress in using exposure in the treatment of anxiety? (The key here is that the therapist believes in measurement, collecting data to track your child’s progress.)

Five tips for parents of anxious teens

  1. You need not feel alone.
    Almost one-in-three adolescents, 31.9%, experience an anxiety disorder.
  2. Don’t be surprised if your teen resists seeking therapy.
    After all, the last thing an anxious teen wants to do is talk about the thing that makes them anxious.
  3. Your teen’s anxiety disorders may not look like anxiety.
    For example, your child may exhibit defiance, aggressiveness, manipulation, or other acting-out behaviors to avoid situations that make them anxious.
  4. Remember, your teen can’t “just relax.”
    While you may experience anxiety as “no big deal,” your child experiences it as a very big deal…a persistent, negative feeling that they can’t control.
  5. Don’t put off seeking treatment.
    The longer your teen’s anxiety disorder goes untreated, the more conditioned they become to escaping and avoiding their fear.
Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication–Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-9. PMID: 20855043

About the Author

Headshot: Daniel Villiers, Ph.D.
Dr. Dan brings over 10 years of experience working with children, adolescents, young adults and families in a range of clinical and educational settings.