Is my child’s anxiety “normal”?

Anxiety is a normal and helpful response to danger: it puts us into a mentally and physically alert state of “fight or flight” to prepare us to fend off attacks from predators.

We all experience the emotion of anxiety at some point in our lives. Adults recognize the symptoms of feelings of tension and fear, worried thoughts, and physical symptoms such as shortness of breath, sweating or a rapid heart rate typically triggered by a perceived threat as anxiety.

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.

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.

Sometimes a level of anxiety seems out of proportion to the actual threat. Many teens feel nervous about starting high school; but for some the fear becomes so great that it impacts the ability to function. Persistent worry can ruin the summer and they may shut down emotionally and verbally in their classes. Some may even try to avoid school all together.

“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.

Here are some helpful questions for you to determine if you’d like to consult with a mental health professional.

In this difficult time, there is a fine balance between adjustment to new circumstances and general uncertainty and being overwhelmed by anxiety.

• 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 follow-through, punctuality, sleep habits, hygiene, school attendance, or grades?
• Does your child seem more emotional, sensitive, defensive, or easily frustrated?

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

Here are examples of teen anxiety we encounter in our practice and an assessment of whether a professional evaluation is warranted.

Example 1: Test anxiety

“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.”

Without  any other significant incidents of anxiety, this case doesn’t appear to be an anxiety disorder. Despite  discomfort, she performs on the exams and her anxiety doesn’t linger after the test is done. Learning some relaxation techniques would be beneficial but professional help doesn’t seem warranted.

Example 2: Social Avoidance

“Our son is a sophomore in high school. While he’s always been somewhat nervous in social situations, he has completely stopped joining any social activities with friends or classmates. He claims to be happy staying in doing his schoolwork and watching videos online.”

Complete withdrawal from social life is a red flag in these quarantined circumstances. His life has gotten even 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: Graduation and beyond

It’s not clear what will happen to our high school juniors and seniors. Are pass/fail grades acceptable for a transcript? AP, ACT and SAT tests are being altered and even cancelled. So many kids balance academic loads with extracurricular activities to enrich their lives and find ways to engage in college life. How will their loss affect college admissions? What happens to graduation celebrations?

These questions and the lack of clear answers can be very distressing. Is your child avoiding doing whatever leads to completing high school? Have they closed down emotionally and socially? 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.

Cognitive Behavioral Therapy (CBT) is particularly effective in treating anxiety disorders, especially when the treatment involves exposure therapy. Exposure therapy 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.

We advise parents to seek out an anxiety specialist who utilizes exposure therapy. Check the websites of the Anxiety Disorder Association of America (adaa.org) and the Association for Behavioral and Cognitive Therapies (abct.org).

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.)
• How do you use video? Do you have other strategies, especially with social distancing restrictions? ? (Exposure therapy works most efficiently when done with different strategies), 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.)

Dr. Dan Villiers is the Founder and Executive Director of the Anxiety institute in Greenwich, CT a comprehensive outpatient practice specializing in the treatment of anxiety, OCD and trauma. Dr. Dan has been called the “Anxiety Whisperer” for having motivated over 950 treatment avoidant and resistant teenagers to go from house-bound to school-bound through their commitment to intensive treatment.

1. You need not feel alone.
   According to the National Institute of Health, almost one-in-three adolescents, 31.9%,experience an anxiety disorder.  These numbers have been rising.
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