Anxiety in adolescents
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Anxiety in Adolescents. Julie Ryan, M.A. & Carrie Masia, Ph.D. NYU Child Study Center NYU School of Medicine. Facts about Anxiety Disorders. Anxiety is the most prevalent problem in children and adolescents Begins early High co- occurrance of anxiety disorders, and with depression

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Anxiety in Adolescents

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Anxiety in adolescents

Anxiety in Adolescents

Julie Ryan, M.A. & Carrie Masia, Ph.D.

NYU Child Study Center

NYU School of Medicine


Facts about anxiety disorders

Facts about Anxiety Disorders

  • Anxiety is the most prevalent problem in children and adolescents

  • Begins early

  • High co-occurrance of anxiety disorders, and with depression

  • Persistent when untreated

  • Risk for negative long-term consequences when untreated


Consequences of anxiety in youth

Consequences of Anxiety in Youth

  • Personal: low self-concept, feelings of helplessness, somatic complaints, delayed progress in meeting developmental tasks

  • Academic: concentration and attention difficulties, falling behind in school, difficulty participating in class

  • Social: difficulty initiating or sustaining friendships

  • Familial: increased family stress, fighting, struggles


Why is it difficult to identify anxiety in youth

Why is it difficult to identify anxiety in youth?

  • Children often do not disclose problems to parents or school personnel

  • Families may not view anxiety as serious

  • Externalizing problems identified more easily: internalizing disorders are often overlooked


Anxiety disorders in teenagers

Anxiety Disorders in Teenagers

  • Social Anxiety Disorder (Social phobia)

  • Obsessive Compulsive Disorder

  • Separation Anxiety Disorder

  • Generalized Anxiety Disorder

  • Panic Disorder

  • School refusal


Social anxiety disorder social phobia

Social Anxiety Disorder (Social phobia)

  • Fear of public humiliation, negative evaluation, or embarrassment

  • Intense fear of social and performance situations

  • Fear embarrassing themselves or be negatively evaluated

  • Fears situations such as:

    • unstructured interactions with peers

    • initiating conversations

    • performing in front of others

    • inviting others to get together

    • Eating in front of others


Social anxiety disorder social phobia1

Social Anxiety Disorder (Social phobia)

  • Minimal interaction and conversation with peers

  • Appears isolated and on the fringes of the group

  • May sit alone in the library or cafeteria, hang back,

  • Excessive shyness

  • Difficulty with public speaking, reading aloud, being called on in class, gym class – may impair grades

  • Anticipation of a social event may provoke a panic attack


Generalized anxiety disorder

Generalized Anxiety Disorder

  • Excessive and uncontrollable worry about school, grades, performance, future, family, health, finances

  • "What if" concerns that span far into the future

  • Physical symptoms: headaches, stomachaches, inability to unwind/relax

  • Difficulty concentrating, always thinking what's next

  • Low risk-taking; Need for reassurance and approval for small steps


G a d more worries

G.A.D. - More Worries

  • Perfectionism, fear of making mistakes, unrealistic, unfavorable assessment of their grades, abilities

  • Over-responsibility: if disaster happens that it's their fault

  • Negative news that happens to others, fears will happen to them; everything is contagious by association: divorce, illness, car accidents, food poisoning

  • Sleep difficulties, irritability, fatigue


Obsessive compulsive disorder

Obsessive Compulsive Disorder

  • Obsessions are recurrent, intrusive, uncontrollable thoughts, images, or urges that result in anxiety and discomfort

    • Typically these thoughts, images, and urges are resisted

  • Compulsions are behaviors that are performed to suppress the obsessions and reduce the anxiety and discomfort, providing relief

  • Some common types of compulsions:

    • Cleaning or Washing

    • Checking rituals

    • Repeating a phrase a specific number of times


Panic disorder

Panic Disorder

  • Experience of unexpected panic attack (i.e., a false alarm)

    • Symptoms- e.g. heart racing, difficulty breathing, dizziness, sweating, trembling, fear of loosing control or “going crazy”

  • Develop anxiety, worry, or fear about having another attack or its implications

  • Symptoms and concern about another attack persists for one month or more

  • Can sometimes lead to Agoraphobia – a fear or avoidance of situations/events associated with panic


Specific phobias

Specific Phobias

  • Extreme and irrational fear of a specific object or situation

  • Markedly interferes with one's ability to function

  • May recognize fears are unreasonable, but go to great lengths to avoid the feared object or situation

    Types of phobias

    • Blood-injury-injection phobia (e.g., getting blood taken, needles)

    • Situational phobia – (e.g., planes, subways)

    • Natural environment phobia – (e.g., heights, storms)

    • Animal phobia – (e.g., dogs, snakes, spiders)

    • Other phobias – Do not fit into the other categories (e.g., fear of choking, vomiting)


Separation anxiety disorder

Separation Anxiety Disorder

  • Worry about harm of self or parent, often leads to school refusal

  • Excessive distress when separated from their parent. Often they will beg or please for their parent to stay.

  • Their worry center around harm befalling themselves or attachment figures (being kidknapped, parent in accident)

  • Sometimes child refuses to go school or to camp

  • They can be fearful to be alone at home or to walk alone

  • Nightmares with theme of separation

  • Complaints of physical symptoms when separation occurs or is anticipated


School refusal

School Refusal

  • Refuse to attend school and/or have trouble remaining in class an entire day OR Rarely miss school but attend with a lot of distress.

  • Separation anxiety

  • Worry

  • Withdrawal

  • Shyness, social anxiety

  • Depression

  • Fears

  • Repeated Reassurance seeking

  • Physical complaints

  • Complaints about teacher or peers

  • Sleep disturbance

  • Temper outbursts

    • Verbal or physical aggression

  • In younger children

    • Clinging, Crying or whining before school

  • Delaying in dressing/preparing for school


Anxiety and the school setting

Anxiety and the School Setting

  • Many Aspects of the School Setting May Induce Anxiety

  • Separation from Family

  • Social Interaction

  • Social Evaluation

  • Performance Evaluation

  • Potential Threats


The nature of anxiety disorders

The Nature of Anxiety Disorders

  • Three components

    • Behavioral

    • Cognitive

    • Physiological

I am going to fail the test


The four ds

THE FOUR Ds

  • Disproportion--Excessive and well out of proportion to the context or situational trigger

  • Disruption--Interferes with ability to function or with quality of life

  • Distress—Burdensome and bothersome

  • Duration– Consistent over a period of time


Parents and teachers reinforce but don t rescue

Parents and Teachers-Reinforce but don’t rescue

  • Encourage child to solve his or her problems. Have child generate a list of ways to handle concerns. Assist child with choosing realistic and helpful ways to solve a problem

  • If you solve the problem, child is prevented from learning to manage stress on his or her own

  • When child does something you like, tell him or her!


Tips for teachers

Tips for Teachers

  • Keep an eye out for anxiety symptoms

  • Refer the student to get more help

  • Peer-pairing for anxious youth or new students

  • Subtle reinforcement for socially anxious youth

  • Systematic ignoring and attending

  • Focus on problem solving: Socratic method


Treatments for anxiety

Treatments for Anxiety

  • Therapies

    • Family therapy

    • Cognitive Behavioral therapy

    • Interpersonal Psychotherapy

    • Group and Individual therapy

  • Medication


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