Anxiety in the Not-so-Littles
Updated: Nov 22, 2021
Anxiety disorders are prevalent among adolescents, and this one hits home for me, as my otherwise confident and charismatic son is nearly crippled by social anxiety. It is estimated that the prevalence of anxiety is as high as one in every four teens between the ages of 13 and 18 years of age. This may present as a generalized anxiety disorder, panic disorder, or social anxiety. These can coexist with other mental health problems as well, such as major depression disorder. There is also a relationship between anxiety disorders and sleep difficulties, which can further impact mental health. These children are significantly more likely to be those who struggle with anxiety as adults, and ultimately have poor coping skills, chronic stress, less life satisfaction, and poor family relationships.
I suspect these issues are among those issues for which "we don't talk about," because they are messy and uncomfortable; however, they are also destructive and all-consuming. Let me open discussion with these thoughts.
Generalized Anxiety Disorder
About 3 percent of adolescents are diagnosed with excessive worry and anxiety occurring more days than not for at least 6 months. Symptoms may including feeling restless, easily fatigued, difficulty concentrating, irritability, muscle tension, and sleep disturbances. These are our little ones who worry about multiple issues and are unable to control their worry. My own son for example, worries about school, being late for school, having all his supplies - but ironically, his worry keeps him from having awareness of any assigned classwork. His grades suffer significantly and he suffers great consequence, which only worsen his anxiety. His fight-or-flight kicks in so that he is more focused on surviving the day than maintaining an organized plan for his academics.
Among those with anxiety, are the adolescents who also suffer panic attacks. This will present with an abrupt sense of fear peaking within minutes and quickly resolving, usually within ten to fifteen minutes, though some certainly can last longer. They may experience palpitations, sweating, trembling, shortness of breath, dizziness, and fears of dying or losing control. Behaviors such as avoiding situations and places where panic attack have occurred is common.
Our children who suffer with anxiety and panic attacks often worry about behaving in a way that would be considered negative by their peers and others. This impacts their functioning at school, home, an with peers. My own son has such significant anxiety at school that he can come home raging, almost as if he was so tense at school all day that he just releases that in rage as soon as he walks in the door. When anxious, we haven't the cognitive ability to really sit and learn. Our minds are focused more on safety and alert to danger.
This anxiety may be limited to certain places, performances, just at home or just at school. It may be associated with a traumatic experience and they may suffer complete lack of motivation or interest, or even have suicidal thoughts. Some of these littles will also have attention-deficit hyperactivity disorder or autistic characteristics. In my own practice, these adolescents often present with a complaint that isn't really about their mental health, such as belly upset or even significant disobedience. They may even be experimenting with substance abuse.
We will want to work through ruling out asthma, thyroid disease, and other issues such as an overabundance of caffeine, energy drinks, steroids, and decongestants, or even withdraw from benzodiazepines or cannabis, but if generalized anxiety disorder is our ultimate finding, there are a multitude of approaches to management and treatment.
Our approach, as always, will dig for an underlying cause. We will then offer an integrative approach, but if necessary, particularly with significant cases, we may want to consider pharmacologic therapy. As we stabilize, we can then begin to focus on implementing lifestyle changes and various strategies for resolution so that in time, we can often eliminate the pharmaceutical support.