It sounds like the perfect child – they stress about doing well in school, never or rarely get into trouble, and are quiet and polite in company …
The Perfect Child?
While these all sound like wonderful traits, they can also be the sign of anxiety emerging. Anxious kids are rarely “naughty” kids, they are shy, serious, and work hard at doing well and pleasing those important to them.
Anxious teens often suffer in silence. The nature of anxiety means they are unlikely to speak up about it and share, and they may have thoughts that tell them other people won’t like them if they knew how “different” they are.
Anxiety is believed to affect 10% of young people aged 18-24. Due to the silent nature of anxiety, rates could be even higher, and many anxious young people go on to experience anxiety as adults, believing all the while that “worry” is normal and a part of life.
We often think of anxiety as presenting as panic, and thus, if we can’t see obvious symptoms such as hyperventilation, we may dismiss subtler ones as “normal.” However, anxiety in young people rarely escalates to panic attacks; it is more often seen in subtler ways such as persistent worrying, irritability, trouble concentrating, poor sleep, tummy aches, seeking reassurance, and avoidance.
Anxiety left untreated rarely recovers on its own. This is due to the symptoms of anxiety eliciting caring behaviours from loved ones which actually escalate the anxiety symptoms. For example, a child who fears the dark (very normal in young children) may become upset at sleeping in a darkened room by themselves, and a parent who sees their distress may comfort them by allowing the child to sleep in their bed. In a child without anxiety issues, this behaviour will be fine and they will return to their own bed in the course of time. For an anxious child, this behaviour will reinforce their fears of the dark, and their trust in their parent’s protection will lead them to feel they can only be safe with their parent during the night.
Symptoms of Anxiety in Teens
- Hypervigilance: When anxiety is present, you may notice your loved one is on high alert. You can see this in a variety of ways, highlighting what their anxiety is. For example, if it is a fear of spiders, you may notice them scan rooms and looking in corners before entering. If the fear is social, you may notice them hesitate before speaking, speak only when necessary, and being hyper aware of perceived criticism in others (notice when the other person is not interested, read too much into body cues, tone of voice or text messages).
- Physical arousal: While it is uncommon for children to experience panic attacks, it becomes more common in adolescence. Signs of a panic attack are rapid, deep breathing, racing heart, light-headedness, shaking, sweating, and fears of having a heart attack or going crazy. The more common physical signs we see with anxiety in children are an upset stomach, butterflies in the tummy, headaches, rapid speech, and tears or tantrums if severe.
- Thoughts: There are two main types of thoughts that appear with anxiety. If you notice your loved one verbalising these thoughts it is a good indication they may be experiencing anxiety at the time. These thoughts are the “I can’ts” which come from a fear of not being able to cope, eg “I can’t do this,” “I can’t handle it” or “Can you do it for me?” The other thoughts which are common are the “what ifs.” These thoughts predict doom, such as “What if … happens” or “If I … then something bad will happen.” As you might have noticed, these thoughts can be pretty scary, so the person having them will likely not want to talk about them, and the fear from the thoughts leads back to the physical symptoms!
- Behaviour: Behaviour is a key indicator of anxiety in the young. When feeling anxious, your loved one may do a couple of things; seek reassurance, and avoid feared events or objects. When anxious and having thoughts such as “I can’t do this,” naturally they may come to you for help or just reassurance they are doing it right. In children without anxiety it is natural and helpful to provide this reassurance. In the anxious child this reassurance leads back to the thoughts prompting them and confirms they cannot do it themselves, and need guidance from someone more capable (you). The other behavioural sign of anxiety is avoidance. This may be extreme and obvious, such as school refusal, or more subtle eg not “feeling” like it. If the avoidance is accompanied by a tummy ache, it is very likely to be anxiety.
Helping Your Teen with Anxiety
There is good news: if you have noticed these signs in your teen, treatment is easier the earlier anxiety is noticed. Anxiety is one of the most common disorders we see in treatment, and one of the simplest to treat!
Coming from a Cognitive Behaviour Therapy (CBT) treatment perspective, there will be several specific strategies used to help treat the above signs:
- Relaxation: Various methods of relaxing the body and mind will be introduced to calm the physical symptoms of anxiety. The body cannot be anxious and relaxed at the same time, so with practice, we will train the body to relax when it wants to tense up.
- Cognitive Restructuring: This is a technique to combat the “what ifs” and “I can’ts.” Cognitive restructuring will help your loved one to find more helpful “brave” thoughts which will help them cope in the face of anxiety, and re-train their brains to find more rational and realistic thoughts.
- Exposure: Exposure therapy is the age old practice of “facing your fears.” This is done in a controlled way, beginning with facing smaller fears your loved one feels capable of mastering. As steps are completed, self-confidence and mastery increase and anxiety decreases. Before they are aware, your loved one will be tackling fears they swore they would never face!
This is an introduction into the identification and treatment of anxiety in young people. In therapy, a thorough assessment of yours or your loved one’s anxiety will be conducted to identify what their unique fears are, as well as their physiological symptoms, thoughts and behaviours. The treatment plan will then be tailored to suit these, in close collaboration with the individual and those involved. As these skills will need to be consistently applied over time to ensure the anxiety does not return, you will in a sense be trained to treat anxiety yourself!
For further information on helping a loved one with anxiety, the book “Freeing your child from anxiety” by Tamar E. Chansky is an easy book to help guide you.
Author: Dr Rose Gillett, B Psych (Hons), D Psych (Clin), MAPS.
Rose Gillett is a clinical psychologist, working with children, adolescents, adults and couples. She is passionate about helping her clients achieve their goals, and has particular interest areas in attachment concerns in adults and young people, PTSD, and alcohol and drug addiction
To make an appointment with Clinical Psychologist Dr Rose Gillett, try Online Booking – Loganholme or call M1 Psychology (Loganholme) on (07) 3067 9129.
- Chansky, T. E. (2004). Freeing your child from anxiety. New York: Three Rivers Press.
- Rapee, R. M., Wignall, A., Hudson, J. L., & Schniering, C. A. (2000). Treating anxious children and adolescents. Oakland, CA: New Harbinger Publications, Inc.
- Rapee, R. M., Wignall, A., Spence, S. H., Cobham, V., & Lyneham, H. (2008). Helping your anxious child (2nd). Oakland, CA: New Harbinger Publications, Inc.