A Parent's Guide to Anxiety in Teens
Anxiety is a common experience among children and adolescents, and there’s a difference between everyday stress/anxiety and an anxiety disorder. As a parent, you want to support your child to the best of your ability. It’s important to know when anxiety becomes an issue, and what we can do to support the child.
Symptoms of Anxiety
You may be familiar with the symptoms of anxiety in adults, but they might look different in children and teens. According to the NHS, younger children may experience difficulty concentrating, insomnia, anger, restlessness, and clinginess. However, these symptoms change as the child moves on into adolescent years.
The American Academy of Child & Adolescent Psychiatry states that anxiety symptoms in teens may include:
Excessive fears and worries
Feelings of restlessness
A tendency to be excessively wary and/or vigilant
Dependency, withdrawal, or dis-ease in social situations
Overly restrained or overly emotional in social situations
Muscle tension or pain
Gastrointestinal issues such as stomachaches, headaches, and cramps
Blotching, excessive sweating, or trembling
Engagement in risky behaviors
It is important to note that symptoms may vary greatly from individual to individual. Some adolescents may experience more social anxiety symptoms, while others may experience anxiety specifically related to schoolwork. Knowing all the potential symptoms can help you recognize when your teen is experiencing anxiety.
When is Anxiety Concerning?
Some anxiety is normal. Many individuals experience stress and anxiety semi-regularly. It might be due to a stressful situation or experience, and it may come and go. Teenagers may experience situational anxiety when it comes to big tests, certain social situations, or a big game.
However, anxiety can become a problem. But when? The most simple answer is that anxiety becomes concerning when it interferes with daily life. The Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5) states anxiety is:
Excessive worry and apprehensive expectations, occurring more days than not for at least 6 months, about a number of events or activities, such as work or school performance.
The anxiety and worry are associated with three or more of the following six symptoms with at least some symptoms present for more days than not for the past 6 months:
restlessness or feeling keyed up or on edge
easily fatigued
difficulty concentrating or mind going blank
irritability
muscle tension
sleep disturbance such as difficulty falling or staying asleep, or restless and unsatisfying sleep
The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
A few important things to note here are the continuity and the interference with function. When anxiety is more common than not, it may be time to seek help. And when the anxiety or its symptoms cause impairment in daily life and responsibilities, it is likely a sign of a problem that needs addressing.
Therapists and clinicians may use a variety of screening tools to assess whether your teen’s anxiety is of concern. These include the SCARED questionnaire (Screen for Child Anxiety Related Disorders) and the Spence Children’s Anxiety Scale.
Types of Anxiety Disorders
There are multiple different types of anxiety disorders that a clinician may diagnose. Although not every case may fit perfectly into one of the types of anxiety disorders, individuals generally fit into one of these subsections.
Generalized Anxiety Disorder
The most common is generalized anxiety disorder (GAD). As the name suggests, GAD is a general anxiety in life. It may arise surrounding things like schoolwork, family, relationships, health, or any other part of life. GAD is a persistent anxiety that is not proportional to the circumstances.
Panic Disorders
Panic disorders involve recurring and/or unexpected panic attacks. These are generally characterized by intense feelings of fear or discomfort, physical discomfort such as a racing heart or chest pain, and general debilitation. These are often unpredictable and may arise during the day without provocation, at night (known as nocturnal panic attacks), or be a silent panic attack
Social Anxiety Disorder
Social anxiety is common in general among adolescents. It’s a time in our lives when our social lives greatly impact our wellbeing. The disorder arises when the fear of social situations becomes overwhelming or prevents the individual from interacting with others. It may feel like a fear of being judged or embarrassed by others.
Agoraphobia
Agoraphobia is often thought to be the fear of leaving home. However, it’s actually the fear of being stuck in a situation where escape or help may be difficult. As such, individuals often avoid public places and crowds, and may only feel safe inside their home.
Selective Mutism
Selective mutism is a disorder in which an individual is unable to speak in certain social situations. This may be with friend groups, in class, or any other social situation. However, the individual has no problem holding conversation one-on-one or in other types of interactions.
Phobias
There are numerous other phobias that fall into the category of anxiety disorders. A phobia is an irrational and persistent fear of something such as heights, specific animals, or flying. Common phobias include arachnophobia (fear of spiders), acrophobia (fear of heights) and claustrophobia (fear of enclosed spaces).
Separation Anxiety
Separation anxiety is the excessive fear of being separated from someone. Generally, this is a fear of separation from a close friend or family member. The person experiencing separation anxiety may not function well when not in the vicinity of the person.
Risk Factors
Anxiety can arise unexpectedly in many teens. There are a few risk factors that seem to play a big role in the development of anxiety disorders.
Genetic Factors
First, there are always semi-unknown genetic factors. There has been research to suggest having a family member with GAD increases the risk of the child developing GAD. Researchers believe this may be partially due to genetics.
Personality Traits
Certain personality traits are associated with higher rates of anxiety. Adolescents who are shy, slower to gain confidence with strangers, or less likely to explore new situations are more likely to experience anxiety in their teen years.
Family Stressors
There are many different experiences that correlate with heightened anxiety in teens. These include parental anxiety, parental unemployment, financial problems, abuse, and neglect. Having an experience like this doesn’t mean your child will have an anxiety disorder, but it can heighten the risk.
Developmental Challenges
Adolescents are going through big changes developmentally. Changes in hormones, insecurity about changes in the body, and pressure to perform in school are examples of this. Most teens are subject to these things, but difficulties or challenges with these aspects of growing up may increase the risk of developing an anxiety disorder.
Social Factors
There are many social factors that can play a role in anxiety. Experiences like bullying, changing friend groups, issues with intimacy, and having a friend group that is also experiencing anxiety may all increase the risk of anxiety.
Social Media Use
Social media has been found in research to increase both depression and anxiety in youth. Too much time on these platforms, as well as a need for validation or a fear of missing out can lead to anxiety.
Socioeconomic Status
Adolescents of a low socioeconomic status are more likely to experience anxiety disorders. This may have a variety of causes including financial stress, increased rates of violence at home, insecurity, and more.
Systemic Issues
Some research has found that non-white individuals may be at a higher risk of anxiety. This is likely influenced by discrimination, a lack of support, mental health care focused on white individuals, and poverty levels.
Other Mental Health Disorders
Finally, teenagers with other mental health disorders are at an increased risk of developing an anxiety disorder. This is also true for family members; teens with a family member with any mental health disorder are more likely to experience anxiety.
Why is Anxiety on the Rise in Teens?
The rates of anxiety in teens have been on the rise in recent years. Researchers with the University of Connecticut investigated this question in a 2024 study. They cited several reasons for the increase in adolescent anxiety.
Biology and Epigenetics
According to the study, there are two interacting factors that may be contributing to the rise of anxiety in teens. First, plenty of research finds a strong heritability of anxiety disorders. This means people with anxiety are more likely to have children who experience anxiety, although specific genes have not been pinpointed fully. Some studies suggest the PDE4B gene as a major actor, but more research is needed.
Together with gene profile, environmental elements play a role. Specifically, the study mentions pollution and toxins such as particulate matter, nitrogen dioxide, bisphenol A, and phthalate. These have been shown to affect pre and post-natal development, and exposure correlates with anxiety and depressive disorders.
The interesting part comes with epigenetics. Studies suggest that those with some genetic predisposition to anxiety who experience higher levels of pollution and exposure to toxins experience DNA hypermethylation (the excessive adding of methyl groups to DNA). This causes a change in gene expression and in this case may trigger anxiety genes, leading to increased rates of anxiety.
Digital Technology
We obviously use more digital technology today than in past decades. A 2023 Pew Research Center survey found that 95% of teens have smartphones and 96% are on the internet daily. Education increasingly uses digital technology, including for research, online learning, and collaborative projects. And social media is the way many teens stay connected with their peer group.
There is a growing body of research to suggest social media use increases anxiety levels. The value system of likes and followers may play a role, the social comparison, and the information overload. Teens are also subjected to an idealized version of other’s lives. On the other hand, for some, social media may provide a great place to find a supportive community.
Family Dynamics
The study notes that changes in nuclear family dynamics may play a role. Where extended family support has been the norm in many cultures throughout history, the United States has turned toward away from alloparenting practices (parenting by extended family members). This is partially due to the increasingly individualistic society, as well as geographic dispersal.
Academic Pressure
Pursuit of higher education has been a reality for decades, but university admission has become more and more competitive. According to the study’s systematic review, academic pressure was closely linked with poor mental health outcomes in teenagers. Additionally, studies have found that academic pressure was the top concern among teens and young adults. With increased pressure and competition, this academic pressure is possibly a culprit in the increasing rates of anxiety.
Political and Environmental Uncertainty
It is well-established that political and environmental policies can exacerbate stress. Factors like the COVID-19 pandemic, political instability, and climate change are causing increased anxiety in teens according to recent surveys. Part of this may be due to the availability of information, as adolescents are much more aware of the issues and policies in the world today than they were a few decades ago.
Supporting a Teen with Anxiety
If you suspect your child is struggling with anxiety, it’s important to know what to do to support them. Early intervention and support is associated with lower long-term prevalence of anxiety and better outcomes.
Staying Calm
First, remember to stay calm as much as possible. Responding with anxiety, stress, or anger may actually exacerbate the symptoms of anxiety. Instead, focus on yourself as the parent first. Remember that being a calm, supportive parent is the most important thing you can do in this moment.
Validating and Acknowledging
Next, make sure to both acknowledge and validate your child’s experience. Emotional invalidation can cause significant anxiety and further problems. Put forth effort to listen to your adolescent without judgement, with a desire to understand, and with compassion. Make space for their feelings and experience, and allow yourself just to listen.
Lifestyle Changes
You might consider lifestyle changes both for yourself or your child. These might include changing extracurriculars, promoting regular exercise, changing sleep routines, improving diet, setting boundaries with screen time, or encouraging social connection with family or peers. All of these things are associated with better mental health outcomes in general and specifically with anxiety.
Coping Mechanisms
There are many coping mechanisms that have been found to help with anxiety in both teens and adults. Teens often don’t have a set of tools to work with. As parents, you have the ability to offer coping mechanisms to help support your child when anxiety arises.
Things like exercise and yoga can be helpful when one is experiencing anxiety. Journaling is another great way to intervene when anxiety arises. You also might try incorporating more playful activities to help deal with anxiety such as listening to music, reading a book, doing a puzzle, or watching a movie together.
Mindfulness Practices
There are many somatic exercises for anxiety that can be helpful, as can mindfulness-based interventions. Much research has been done on the topic, and finds that mindfulness-based interventions are very effective for anxiety and depression. Practices like body scans, breath practices, and grounding meditations can lead to both short-term relief and long-term lessening of symptoms.
Therapeutic Approaches
There are multiple different therapeutic approaches that can be effective in working with anxiety. According to a paper from the APA (American Psychological Association), “The anxiety disorder treatment with the strongest evidence base for success is CBT tailored to the specific anxiety disorder.” CBT (Cognitive Behavioral Therapy) focuses on addressing the anxious thoughts and recognizing them as just thoughts, not reality.
Therapy takes time, and is not some sort of quick “fix.” Individuals look at cognitive distortions, such as emotional reasoning, probability overestimation, and overgeneralization. By noticing and labeling the thoughts, teens can detach from the thoughts and recognize it as simply a thought.
Beyond the cognitive aspect, therapists work with the adolescents to address the behavior. By exposing the individual to the anxiety-producing experiences with a new set of tools, the person learns to approach these situations with less anxiety and more stability.
If you or your child needs support with anxiety, please reach out for a free consultation. If I am not the right fit, I will happily help you find the right therapist for your family!
