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Anxiety in Teens: Psychiatrist Laura Markley Offers Advice

Anxiety is a mental health condition that often emerges in early adolescence. Your Teen turned to Dr. Laura Markley, a child & adolescent psychiatrist at Akron Children’s Hospital, for answers about high school anxiety in teens.

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Q: Doesn’t everyone feel some type of anxiety?

Markley: Most people experience anxiety from time to time. But for a teen with an anxiety disorder, the anxiety tends to worsen over time and can interfere with daily activities such as school work, relationships, and sleep. About one in four teens will experience an anxiety disorder at some point in their life. And about one in 20 will experience a severe anxiety disorder.

Q: Do you see a link between social media and anxiety in teens?

Markley: Social media and the Internet can have positive uses in our lives. But with this generation, social media has become the new medium of communication in place of in-person conversation. I have observed that teens may have a high quantity of relationships, but fewer quality relationships. I see this causing a struggle to identify, articulate, and open up about their feelings. Communication over social media and texting, instead of conversing in person, is hampering their ability to communicate when they need help or are feeling anxious and need to talk through those feelings. Teens can be “connected” to everyone—and yet at times feel connected with no one. These feelings of emotional isolation can lead to or worsen anxiety.

Q: How do parents factor into the equation?

Markley: Kids learn how to communicate from watching their parents at home. Parents must model how to interact and communicate with others. Family time should include time away from screens. If quality family time is frequently spent staring at screens, our teens will struggle to learn how to express how they feel in general or when they need help.

Q: What are the symptoms of anxiety?

Markley: There are five.

  1. Anxiety that Interferes. Fearing social or performance situations in which a teen expects to feel embarrassed, judged, or rejected. Teens can develop anxiety that interferes with their ability to achieve in school.
  2. Physical symptoms. A teen may have headaches, feel sick before school, have diarrhea, or report chronic stomach pain with no physical cause. Sometimes there is a pattern to their illness where the child feels sick on school days, but is fine on the weekend. Parents should know that in most cases they are not “faking it”—their emotions are overloaded to the point that their body is experiencing symptoms.
  3. Change in food or sleep pattern. There may be noticeable changes in their normal appetite and/or sleep patterns, either difficulty sleeping or sleeping all the time.
  4. Difficulty concentrating. They may have difficulty concentrating in school, which can lead parents to become concerned about ADHD because of falling grades. Often, we find instead that the patient is anxious/depressed.
  5. Lack of Enjoyment. A parent might also notice a withdrawal from friends or family, or activities they used to enjoy. Depression and anxiety tend to occur together, so a child who is anxious can become depressed, and vice versa.
Q: What are the treatment options for anxiety?

Markley: Treatment considerations for anxiety are psychotherapy and medication. Your teen’s primary care physician is a great first step for recommendations and treatment for anxiety.

  • Therapy Only. Therapy is often the first-line treatment for anxiety disorders. Cognitive behavioral therapies are very effective, especially for teenagers. These therapies teach an adolescent coping skills so they can stop and confront the thoughts that bring on anxiety to gain better control of their anxiety. They may learn to cope using a medium that appeals to them, such as art, music, keeping a journal, jogging, or exercise.
  • Therapy Plus Medicine. Depending on the degree of impairment, therapy plus medication may be appropriate. If a teen can’t function (they are missing school, isolating themselves, etc.), or if they are experiencing worsening depression, then Selective Serotonin Re-Uptake Inhibitors (SSRIs), commonly called “anti-depressants,” may be recommended. SSRIs are effective in treating the biological imbalances in the brain that contribute to anxiety. In general, sedating medications, such as benzodiazepines (Xanax, Ativan), are not recommended in treating anxiety disorders in youth. They can impair cognitive abilities and development in young brains.
Q: How effective is treatment?

Markley: The good news is that treatment works, but it takes time and patience. A patient should feel improvement in 2-3 months (sometimes sooner), and experience remission in 3-4 months with combination treatment. It’s very important to continue treatment after remission to solidify the gains the teen makes and prevent relapses. Too often when things get better, a teenager will stop going to therapy and taking their meds. This can lead to a rebound of their symptoms.

Q: What advice do you have for parents of teens?

Markley: Treat mental health concerns with the same importance and urgency as physical health concerns: the sooner you address an illness, the better off your child will be. Don’t wait to see if things improve on their own, and don’t take issues lightly. If a teen musters the courage to tell you something is wrong, take it seriously. Most importantly, be available. Model good behavior with screens and social media. Have as much interaction with your kids as possible where they have your full, undistracted attention.

Jane Parent

Jane Parent is senior editor of Your Teen.