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Running Head: ANXIETY DISORDER AWARENESS: ADOLECENTS

Abstract
This paper explores five different anxiety disorders that are popular in the adolescent community.
Those five anxiety disorders include: generalized anxiety disorder, separation anxiety disorder,
social phobia, obsessive compulsive disorder, and posttraumatic stress disorder. Increasing public
awareness and identification of adolescents who suffer from these anxiety disorders is an
extremely essential part in bettering generations to come. With implementing intervention
methods, and raising awareness of red flags, the effects of an un/underdiagnosed anxiety disorder
would decrease.

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Anxiety disorders in adolescents are often times underdiagnosed. In order to increase

public awareness and identification of adolescents with anxiety disorders, the community
(parents, teachers, coaches, etc.) who surround the adolescents must be made aware of "red
flags" as well as intervention methods. Firstly, the community must be made aware of the anxiety
disorders that commonly affect adolescents. Secondly, those around the child must be able to
recognize red flags. Lastly, the community must know how to successfully implement
intervention methods once they recognize a child who is suffering from an anxiety disorder.
Background
In order to increase awareness and identification of adolescents with anxiety disorders,
the community must first become aware of the different anxiety disorders that commonly affect
the adolescent community. Firstly, Merriam- Websters online dictionary defines anxiety as the
fear or nervousness about what might happen (2015). Anxiety disorder is defined as the
uncontrollable, persistent worry or nervousness (Massachusetts General Hospital, 2010). Ken
Duckworth states, The most common anxiety disorders in adolescents include: generalized
anxiety disorder, separation anxiety disorder, social phobia disorder (social anxiety disorder),
obsessive compulsive disorder (OCD), and posttraumatic stress disorder (PTSD) (2014).
For start, generalized anxiety disorder (GAD), is defined as the medical condition where
one feels nervous or anxious or one worries uncontrollably for a long period of time (2014).
Generalized anxiety disorder only affects 3.1 % of the American population, 18 and older (n.d.);
However, it only affects 3 to 4% of adolescents (2014). People ages 15-24 are more likely to
suffer from generalized anxiety disorder. Also, 2 out of 3 adolescents who suffer from GAD are
females. It is also stated that GAD generally begins at age 12 (Hand, 2014). Symptoms of GAD

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include: restlessness, extreme self-criticalness, severe persistent worry, sweating, fatigue, etc. It
takes approximately at least 6 months to diagnose GAD (2014). Adolescents suffering from
generalized anxiety disorder are more worried about things than their peers. Their high level of
anxiousness and worry affects their level of functionality, socially and academically. These
children are often times preoccupied with constant worries about success, approval from others,
as well as their performance in activities they participate in.
Generalized anxiety disorder is a treatable mental health disorder. With support from
family and teachers, along with psychological interventions and/or biological interventions,
GAD can be managed (2014). An example of a psychological intervention is counseling.
Counseling has been proven to help decrease the effect GAD has on an adolescents everyday
life. It is stated that there are many psychological interventions that could be beneficial. Those
intervention methods include: individual psychotherapy, cognitive behavior therapy, parent
guidance sessions, group psychotherapy, and school based counseling. Massachusetts General
Hospital states that psychotherapy alone may not be sufficient for adolescents. For this reason,
biological intervention is used often times with psychotherapy. Examples of a biological
intervention include medicines such as: Prozac, Celexa, Paxil, Zoloft, and Lexapro. There are no
FDA (The U.S. Food and Drug Administration) approved medications for generalized anxiety
disorder; however, GAD can be treated with antidepressants (2014).
Separation anxiety disorder is defined as a medical condition that is characterized by
significant distress when a person is away from parents, another caregiver, or home (2014). It is
stated that a child may occasionally feel worried at the time of separation, which is normal. A
certain level of separation anxiety disorder is an expected, normal part of healthy development,
varying between the ages of infancy, and age 6. However, when a child is suffering from

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separation anxiety disorder, the distress they feel at the time of separation is severe; it limits their
ability to engage in everyday activities (2014). Separation anxiety disorder affects
approximately 2 to 5% of adolescents. Children with separation anxiety are extremely agitated
and anxious with just the thought of being separated from their primary caregiver. It is reported
that older children who suffer from separation anxiety resort to extreme measures, so that they do
not have to part from their primary care giver. Symptoms of this anxiety disorder include: school
refusal, consistent and extreme worry, difficulty sleeping alone, and other physical symptoms
(2014). It takes approximately 6 months of extreme symptoms to diagnose separation anxiety
disorder (2014). Massachusetts General Hospital states that diagnosing this disorder can be
challenging, for the simple fact that children with this anxiety disorder may often times suffer
from other types of anxiety disorders. If left untreated, separation anxiety disorder may limit
numerous areas of a childs life.
Social phobia also known as social anxiety disorder is a medical condition that is
characterized by extreme and consistent fear of meeting new people (2014). Massachusetts
General Hospital states that, social phobia is different than the occasional shyness and
nervousness a child might feel. Adolescents who suffer from social anxiety disorder often times
have negative views of themselves. These children usually are extremely afraid, or act out when
forced to speak in social settings. When comparing social phobia in adults to social phobia in
adolescents, it is made evident that it affects both age groups differently. An example of this is,
avoiding group projects and attending places such as the mall and places where there are a lot of
people. Social anxiety disorder limits a persons ability to function in social settings. Social
phobia is commonly found in adults, only affecting 1% of children. It is also stated that the
incidence is higher than 1%, because symptoms may seem to be caused by shyness or a shy

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personality. Symptoms include: constant anxiety attacks when forced to be in social settings,
avoidance of social situations, numbness, and sweating (2014). It takes approximately 6 months
of extreme symptoms to diagnose social anxiety disorder (2014). Social anxiety disorder
includes the same treatment plan as GAD, Antidepressants, and therapy.
Obsessive compulsive disorder, also known as OCD, is defined as a medical disorder that
causes repetitive obsessions, thoughts or behaviors. The unpleasant repetitive thoughts are called
obsessions. The unpleasant repetitive behaviors are called compulsions. Those obsessions and
compulsions may consume a lot of a persons tine. OCD only affects 1% of children and
adolescents. Obsessive compulsive disorder has genetic and environmental factors.
Massachusetts General Hospital argues that diagnosing OCD in adolescents may be difficult
(2014). The symptoms can easily be written off as willful disregard. Symptoms include:
resistance to stop obsessions and compulsions, extreme distress that interrupt ritual, and repeated
actions. It is also stated that adolescents usually suppress symptoms in a school setting.
Depression and suicidal often times develops in children with posttraumatic stress disorder. It
takes approximately 6 months of severe symptoms to diagnose OCD. Obsessive compulsive
disorder is treated the same way as GAD.
Next, post-traumatic stress disorder, also known as PTSD, is defined as a mental health
condition that is triggered by experiencing or witnessing terrifying events (2010). Adolescents
who develop this disorder usually go through a traumatic experience like a flood, rape, and/or
physical, sexual, or verbal abuse. People who go through terrifying events suffer symptoms of
PTSD for a while, but they do not have PTSD. Symptoms of PTSD include: self-harm, constant
fear, worry, anger, and sadness, and out of place sexual behavior (2014). Massachusetts General
Hospital says that there are 3 risk factors for PTSD. Those risk factors are, how severe the

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trauma is, how the parents react to the trauma, and how close or far away the child is from the
trauma (2010). Children and teens go through more severe traumatic experiences than any other
age group. Also, minorities affected by PTSD than any other age group. Neglect and physical
abuse are the most common reasons why a child might develop PTSD. It is reported that out of
the 43% of girls who experience a horrific event, 15% of them suffer from PTSD. Out of the
43% of boys that experience a horrific event, only 6% suffer from anxiety disorder. (2014). It is
also stated that children and teens are more likely to develop PTSD due to the high level of
severe traumas they experience. A child who is suffering from PTSD may experience flashbacks.
Also, aggressive behaviors, out- of- place sexual behaviors, self-harm, and substance abuse are
all possible detriments caused by PTSD. It takes approximately 6 months of extreme symptoms
to diagnose. PTSD is treatable. Three psychotherapy treatments discussed are, cognitive
behavioral therapy, play therapy, and psychological first aid/ crisis management.

Red Flags
In order to successfully intervene, the people who surround the child must be able to
recognize red flags. Merriam-Websters online dictionary defines a red flag as a warning sign, a
sign that there is a problem that should be noticed or dealt with (2015). Worrywisekids.org
documents that there are numerous red flags to look for in a distinguishing a child who is
suffering from an anxiety disorder. Some of those red flags include: being easily distressed or
agitated during stressful events, repetitive reassurance questions like what if, excessive
avoidance, difficulty sleeping, or sleeping alone, and severe cases of perfectionism and self-

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criticalness (n.d.). Once one recognizes one or more of these symptoms is a child, interference is
the next step.
Case Study
Holly is an 8 year old Caucasian female who presented well-dressed/groomed. She was
upbeat and initially shy, but was quickly talkative and engaging. She was accompanied by her
younger sister, Molly, and her mom and her mom's significant other. Prior to evaluation, Mom
discussed the two girls with intake coordinator explaining that both girls were in need of
services, but today's intake would be focusing upon Hollys needs. Holly was willing to discuss
her symptoms and experiences with Mom's help. Holly explained that in January 2012, Holly
and her sister were having a visit with their biological Dad (parents divorced). The three of them
were showering together and that the girls were laughing and being silly. Dad quickly became
enraged and pushed Molly up against the wall by her throat, choking her. Immediately the girls
began crying and Dad laughed. This was reported to Mom when they returned home to her. Child
protective services were contacted and supervised visits were implemented. The girls saw their
dad over the next few holidays following the incident. The visits were supervised by CPS
caseworker. Mom disclosed that Dad was abusive to her in the presence of the girls, although
girls may have been too young to remember. Mom disclosed that Dad often took punishment to
the extreme with the girls. The girls and their mother began to see a therapist to work through the
trauma that this incident caused. Holly was exhibiting symptoms of anxiety, nightmares, bed
wetting, general fears that dad would be coming to the house or was hiding in the closet.
Additionally, any contact with dad caused anticipatory anxiety for about 2 weeks. It often took
just as long to "recover" from the visits. Mom also reported periods when Holly "zones out" for a
few moments and it is necessary to help her "snap out of it." Mom also reported that Holly often

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resorted to baby talk when discussing dad or anything related to dad. Mom also reported that
Holly exhibited a few nervous "tics"--rubbing her chest and shaking her hands.

Intervention methods
Intervention is an extremely vital part of ensuring functionality for adolescents suffering
from an anxiety disorder. With the proper intervention techniques, and knowledge of red flags,
intervening can be an extremely beneficial action. Examples of intervening at home include:
Planning for transitions, firmly setting limits, and supporting behavioral strategies. Interventions
in school include: scheduling check-ins on arrival to school to reduce a childs anxiety, and
developing relaxation techniques to reduce anxiety in school (2014). Each anxiety disorder has
individual intervention methods that specifically tend to that anxiety disorder. Although each
anxiety disorder is different, they all have general treatments that apply to all of them. According
to LCSW (licensed clinical social worker) Amy Mack, The most common treatment for these
anxiety disorders are anti-depressants and different variations of therapy Mack, A. (2015,
March). Personal interview.
Why intervene?
Anxiety disorder is a hidden disability (Minahan, 2012). The Anxiety Disorders
Association of America documents that one in eight children suffer from an anxiety disorder.
Without interference, an adolescent is at risk for decreasing their functionality, socially and
academically. Any type of anxiety disorder can affect a child behaviorally and academically. It is
reported by Jessica Minahan that anxiety impacts a student's working memory, making it difficult
to learn and retain information. A student suffering from an anxiety disorder thinks and learns

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less efficiently than another student. Because levels of anxiety fluctuate in adolescents, the
community who surround the child, more specifically teachers, to make an accurate conclusion
(2012). Other learning disabilities such as dyslexia, and reading disabilities show a more
consistent struggle. Because teachers are not used to looking at a disability as only affecting a
child sometimes, it is harder to recognize a child who is suffering academically due to anxiety
disorder. Behaviorally, anxiety disorder is easier to detect. A teacher can easily learn to
recognize behavior signs. Those signs include: increased inflexibility, over-reactivity, emotional
intensity, and impulsivity. Educating teachers and parents about anxiety disorder and the
behavioral signs they may see in the classroom makes this invisible disability easier to detect and
understand.
In conclusion, anxiety disorder in adolescents is often times underdiagnosed. In order to
decrease the significant amount of underdiagnosed cases the community who surround the
adolescent must first be made aware of the most common anxiety disorders that affect children.
The most common anxiety disorders in the adolescent community include: generalized anxiety
disorder, separation anxiety disorder, social phobia, obsessive compulsive disorder, and
posttraumatic stress disorder. Each anxiety disorder is treated with a variation of antidepressants along with psychological therapy as well as cognitive behavioral therapy.
Recognizing red flags is also essential when raising awareness for adolescents with an anxiety
disorder.

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