Brain Facts

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Adolescence anxiety - How to Respond

If your teenager is willing to talk about his fears and anxieties, listen carefully and respectfully. Without discounting his feelings, help him understand that increased feelings of uneasiness about his body, performance, and peer acceptance and a general uncertainty are all natural parts of adolescence.

By helping him trace his anxiety to specific situations and experiences, you may help him reduce the overwhelming nature of his feelings. Reassure him that, although his concerns are real, in all likelihood he will be able to handle them and that as he gets older, he will develop different techniques to be better able to deal with stress and anxiety.

Remind him of other times when he was initially afraid but still managed to enter into new situations, such as junior high school or camp. Praise him when he takes part in spite of his uneasiness. Point out that you are proud of his ability to act in the face of considerable anxiety. Remember, your teenager may not always be comfortable talking about feelings that he views as signs of weakness. While it may seem at the moment as though he's not listening, later he may be soothed by your attempts to help.

If fearfulness begins to take over your teenager's life and limit his activities, or if the anxiety lasts over six months, seek professional advice. His doctor or teacher will be able to recommend a child and adolescent psychiatrist or other professional specializing in treating adolescents.

Managing anxiety disorders - as with any adolescent emotional disturbance - usually requires a combination of treatment interventions. The most effective plan must be individualized to the teenager and his family. While these disorders can cause considerable distress and disruption to the teen's life, the overall prognosis is good.

Treatment for an anxiety disorder begins with an evaluation of symptoms, family and social context, and the extent of interference or impairment to the teen. Parents, as well as the teenager, should be included in this process. School records and personnel may be consulted to identify how the teen's performance and function in school has been affected by the disorder.

The evaluating clinician will also consider any underlying physical illnesses or diseases, such as diabetes, that could be causing the anxiety symptoms. Medications that might cause anxiety (such as some drugs used in treating asthma) will be reviewed. Since large amounts of caffeine, in coffee or soft drinks, can cause agitation, a clinician might look at the youngster's diet as well. Other biological, psychological, family, and social factors that might predispose the youngster to undue anxiety will also be considered.

If a teenager refuses to go to school, a clinician will explore other possible explanations before labeling it school avoidance. Perhaps the teen is being threatened or harassed, is depressed, or has an unrecognized learning disability. He may also be skipping school in order to be with friends, not from anxiety about performance or separation.

If the teenager has engaged in suicidal or self-endangering behavior, is trying to self medicate through alcohol or drug use, or is seriously depressed, these problems should be addressed immediately. In such cases, hospitalization may be recommended to protect the youngster.

In most cases, treatment of anxiety disorders focuses on reducing the symptoms of anxiety, relieving distress, preventing complications associated with the disorder, and minimizing the effects on the teen's social, school, and developmental progress. If the problem manifests in school avoidance, the initial goal will be to get the youngster back to school as soon as possible.

Cognitive-Behavioral Therapy

In many cases, cognitive-behavioral psychotherapy techniques are effective in addressing adolescent anxiety disorders. Such approaches help the teenager examine his anxiety, anticipate situations in which it is likely to occur, and understand its effects. This can help a youngster recognize the exaggerated nature of his fears and develop a corrective approach to the problem. Moreover, cognitive-behavioral therapy tends to be specific to the anxiety problem, and the teen actively participates, which usually enhances the youngster's understanding.

Other Therapies

In some instances, long-term psychotherapy, and family therapy may also be recommended.


When symptoms are severe, a combination of therapy and medication may be used. Antidepressant medications, such as nortriptyline (Pamelor), imipramine (Tofranil), doxepin (Sinequan), paroxetine (Paxil), sertraline (Zoloft), or fluoxetine (Prozac), or anxiety-reducing drugs, such as alprazolam (Xanax), clonazepam (Klonopin), or lorazepam (Ativan) may be prescribed in combination with cognitive or other psychotherapy. When tricyclic antidepressant medications such as imipramine are pre-scribed, your teen's physician may want to monitor for potential side effects by conducting periodic physical exams and occasional electrocardiograms (EKGs).

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