Anxiety on the Rise
by Effective School Solutions
When we talk about the mental health crisis affecting our nation’s youth, we’re referring to a wide range of conditions, the two most prevalent of which are anxiety and depression. Depression is often seen as the more worrisome because its symptoms can be so excruciating and even life-threatening. At its worst, depression can lead to feelings of hopelessness, despair, and suicidal ideation — serious symptoms that call for immediate intervention.
Anxiety, however, brings its own forms of suffering and can be profoundly disruptive and debilitating. At the same time, anxiety and depression often co-occur. Those with anxiety are at greater risk for depression and vice versa. So recognizing and treating anxiety disorders as early as possible is vitally important.
Not All Anxious Feelings Are Problematic
Feeling anxious on occasion is simply a part of being human. Experiencing mild worry about an upcoming test, or feeling butterflies in the stomach before entering a roomful of strangers are normal episodes of nervousness that just about everyone experiences at some point. Indeed, occasional fear and anxiety are healthy and adaptive and help to keep us safe. But while mild worries are normal and disappear when the triggering situation passes, disordered anxiety is more pervasive. Troublesome anxiety is out of proportion to the situation, often hinders behavior, and may get worse over time.
The Most Common Types of Anxiety Kids Experience
There are a number of different anxiety disorders, but what they all have in common is that they lead to suffering, and can disrupt and diminish young people’s lives. The following are some of the most common anxiety disorders young people experience.
Social anxiety disorder. Children and teens with social anxiety disorder suffer from extreme feelings of self-consciousness that make it hard for them to interact in normal social situations. Some degree of self-consciousness among adolescents is normal, but kids with social anxiety find daily encounters with peers highly stressful — and may find it impossible to participate fully in school. As a result, young people with this kind of anxiety disorder increasingly avoid social situations, which can lead to loneliness, poor school performance, and an avoidance of other activities.
Panic disorder. Students with panic disorder experience recurring (often spontaneous) panic attacks. The physical manifestations of these episodes — racing heart, dizziness, sweating, shortness of breath — are so overwhelming that sufferers may fear they’re dying or going crazy.
Specific phobias. Kids with specific phobias experience extreme fear when they encounter a specific trigger. Triggers can be almost anything, ranging from spiders or insects to heights or bridges to choking or vomiting. In response to their phobia, sufferers will try to avoid the trigger. For instance, someone with a phobia of choking may avoid eating many types of food.
Separation anxiety disorder. While it’s normal for very young children to experience distress when separated from their caregivers, separation anxiety is problematic when excessive distress is felt by older students who would normally separate with ease.
Obsessive-compulsive disorder. Young people with obsessive-compulsive disorder (OCD) experience unwanted thoughts (obsessions), and frequently engage in behaviors (compulsions) designed to alleviate the anxiety caused by the intrusive thoughts. For someone with OCD, the thoughts and feelings can take up a lot of mental energy.
Generalized anxiety disorder. Students with generalized anxiety disorder experience intense worries and fears that seems to have no real cause. Unlike phobias, their fears are directed at many things, such as their school performance, their past behaviors, and real or imagined future events.
Why Are Anxiety Disorders On the Rise?
Anxiety is on the rise among people of all ages, but the greatest increases have been among young people. In many cases, we don’t know the factors that lead to the development of a child or teen’s anxiety disorder. It’s likely that genes, brain wiring, temperament, and other unknown factors all play a role. Yet these factors seem insufficient to explain the marked increase we’ve witnessed among children and adolescents in recent years.
It’s tempting to blame the increase in anxiety on the pandemic. And without a doubt, that unprecedented crisis has made everything worse. Various studies have shown that the pandemic increased both rates of depression and anxiety in the population as a whole and among young people in particular. But ample research has also shown that rates of anxiety were already climbing before the pandemic. According to the CDC more than 9% of young people between the ages of 3 and 17 were diagnosed with anxiety in the four years leading up to the pandemic, and that number had been rising steadily for the past two decades.
So what’s changed?
High expectations and the pressure to succeed. Today’s young people feel pressures that no previous generation did. High-stakes testing, the pressure to get good grades and to get into a good college, and an emphasis on resume-building extracurricular activities can leave students feeling stressed and out of balance. Without adequate downtime to run around, relax, and just be kids, they can become perfectionistic, overwhelmed, and anxious.
Social media. Our kids spend a lot of time on social media, where likes and approval are the currency of the realm. While some kids say social media makes them feel connected, it’s also clear that for many it leads to negative self-comparisons and feelings of inadequacy. In addition, too much time spent interacting with screens can crowd out time for in-person, face-to-face interactions and may end up contributing to social avoidance.
Real-World Issues. Kids in twenty-first-century America live in a complex culture with many realities that can feed anxiety. As the threats of climate change loom, children and teens may experience stress and worry about its impact on their future. Once a rare event, school shootings are now so common that many schools regularly have lockdown drills, which can themselves be terrifying for young people. Racism, anti-LGBTQ prejudice, and other forms of social injustice are now front and center for many young people — whether because they experience them firsthand or because of time spent online.
Recognizing Anxiety Disorders
Recognizing anxiety disorders is the key to treating them. Some forms of anxiety are relatively easy to spot. An anxiety disorder like OCD, for example, often announces itself when a young person begins to engage in compulsive behaviors, like excessive handwashing or repetitive checking. Similarly, specific phobias are often easy to identify. Other anxieties, though, are often less visible.
Generalized anxiety disorder, for instance, can be harder to identify — especially once students hit adolescence, when they become experts at hiding their thoughts and feelings. But to an informed eye, there are a number of behaviors that might signal a teenager is dealing with anxiety.
School refusal is one such sign. According to the Child Mind Institute, “school avoidance can mask anxiety about any number of issues. “Since so much of what adolescents are focused on is connected with school — think academics, sports, other activities and social life — school can be the setting of a lot of things a teenager might be anxious about. Hence when kids resist going to school, it’s not necessarily about school itself.”
Other signs could be irritability, difficulty sleeping, trouble concentrating, and excessive worrying, among others. At school, episodes of acting out or defiance, which look like “misbehaving,” may in fact be fueled by underlying anxiety and feelings of being overwhelmed.
Therapeutic Interventions
Fortunately anxiety is treatable with the right interventions. Intervention, however, is key. Left on their own, anxiety disorders can worsen. Although strategies like avoidance feel helpful in the short term, over time they can actually deepen fear and anxiety and becomes self-reinforcing. In the worst case, the fears and anxieties spiral out of control and significantly diminish quality of life.
A form of cognitive therapy known as “exposure therapy” is one intervention that has been proven to be successful. Exposure therapy is just what it sounds like — it entails exposing the anxious person to the trigger or triggers that elicit fear and anxiety, and over time the anxiety lessens. Yet as The New York Times recently reported, the treatment, “which is considered a gold-standard approach for tackling anxiety, phobias and obsessive-compulsive disorder” and which often yields big improvements in a matter of months, is rarely used with young people. “Financial barriers and a lack of providers have kept the treatment out of reach for many.”
In addition, exposure therapy for young people has its critics. Exposing a young person to the thing they’re most afraid of can make therapists uncomfortable and may be seen as cruel. A child or teen will have to endure some difficult feelings before they ultimately feel better. But when engaged in with care, a skillful exposure therapist can help young people feel a degree of safety even as they experience fear and dread.
Another tool that can be helpful in reducing anxiety is mindfulness. Mindfulness is a form of meditation that entails being present with what’s happening in the moment — one’s thoughts, feelings and bodily sensations — without criticism or judgment.
A recent study (conducted in adults) found that mindfulness training was as helpful as medication in treating anxiety disorders. In the study, half the participants were given a drug commonly prescribed for anxiety and depression, while the other half participated in an eight-week Mindfulness-Based Stress Reduction course. At the end of eight weeks, both groups experienced a 20% reduction in their anxiety.
Lastly, some young people with severe anxiety disorders may be prescribed medications, which can be used together with behavioral interventions to fully address the condition.
What Can Schools Do?
Perhaps the single most important step schools can take to address the epidemic of anxiety — and other mental health issues among students — is to have a multitiered system of supports (MTSS) in place. An MTSS framework is designed to respond to young people across the continuum of need so that no student falls through the cracks. Universal screening of students can identify issues that may otherwise fly under the radar. And when mental health challenges are identified, there are caregivers available to ensure students have access to appropriate interventions.
Teachers and staff also benefit from an MTSS model, which puts an emphasis on professional development. By equipping them to respond to problematic behavior and to recognize when a young person may be experiencing undiagnosed anxiety, the framework helps the school day run more harmoniously for everyone.
Bringing tools like mindfulness into the classroom can have positive results, as well. Although most mindfulness research has focused on adults, there’s plenty of anecdotal evidence that mindfulness is effective for people of all ages, including kids, and increasingly it has found its way into schools. One organization, Mindful Schools, based in Oakland, California, has been bringing mindfulness into classrooms since 2007, giving young people a tool in their toolbox to chip away at stress and anxiety when they arise.
Amid the current epidemic of anxiety and other mental health challenges, it’s more important than ever to create a school culture in which mental health issues — and their treatment — are seen as ordinary rather than something to be ashamed of, and in which everyone is accepted and welcomed.
