We know that anxiety disorders typically begin in childhood and adolescence, and are one of the most common mental health problems that young people experience. We also know that they are a real problem, interfering in school, at home, in friendships, and leisure activities. Without treatment, they can often persist into adulthood.
Learn more about teens and mental health.
Studies examining the effectiveness of psychological treatments (most commonly Cognitive Behavior Therapy, CBT) for young people with anxiety disorders have typically included children and adolescents together as one large group, and treatments have most often been developed for children aged between seven to 13 years of age. This means that the potential specific needs of teenagers aged 14 to 18 have been neglected in clinical research.
Anxiety in Teenagers is More Complex
In routine clinical practice, therapists often report that in their experience, teenagers with anxiety generally have more complex difficulties than younger children, with differing kinds of problems. Treatments may need to be adapted for this age group.
We examined the clinical characteristics of 100 children and 100 teenagers referred to our clinic by their family physician (or another health professional) for treatment of an anxiety disorder, and found striking differences. We found that children were significantly more likely to be diagnosed with separation anxiety disorder (worry about being apart from a parent or caregiver) than adolescents.
We found the following results on adolescents:
- Have more severe symptoms of anxiety, as rated by both themselves and clinicians
- More likely to be diagnosed with Social Anxiety Disorder (anxiety about social situations) as their main problem
- More likely to be diagnosed with panic disorder (sudden periods of intense anxiety) and/or Agoraphobia (fear and often avoidance of places or situations that might cause symptoms of panic) as their main problem
- More likely to be diagnosed with a mood disorder, like depression, and have a greater number of depressive symptoms
- More likely to have difficulties attending school regularly
Among both children and adolescents, we found:
- Generalized Anxiety Disorder (worrying excessively about a range of everyday situations) to be the most common anxiety disorder
- Relatively few behavior disorders
Although generally there were more referrals for girls than for boys (especially among teenagers), boys and girls did not significantly differ on any of the clinical characteristics that we examined in childhood or adolescence.
Programs Specifically Designed for Teenagers May Improve Treatment Outcomes
These findings are important as they suggest that although there are some similarities, children and teenagers with anxiety disorder differ on a number of key characteristics. Notably, all of the characteristics which distinguished adolescents from children, have been found to be associated with poorer outcome in treatment.
There are clear implications for treatment:
- Simply adapting treatments primarily designed for children to make the materials more ‘adolescent-friendly’ (i.e. to look ‘cooler’) is unlikely to sufficiently meet the needs of adolescents
- Programs for teenagers need to be designed and delivered to adequately address these characteristics. For example, it may be that teenagers benefit from more sessions to address more severe symptoms, additional components that target low mood, and more joined-up working with the education system around school attendance.
Finally, although we have established that adolescents with anxiety disorders do differ to children, we do not yet know why this is. One possibility is that there are particular factors that are specific to this developmental stage (e.g. relating to biological changes or changes in the environment) that could help explain these differences. Another possibility is that some of these teenagers have had anxiety as children, and, without treatment, symptoms have become more severe and distressing over time. This would suggest that reducing stigma, increasing understanding of mental health problems, and providing earlier access to evidence-based treatment are also likely to be of great importance.
Dr. Polly Waite trained as a Clinical Psychologist at University College London, UK. She is a Clinical Lecturer and MRC Clinical Training Fellow, based at the University of Reading in the U.K.
She also works as an Honorary Clinical Psychologist at the Child & Adolescent Mental Health Service (CAMHS) Anxiety and Depression Pathway for Berkshire Healthcare NHS Foundation Trust, where she has recently been running a treatment trial of therapist-supported online CBT for adolescents with anxiety disorders.
Her primary clinical and research interests are anxiety disorders in adolescents, developing treatments for anxiety in young people and the role of family factors in the development and maintenance of anxiety disorders. As well as publications for an academic audience, she has co-written a book for children, friends, family and professionals, ‘Can I tell you about anxiety?’.
Professor Cathy Creswell completed her clinical psychology training and subsequently her PhD at University College London, and has since worked at the University of Reading, where she is an NIHR Research Professor based in the School of Psychology and Clinical Language Sciences. She is also an Honorary Consultant Clinical Psychologist and Joint Director of the University of Reading Anxiety and Depression in Young people (AnDY) clinical research unit.
Cathy has particular research and clinical interests in the development and treatment of anxiety disorders in children and young people. In addition to academic publications, she has co-written two CBT self-help books for parents: ‘overcoming your child’s fears and worries’ and ‘overcoming your child’s shyness and social anxiety’.
