Understanding Adolescent Anxiety

When to seek professional help

As a clinical psychologist who specializes in therapy services for children and adolescents, I see a number of teens and preteens who are experiencing anxiety and depression. Google “rise in adolescent anxiety,” and you’ll discover that the mainstream media has been raising the alarm for the past decade about the fact that American teens are more anxious than ever. In fact, it seems like it’s almost “trendy” for teens to talk about their “anxiety” and “stress.”

But what does it really mean for someone to suffer from anxiety? What are some of the symptoms that parents should monitor? Most importantly, when should you seek professional help for your preteen or adolescent?

Let’s start by looking at some statistics. According to a 2016 article in Psychology Today, 25% of 13 to 18-year-olds have mild to moderate anxiety; 5.9% have severe anxiety. Girls are more likely than boys to be diagnosed with an anxiety disorder, and the median age of onset is 11-years-old.  

Anxiety is often related to depression. A study published in the Journal of Pediatrics in 2016 found that the prevalence of teens who reported a major depressive episode (characterized by a period of two weeks of significant depressive symptoms that interfere with one’s daily functioning) jumped from 8.7% in 2005 to 11.5% in 2014. However, despite the rise in teen depression, the study, which analyzed data from the National Survey on Drug Use and Health, reported that there hasn’t been a corresponding increase in mental health treatment for adolescents and young adults. That’s concerning because it means there are a growing number of young people who are being identified as having symptoms of anxiety and depression, yet they are not being treated. According to the Department of Health and Human Services, more than two million adolescents aged 12-17 reported severe depression that impeded their daily functioning. In fact, the American Academy of Pediatrics now recommends depression screening for all young people ages 11 through 21.

While many individuals experience periods of increased stress, an anxiety disorder entails excessive worry (disproportionate to the situation) that interferes with daily living.  Reasons for increased anxiety include social difficulties which can be exacerbated by social media; societal and parental pressures; media fears related to violence, terrorism, and safety; bullying (including cyber bullying); and school pressures such as over-commitment between school, sports, social life and family obligations.

As a parent, it is important to be aware of the signs and symptoms that your teen may be suffering from an anxiety disorder.  These may include restlessness or feeling on edge, fatigue, irritability, constant worry, avoidant behavior, poor concentration, difficulty sleeping, muscle tension, upset stomach, and shortness of breath.  

If you think your teen or preteen is experiencing anxiety and/or depression, I highly recommend considering therapy now rather than waiting for the symptoms to worsen.  Over time, untreated symptoms of anxiety and depression can lead to secondary challenges, including poor school performance, withdrawal from friendships, loss of interest in extra curricular activities, substance abuse, psychosomatic illness, and low self-esteem.

I have significant experience working with preteens and adolescents experiencing anxiety and depression.  My work often includes consultation with schools and other mental health and educational professionals. I use an integrative approach in therapy, utilizing a combination of cognitive behavioral therapy (CBT) and family systems methods.  Treatment goals are discussed with both your child and your family to develop a plan with the individual adolescent’s needs in mind. For more information, please contact me at 703-825-0502 to learn more about therapy services for your preteen or adolescent.

Shira Gottlieb, Psy.D., Licensed Clinical Psychologist

Dr. Gottlieb is a licensed clinical psychologist. She received her B.A. in psychology, with a minor in neurobiology, from Harvard University, and her Psy.D. from the George Washington University. Dr. Gottlieb utilizes an integrative approach to therapy, incorporating both CBT and Family Systems techniques. Treatment goals are discussed with the child/adolescent and family, and are developed with the individual child's needs in mind. For more information on Dr. Gottlieb please visit her website at http://www.gottliebchildpsych.com/

Identifying Learning Disabilities and Seeking Appropriate Support

By Shira Gottlieb, Psy.D., Licensed Clinical Psychologist

Your child’s teacher or school counselor has met with you to tell you that your child is struggling in a particular subject and may have a learning disability.  Or maybe you’ve noticed that your child is falling behind, even though you know your child is very bright.  You have become concerned.   Now what? As a parent, it’s hard enough to hear your child is struggling.  Now you are about to embark on a confusing journey of trying to find out if your child has a specific learning disability, what type it might be, and what needs to be done to provide your child with the best opportunity to succeed in school.

As a child psychologist, I provide testing for learning disabilities and have seen firsthand the difficulties parents face in understanding the testing methods, evaluation process, theories of learning, and disability labels. Learning disability diagnosis is an inexact science that relies on imperfect systems; however, it is important to understand the current systems as these are what we have in place.

In general, there are two models used in the diagnosis and treatment of learning disabilities.  In my evaluations, I incorporate aspects of both supplemented by additional testing and observation.  This multifaceted approach allows me to develop a comprehensive understanding of your child’s strengths and challenges in order to provide a clear and reliable diagnosis and recommendations.  Here is some information on both models.

Traditionally, neuropsychological and psycho-educational testing use the discrepancy model.  More recently, the education world has switched to focusing on the response to intervention (RTI) model to help identify children with learning disabilities.  Let’s start by looking at this educator model.

RTI is a process used by educators to help students who are struggling with a skill or lesson.  A teacher will use interventions (a set of teaching procedures) with any student to help him or her succeed in the classroom—it’s not just for children with special needs or a learning disability.  If a student is struggling, his or her teacher will use test scores and other measures of progress to choose a researched and proven intervention suited to help the child learn.  If a child does not respond to the initial interventions, more focused interventions are used to help the child master the skill.

According to the National Institute of Health website, RTI involves the following:

• Monitoring all students' progress closely to identify possible learning challenges

• Providing help on different levels or tiers based on the identified learning needs of a particular student

• Moving a student through the tiers as appropriate: increasing educational assistance if the child does not show progress and decreasing educational support as the child’s skillset improves and approaches grade-level expectations

While the RTI model focuses on the child in relation to his or her same-grade peers, the discrepancy model focuses on the individual, while also considering age-appropriate norms.  The term “discrepancy” refers to a mismatch between a child’s intellectual ability (or cognitive potential) and his or her progress in school.  The discrepancy model is a way to capture and compare a student’s scores on different types of tests.  It compares assessments of a child’s intellectual ability with how much progress he or she is making in school (one’s academic achievement).

In some cases, there may be a significant “discrepancy” (difference) between various sets of scores.  This difference may indicate that an underlying condition is making it unusually difficult for a child to learn.

For example, your second grader’s intellectual ability may fall in the high average range (e.g., 84th percentile).  The expectation would be for him to be reading slightly above a typical second grade level.  However, his scores may show that he is actually reading significantly below what one would expect, at the 16th percentile.  In this case, there’s a discrepancy between his cognitive potential (ability) and his current reading level (achievement).

School districts and educational settings will have their own policies to follow in regard to which model they emphasize.  Consequently, it’s not really up to you, as a parent, to make the decision to use one model or the other.  I incorporate aspects of both models, as well as additional testing, to reveal underlying strengths and challenges that are impacting the child’s academic achievement.  For example, if a child is struggling in reading, I will look beyond his or her basic reading level to consider the underlying skills necessary for reading mastery (e.g., phonological processing and rapid naming), as well as other challenges that may be impacting his or her performance (e.g., attention challenges and anxiety).  Also, while my evaluation and report focuses more heavily on the discrepancy model, I incorporate information from the child’s teacher about his or her experiences in the classroom over time to incorporate the RTI method.  Furthermore, my familiarity with both systems is important when talking with parents and schools so that I am able to help parents understand their child’s learning experience and communicate with schools using a common language.  By using a combination of quantitative (statistically and clinically significant) and qualitative measures, I work to provide parents, teachers, students, and myself the most comprehensive understanding of why a child is struggling and what can be done to help him or her succeed.

Most child psychologists never leave their offices when conducting neuropsychological or psycho-educational testing.  My testing package includes classroom observational time before I meet with the child in my office, in addition to a follow-up meeting with teachers, school staff, and other relevant professionals.  These meetings typically occur in the school setting.  I conduct school observations of the child working in his or her daily environment on a subject in which he or she struggles, and an area in which he or she excels.  I also gather information about the child’s performance in real-life situations through questionnaires I provide to teachers and parents.  Follow-up meetings include meeting with teachers and school staff to help create your child’s individualized education program (IEP).

For more information about the kinds of testing and follow-up consultation I provide, please contact me at 703-825-0502 or go to my website at http://www.gottliebchildpsych.com/.

Shira Gottlieb, Psy.D., Licensed Clinical Psychologist

Dr. Gottlieb is a licensed clinical psychologist. She received her B.A. in psychology, with a minor in neurobiology, from Harvard University, and her Psy.D. from the George Washington University.  Dr. Gottlieb works with children and adolescents, and their families, to provide comprehensive neuropsychological and psychoeducational assessments to better understand the individual child’s attention capacities, learning profile, emotional functioning, and behavioral presentation. For more information on Dr. Gottlieb please visit her website at http://www.gottliebchildpsych.com/

“We think your child should be evaluated.”

As a teacher, this sentence is one of the hardest to tell a parent of a young student. Often this is a conversation that is had during parent-teacher conferences, or perhaps the child’s behavior has warranted a special meeting with the parents. Hearing these words from a pediatrician, teacher or school counselor can be highly upsetting for parents, who often blame themselves, or immediately deny the issue. How can you bring up this issue in a way that parents can really hear you, and not immediately react negatively to a suggestion of having their child evaluated professionally?

I’m sure you’ve heard the phrase, “The context is decisive.” As a psychologist specializing in neuropsychological and psychoeducational evaluations, consultation, and treatment, I know that how I handle these sensitive conversations can make all the difference in how a parent feels when they leave my office, and in how they handle taking care of their child’s needs. Your demeanor matters, the order in which you talk about things matters, how you handle their feelings matters, and how you answer their questions matters.

1. Start with all of the positive things you have to say about the child—Tell the parents about how their child was kind to another child that week, or how excited they were to create a new piece of art in school. Say something positive about the child’s relationship with their parents if you can. Remember, parents blame themselves for their child’s behavior most often, so pointing out the positives helps reassure them that they are good parents. A great example is, “John is so creative and loves to talk about the art projects he works on at home with you. I can tell you have a real interest in helping him grow and develop the things he’s most interested in.”

2. Be kind and respectful no matter what—Keep in mind this is such a sensitive subject that parents may act defensive, may be in denial and may even try to blame you. It’s important not to take any of it personally, it’s not about you. Show warmth, empathy and respect to help parents trust and listen to what you have to share.

3. Ask if the parents have concerns and questions about how their child is developing—Ask specific who, what, when, where and how questions to find out if parents have noticed anything. This will help you gather more information and also move the parents towards focusing on the issue. It will also help you learn if the parents have observed anything at all different with their child. It could be as simple as, “Have you noticed if Mary is having a hard time hearing you when she’s turned away from you?” “How long has this been happening and where does it happen most?”

4. Share your concerns—Only do this after the parents have had a chance to talk. It may help to practice this part of the conversation on your own first, and to have some specific statistics to back yourself up. This might include typical developmental milestones for a child of that age etc. Choose your words carefully when doing this and don’t make statements that make it seem like you’ve already come to a conclusion about the child or have labeled the child in some way.

5. Avoid using labels at all or technical terms—Often when we are in a particular field, we become so used to verbiage we use with other professionals in the field that we forget “laymen” may not understand or worse, may misunderstand the terms. Especially in this case, you want to be sure to keep it simple and use only words that describe what you’ve observed about the child. Give specific examples of incidents that have occurred, rather than telling the parent their child “is” something in particular.

6. Stress the importance of checking things out right away rather than waiting—Sometimes a parent thinks a child’s behavior is “just a phase.” They are confused and scared and may want to wait and see if their child “grows out of this.” Stress that the evaluations will shed light on both their child’s strengths and their weaknesses. It’s important to let them know that early evaluation will ensure that their child’s strengths and weaknesses are addressed properly to have them grow and develop. And that the evaluations will help the school provide whatever support is necessary to keep their child from struggling and falling behind. No parent wants to see their child struggle, and this will go a long way toward avoiding that scenario.

7. Be prepared to offer information and resources to the parents—Have contact information and website information about the issues you’ve observed, about the types of evaluations you are recommending, and about the types of help a child can receive at school once the evaluation is complete. Give them a clear pathway to see what needs to be done next for their child. Let them know you are available for them, listen to their concerns, and offer whatever resources are available.

As someone who cares for children every day, you are in a unique position to see things about that child others don’t, and as such you are most likely to see if they are struggling in class. Sharing your concerns respectfully with parents shows you really care about their child. Let the parents know that having their child tested for learning and attention issues is an important step toward helping that child manage his or her challenges. It’s also an opportunity to help him or her make the most of his or her education.

Shira Gottlieb, Psy.D., Licensed Clinical Psychologist

Dr. Gottlieb is a licensed clinical psychologist. She received her B.A. in psychology, with a minor in neurobiology, from Harvard University, and her Psy.D. from the George Washington University.  Dr. Gottlieb works with children and adolescents, and their families, to provide comprehensive neuropsychological and psychoeducational assessments to better understand the individual child’s attention capacities, learning profile, emotional functioning, and behavioral presentation. For more information on Dr. Gottlieb please visit her website at http://www.gottliebchildpsych.com/

What’s In A Label?

Labeling students with learning disabilities—or even as gifted students—has become one of the most controversial subjects in parenting. In researching this blog post, I read dozens of articles entitled “pros and cons of labeling students.” Many of them point to labels causing “low self-esteem” in children with learning disabilities and “too much pressure” for gifted students.

However, when looked at from an academic viewpoint, there’s no question that there is a need to identify and label students with learning disabilities in order to give them the educational and emotional tools they need to succeed. This is where the controversy must end. Because without knowing why they are struggling, these students still know, without a doubt, that they are different in some way from their classmates. In fact, in the comments to one of the articles I read, a teacher pointed out that she had a learning disability and didn’t learn about it until she was 28. She knew all along that she was different though, and had to struggle and study three times harder than her friends. She said that until she discovered what her actual learning disability was, she just thought she was stupid. Her self-esteem was affected without the label, and what’s worse is she never got the extra help she needed while in school. Everything was a struggle, and nobody wants that for their child. 

It’s not the label that’s at fault

Really, the label isn’t the issue, it’s how everyone reacts to it that’s the issue. Using proper testing to discover and identify a child’s learning disability, and then setting up a plan to help them succeed, is paramount to that child’s growth potential. So let’s be clear that labels are necessary, and take a look at why that’s so. Any student who is treated differently is inevitably labeled. When we are unwilling, for whatever reason, to say that a person has a problem, we are helpless to prevent it or improve the situation. Clearly labeling a problem is the first step in dealing with it productively.

Not all uses of labels have negative consequences for children. For example, labels such as “ADHD,” can act as “labels of forgiveness”, relieving parents and children of guilt and blame by providing understanding and increasing the tolerance of teachers. Labels can also be used to bring together children and parents with similar experiences and foster a positive group identity where peers provide support for children and their families.

Medical and administrative labels can open the door to extra resources so children get the help they need, such as additional assistance in the classroom or access to counseling. Labels, where a shared understanding exists can facilitate inter-professional interaction, working for the benefit of the child. They can also help educators identify necessary professional development opportunities and implement appropriate inclusive teaching strategies.

One of the positive effects of labeling students with a "specific learning disability," is that it qualifies them to have an Individualized Education Plan (IEP). This plan allows them to receive instruction at their current level of functioning, provides them with accommodations and specially designed instruction, and creates personalized goals and objectives.

Labeling also qualifies students for services that they may not have been able to receive otherwise, such as instruction in a learning support room. In this setting, they receive instruction in a style and at a pace much more conducive to their learning profile. They receive tailored instruction in a much smaller setting with other students who have similar needs.

By labeling students with a "specific learning disability", they are able to receive help in order to remediate their challenges. For example, if a student has been identified as having a learning disability in reading (e.g., dyslexia), the instruction can be specifically geared at a suitable level, utilizing techniques that are evidence based for the child’s particular difficulties. Receiving instruction based on what students need is crucial in helping them excel and be successful in the future.

A learning disability does not take away a student's value; each person has strengths and challenges, and each person learns differently.  Through working to understand and label the challenge, the school intends to provide the specialized education required to help the student achieve success. As a parent, you can discuss the issue with your child’s teachers as well. Teachers can help prevent the negative consequences of the label by taking a few proactive steps to minimize the chance of problems occurring. Ask your child’s teachers to talk to their class about learning disabilities and how different paces and styles of instruction are used. Open classroom discussions about learning disabilities can help to create an understanding between peers.

Parents and teachers should also be careful not to lower their expectations for the student, and instead offer positive encouragement. A diagnosis can put a new structure in place without a need to lower expectations, but instead shift those expectations and the learning structure in such a way as to support the child by playing to their strengths and bolstering their weaknesses. In fact, many parents say their child has more confidence once the new structure is put in place, and they now have the opportunity to thrive.

Shira Gottlieb, Psy.D., Licensed Clinical Psychologist

Dr. Gottlieb is a licensed clinical psychologist. She received her B.A. in psychology, with a minor in neurobiology, from Harvard University, and her Psy.D. from the George Washington University.  Dr. Gottlieb works with children and adolescents, and their families, to provide comprehensive neuropsychological and psychoeducational assessments to better understand the individual child’s attention capacities, learning profile, emotional functioning, and behavioral presentation. For more information on Dr. Gottlieb please visit her website at http://www.gottliebchildpsych.com/