Your Anxious Teen Girl

Constantly worried and pulling away from friends? Your ADHD daughter may have an anxiety disorder. Here's how to get the right diagnosis, and help your teen learn to cope.

Crossed hands of an ADHD teenage girl. A sign of anxiety.

Young girls often cannot identify their feelings. Anxiety might be felt as jitteriness, a sick stomach, excessive worry, headaches, insomnia, nightmares, or general feelings of not being well.

— Terry Matlen
   
 

Signs of Anxiety

> SOCIAL CHANGES. Suddenly avoiding social contacts--refusing to go to overnights, parties, or school.

> SUDDEN DIP IN GRADES. Anxiety makes it difficult for an already-inattentive, distractible teen to follow a teacher's instructions.

> OCD-LIKE SYMPTOMS. Checking and rechecking the door to make sure it is locked or arranging objects "just so."

> REVISITING CHILDHOOD PHOBIAS. Fearing spiders, thunderstorms, or the dark, as she did when she was a little girl.

> SUBSTANCE ABUSE. Smoking, drinking, or experimenting with illegal drugs (which may have a calming effect).

> Other signs of anxiety include nail biting, a strong startle response, being highly critical of herself, outbursts of anger, becoming frustrated, and frequent urination.

 
   

By the time your ADHD daughter reaches her teen years, you will be a skilled observer of her symptoms--and you will have learned a few tricks to help her cope. But how much do you know about anxiety disorders?

The likelihood of our daughters having a comorbid anxiety disorder is significant. Twenty-five percent of kids with ADHD do, more girls than boys.

Jill's daughter, Katy, a high school sophomore living in Southampton, New York, is a member of the 25-percent club. "When a therapist first diagnosed Katy with ADHD, I did some reading," says Jill. "The most helpful book was Understanding Girls with AD/HD. The book predicted that an adolescent girl with ADHD had a good chance of developing anxiety and depression, to add to her low self-esteem. I never forgot that."

"On Katie's 15th birthday, we went on a shopping spree at Ikea. For much of that summer, she had worked on cleaning, organizing, and redecorating her room. We were proud of her great job. And then it happened--one night she came into the living room with two pairs of socks in her hand. She was hysterical because she didn't know where to put them. I tucked her into bed, and she curled into a fetal position and cried. I put her socks away. That was the first episode, but not the last. The prediction I'd read about came to mind. Anxiety had reared its ugly head."

Anxiety in Our Daughters

According to Terry Matlen, ACSW, director of addconsults.com and author of Survival Tips for Women with AD/HD, "Young girls often cannot identify their feelings. Anxiety might be felt as jitteriness, a sick stomach, excessive worry, headaches, insomnia, nightmares, or general feelings of not being well. Typically, we'll see younger girls complain of physical symptoms, whereas older girls will focus on internal worries.

"If your teen is struggling with internal worries, you may notice her asking what-if questions: 'What if I don't pass this semester?' 'What if I flunk the exam?' 'What if the other girls laugh at me?' Worrying is common in teen girls, but if it affects the quality of your daughter’s everyday life, and seems more intense than in other girls her age, then it should be dealt with."

It was like that for Ashley, a teen from London, Ontario, Canada. According to her mother, Michelle, "Ashley got agitated when I had to travel for work, and she was panicked if I was five minutes late getting home. She was constantly worried that something bad was going to happen to me, or to her. When I arrived home from work, I had to spend a half-hour giving her hugs and telling her everything was OK."

Olivia, 14, of Indianapolis, was diagnosed with ADHD, inattentive type, and dyspraxia a year ago. "I noticed that Olivia started pulling away from her friends and spending more time alone," says her mother, Donna. "She's never been a social butterfly, but even the occasional sleep-over ceased. She closed her Facebook account, told her friends that her cell phone was broken, so she didn't have to text or call them, and chose to stay in the car whenever we did errands. As the school year wore on, she became obsessive over makeup and hair, which she had never cared about before. Nearly every evening, she told me of an incident at school where someone had 'looked at me weird.'"

How to Diagnose Anxiety

If you notice such behaviors, what should you do? "I suggest that a child be seen by her pediatrician, to rule out possible medical reasons for changes in her behaviors, such as a head injury, allergies, or seizures," says Matlen. "If the child is cleared of any medical problem that looks like anxiety, it is time to seek the help of a child psychologist who is experienced in treating ADD and anxiety. If the psychologist feels that the child may benefit from medication, a consultation and treatment by a child psychiatrist should follow."

Diagnosing anxiety requires expertise, says Patricia Quinn, M.D., a developmental pediatrician specializing in ADHD in girls and women and author/coauthor of several books, including 100 Questions & Answers About Attention Deficit Hyperactivity Disorder (ADHD) in Women and Girls. Quinn says that anxiety can be a byproduct of living with ADHD, or it can be a stand-alone disorder. As girls mature, they become more aware of how they appear to others. "Girls as young as eight may feel embarrassed by an incident that stems from ADD," Quinn says. Such incidents--being called on by a teacher while daydreaming, or being the only student who forgot her textbook--create anxiety.

"If a girl has a true anxiety disorder, stimulants can make the symptoms worse," Quinn says. "If the anxiety is secondary to ADD, stimulants will make her better."

When is it time to treat anxiety with medication? It depends on to what extent anxiety is interfering with a girl's life. A phobia about attending school is serious enough to merit treatment. An anxiety disorder is typically treated with selective serotonin reuptake inhibitors (SSRIs).

Tools to Cope

Kristin McClure, MSW, a therapist specializing in anxiety and other mood disorders, recommends a combination of parenting techniques, cognitive behavioral therapy, and mind/body work, either before trying medication or in conjunction with taking it.

"The strategy that teens use to cope with anxiety--avoidance--makes it worse," says McClure. "When a child avoids something she is anxious about, her anxiety drops, leading her to believe that avoidance is a reliable coping strategy. In fact, avoidance prevents her from learning that the thing she was scared of is not so scary. Facing the things that are frightening is the key to ameliorating anxiety," McClure says.

McClure teaches kids to recognize how anxiety decreases their capacity to enjoy life and solve their problems. "I ask the teen, 'What is worry doing for you? Is it helping you to be happy?' Usually the answer is 'no.' Kids think that worry will protect them, make them safer, or control the future in some way, but they are mistaken."

McClure says that one of the best strategies for girls is to problem-solve their worries. "I ask the girl whether she can eliminate or manage the source of her worry. If a child is worried about her grades, for example, I ask: 'What can be done to solve this worry?' The girl will say she could study or create a homework schedule. I tell her, 'Then do that, and stop worrying.'"

Interventions that target a girl's relationship with her body can be helpful. "Progressive muscle relaxation and diaphragmatic breathing are relaxation strategies that help kids with anxiety," says McClure. "Meditation and yoga are also beneficial."

Donna, Ashley's mother, leaves parents with this bit of wisdom: "The more I read, the more I realize that ADHD rarely exists in a vacuum. There are many conditions that overlap with ADHD symptoms, and many kids get inaccurate or incomplete diagnoses. As a parent, you cannot assume you know everything that is going on with your child. If you are seeing a few peculiarities, you can bet that your child is internalizing many more than that, and may be in more distress than you imagine."

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This article appears in the Spring 2013 issue of ADDitude.
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