Illustration by Cathryn Virginia
As my son was finishing his first year of middle school in June, many of my conversations with fellow parents eventually landed on the same topic: stressed-out kids. What we discussed went far beyond the anxiety I remembered from my middle school years in the 1980s.
It turns out that kids in middle school are at a prime age for the onset of anxiety disorders, depression and other mental illness — one in five children experiences a mental illness, and 80 percent of that population doesn’t get the treatment they need, according to Voices for Virginia’s Children.
“Half of all lifetime instances of mental illness begin before age 14,” says Margaret Nimmo Holland, executive director of Voices. “The state estimates that in Virginia, there are 130,000 kids with a serious mental-health issue. … If we ignore children, we are ignoring a lot of people.”
Anxiety often peaks in middle school because of changes in social structure, the addition of new friendships, and the “top of the heap/bottom of the heap” feeling as students transition from elementary school, says Jentae Mayo, a Henrico County school guidance counselor and the vice president for middle school counselors with the Virginia School Counselor Association. Add in high-stakes testing, social media’s “selfie culture,” over-involved parents and overscheduling, and today’s preteens and teens, especially girls, face overwhelming pressures.
Jaee Bodas, a specialist in childhood anxiety disorders at the Virginia Treatment Center for Children and an assistant professor at VCU Health, says there are more triggers now than there used to be. “When we were in middle school, you would go home and it was the end of school. Now, kids are on social media and they continue to have contact with their friends. It encompasses their whole life. And [school] is getting to be more competitive now.”
EVERY ‘LIKE’ COUNTS
Social media is cited by all the experts as a trigger for anxiety and depression during the middle school years. Entering middle school is often the milestone that marks the acquisition of a kids’ first smartphone, and along with that comes access to Instagram, Snapchat, Twitter and Musical.ly, the video social network that's the latest craze among tweens. Parents can say “no,” but social media is so ubiquitous that most kids will find a way to have an account, even if it means they have to manage their profile from a friend’s phone.
Social media makes life stressful for middle schoolers because it is all about comparison and competition. “You are putting yourself out there all the time for people to judge, and your posts compete with everyone else’s,” says Mark Loewen, founder of LaunchPad Counseling. “Every ‘like’ counts.”
It’s common to see a tween obsessively checking their phone after posting a photo or video to watch the “likes” add up. It’s instant validation, or, on the flip side, a lack of response or unkind comments, can be devastating. “Everyone has access to you and you can be bullied all the time,” Loewen says. “It definitely has an impact. Kids may not articulate it. They just think that’s what life is supposed to be. They have never known any different.”
Kids will even delete a photo from their account if it does not garner enough "likes" so as not to appear unpopular.
Maria Clark Fleshood, an Ashland-based licensed professional counselor and author of “From Tweens to Teens: Preparing Girls for Adolescence,” says middle schoolers’ brains are not developmentally prepared to deal with this kind of pressure. “They don’t have the internal structures to face what they are getting ready to face,” she says. “A lot of their self-image and self-confidence is built into how many people they are connected to on social media. But when the computer is off, or someone does not text back in the middle of the night, that’s when they fall. They can flip from anxiety to depression, and technology really feeds into that.”
In addition, kids are literally losing sleep over social media, staying up until all hours waiting for “likes” to roll in. “REM sleep is when the body heals,” Fleshood says. Quality sleep is crucial for good mental health.
Fleshood says middle-school girls are more vulnerable than boys to social media due to their advanced brain development, especially in speech and language areas. “You will find girls doing more texting and communicating with words more often than boys to engage and connect,” she says. Boys, on the other hand, communicate more through gaming or activities such as sports. They may engage in social media, but for them, it matters less.
"Girls have a stronger need at this age to feel like they belong and matter, and social media really emphasizes that,” Fleshood says. “I have girls who can drop in a minute if they see a picture of a party and see they weren’t invited. Their automatic assumption is ‘I’m not liked.’ Their self-confidence can go up and down within seconds.”
Ann Reavey, school counselor at Sabot at Stony Point and mother to daughters Rosie, 16, and Nora, 14, says she follows and shares the advice offered by anxiety expert Dr. Paul Foxman, author of “The Worried Child”: Pay attention to your children’s sleep needs (they should be getting at least 9 hours per night); make sure they get exercise every day; limit media exposure; absolutely no electronics in the bedroom; and limit access to social media. When a child is looking at a screen for hours every day, “all of these things will be disturbed,” she says.
What’s worked in Reavey's family is simply not allowing her children to have cellphones in middle school. “Rosie was the last person in her middle school class to get a phone, and we had three years to talk about what she was missing out on,” Reavey says. “She was able to talk about all of the drama that was going on with all of her classmates [on social media] that she wasn't a part of, and I think she was grateful she wasn’t a part of it.”
Daughter Nora, however, is pushing hard for a phone. “She is not going to get a phone,” Reavey says firmly. Though she offers advice to other parents on social media, and teaches kids about its pitfalls, she admits it is difficult being the parent. “When I am in it myself, it is not black and white at all; it seems very muddy. I have to be so tuned into my child and that can be difficult at times during those preteen years. The child wants to be independent and autonomous, and they are just not ready for it yet. The push and pull is very difficult.”
OVERSCHEDULED AND UNDER STRESS
It’s seemingly not enough to be a strong student academically. Many kids also participate in multiple activities, perform community service work, play on a sports team and play an instrument, all to get into a “good” college years down the road. “The pressure has fallen down to 10-, 11-, 12-year-olds,” Fleshood says.
Tweens face “an unprecedented pressure to succeed,” she adds. “From schools, from parents, from peers there is an intense pressure to perform. Kids between the ages of 9 and 13, when asked what causes them the most stress, they say grades, school and homework.”
Loewen, a registered play therapist who uses games and art when he works with kids, says that a lack of unstructured time is one factor that leads to anxiety.
“A lot of the coping mechanisms that used to exist, don’t today: access to nature, using creativity in our play,” he says. “When I assess a child, I check how scheduled they are. Sometimes just coming here and getting to play is what they need. Free time is recovery time.”
WHAT IS NORMAL?
Anxiety is a normal emotion that is necessary for survival. When anxiety starts to take over and get in the way of daily life, however, it’s time to get help.
“When a family comes to me, I look at two things,” Bodas says. “First, the level of distress the child and household experiences, and the second indicator, from my point of view, is how much it messes things up for the child or the family.”
Take test anxiety. It's normal to be nervous about a big math test. “It’s adaptive,” Bodas says, “it helps [kids] prepare. But when it gets to the point of panic attacks, and it messes things up if the child is refusing to go to school or refusing to take the test, it’s a problem.”
Grace and David Gallagher are helping other teens through a foundation named for their daughter Cameron. (Photo by Beth Furgurson)
The Cameron K. Gallagher Foundation, founded in 2014 by Grace and David Gallagher after the death of their daughter Cameron, has raised awareness of teen and tween anxiety and depression.
Cameron, a 16-year-old Freeman High School student who died from cardiac arrhythmia after running the Shamrock Half Marathon in 2014, suffered from depression and anxiety. Before her death, she was making plans to organize a 5K run to encourage people to “Speak Up” about teen depression, and her parents started the foundation to fulfill her dream and organize the race — what is now the SpeakUp5K.
The Cameron Gallagher Foundation has grown quickly to include programs to promote understanding of teen anxiety and depression and to empower teens who are struggling to talk publicly about it. “Kids say, ‘please keep doing what you’re doing, we need this,’” says Grace Gallagher, the foundation’s executive director. “I hear a lot of, ‘thank yous’ and ‘I never knew somebody cared about my struggle.’ Kids really are ready to talk about it.”
Running a foundation is a new endeavor for Grace, who says she was “just a mom raising five kids,” prior to Cameron’s death. But as a parent to a child who struggled with anxiety and depression that at times were so severe she was hospitalized, Grace gained the kind of firsthand experience that brings great insight. “It’s not just [your child’s] struggle,” she says. “It’s an entire family that needs to live it. As a parent, you are a fixer and want to fix it, but you can’t really.”
That’s not to say treatment doesn't work. In most cases it does, and that’s why it’s so important to identify the problem and seek help. “We only read about children’s mental health when something bad happens,” says Voices’ Holland. “It creates a skewed perception of mental illness. We are trying to lift up stories about what works, to show children who have been successful in their recovery, who are living with a mental health condition but are not disabled by it. … There has been a lot of research about what works.”
PLAYING THROUGH THE PROBLEM
VTCC’s Bodas says the first line of treatment for mild anxiety disorders among middle-school aged children is usually cognitive behavior therapy, an approach that focuses on developing coping strategies and changing ingrained thought patterns. “It teaches anxiety management skills,” Bodas says. “Anxiety never goes away, but what you learn to do is manage it so that it doesn’t become a problem — you are in charge of the anxiety.”
For moderate to severe anxiety, anti-anxiety medication combined with therapy is the general guideline for treatment. Even a psychiatrist who prescribes medication will emphasize therapy, Bodas says. “Medication will take the edge off of the anxiety, but it never treats what gets you to be anxious.”
Play is another tool that some therapists use. Sometimes, something as simple as playing a game of Sorry! with an anxious tween will help to relax them to open up. “I use play as a tool to fully engage a child,” Loewen explains. “The saying goes that you don't teach a drowning person how to swim. They can best learn a skill when they are calm and safe. Pretty much anything we play will turn out to be therapeutic.”
Mindfulness meditation has become a proven way to combat anxiety, and it’s a useful coping mechanism not just for those with diagnosed anxiety disorders.
With mindfulness, one maintains an awareness of present thoughts, feelings, bodily sensations and the environment, without judging whether there’s a “right” or “wrong” way to be.
Its roots come from Buddhist meditation, and the University of Massachusetts Medical School’s Mindfulness-Based Stress Reduction program, founded in 1979, has brought a secular form of the practice to the mainstream. Numerous studies back up its benefits, especially in treating anxiety and depression. Increasingly, it’s being used in schools at all grade levels, to help kids focus, relax and deal with stress.
Fleshood promotes mindfulness training for tweens. “This age is what I call the complex age,” she says. “The brain has a burst of growth and maturation taking place like never before in their lives. Their bodies are changing, their self-confidence is being challenged, and the changes in the brain evoke tension and anxiety. Mindfulness is a great tool.”
The Gallagher Foundation offers a free program in its West End offices, Mindful Mondays, to teach the technique to teens. It’s offered on second Mondays through March. The foundation wants to extend the program to middle schoolers.
“Mindfulness is proven to help with anxiety and depression in all age groups,” says Grace Gallagher. “We need to give these middle schoolers these tools in sixth grade. We need to say, ‘Your mental health is important. Just like I’m giving you vegetables on your plate, I’m giving you mindfulness for good mental health.’ ”
WHERE CAN YOU GET HELP?
Navigating the mental health system can be daunting for parents. In Richmond, the nonprofit Children’s Mental Health Resource Center educates families about the mental health services available for children and adolescents and connects them to the appropriate resources. “Anxiety and depression are 80 percent of what people are dealing with,” says Lynette Brinkerhoff, program director.
When the resource center receives a call, Brinkerhoff says its staff talks a parent through what’s going on with their child and helps point them to people who can help. They know what insurance plans providers accept, who specializes in what and who has a waiting list. “It’s hard to know where to go if you’re facing it for the first time as a parent,” she says. “We’re the GPS for children’s mental health. It takes courage to even make the phone call and admit your child needs help. Parents don’t realize how treatable anxiety and depression are.”
The Cameron K. Gallagher Foundation has provided $100,000 to the resource center. “They will follow up with you to see if you are getting the help you need,” Grace Gallagher says. “They will not give up on you.”