Have you ever been nervous before a test? Have you ever been stressed because of school and the piles of workload? Read this article to find out the science behind how anxiety impacts your academic performance.
1. Overview
School is an environment filled with high expectations, large groups of people and many situations in which anxiety can be present. According to the Anxiety and Depression Association of America, 1 in 8 Children has anxiety and in 80% of those cases, they do not receive treatment. Yet, there are still many undiagnosed cases, thereby, a risk of neglection of mental health affecting their social presence, self-esteem, and self-hygiene, and eventually impacting their academic performance. Different variables may increase the chances of an anxiety disorder, including the fear of a particular event present in life or a fear caused by distress in daily activities. These types of disorders are constantly investigated by scientists to look for the reasons behind their causes and how they affect the students' academic results.
2. How are anxiety disorders characterized
2.1 Prevalence
In 2015, Researchers concluded that Anxiety disorders were found to be the most common form of mental disorder as it was seen to be found in 5-10% of young people ages 6-18 years. It has been estimated that around 15-20% of children experience anxiety disorder that can last up to 18 years. However, Prevalence estimates for specific anxiety disorders tend to be less reliable due to the variation in studies that are influenced by the variation in the ages of the people observed. Prevalence seen in different disorders seen in children such as in separation anxiety disorder where there is a variation of 1-6% in youth under 13, while social anxiety disorder is seen to have a prevalence of 3-11%. However, studies show that generalised anxiety disorder is found to be the most common type of treated disorder with the lowest prevalence of 0.5- 4%. During these studies, certain phobias were found to be the most prevalent anxiety disorder, but they have the least impact due to their lack of clinical studies.
2.2 Comorbidity
Research has shown that a single anxiety disorder is rare as it is not found in young people as it is more common for young people to meet the criteria of multiple anxiety disorders, showing strong comorbidity with depression. 10-15% of young adults show a diagnosis of mood disorders. In most young cases, anxiety disorders also are comorbid with external disorders, including attention deficit hyperactivity disorder and oppositional defiant disorder. Recent studies look deeper into the correlation of comorbidity with autism spectrum and conclude that there have been high rates of anxiety among young autistic people. Possibilities for these comorbidities overlap the symptoms between the two disorders in which anxiety seems to develop as a consequence of autism.
Future mental disorders such as anxiety, mood and eating disorders are highly likely to be caused due to current anxiety disorders. However, anxiety disorders that are identified in the adolescent years protect substance use in the future.
2.3 Age of onset
Specific symptoms for anxiety disorders such as separation anxiety and phobias appear in people as early as before the age of 10. Social anxiety disorders are common in many cases, however, are most commonly found in the early stages of adolescence. Data onset for generalised anxiety disorder and panic disorder commonly appears in earlier stages of adulthood.
2.4 Impact
Avoidance of symptoms is the main cause of anxiety, this can impact people as early as in their elementary school days and continues to affect the rest of their developing stages. Younger people with anxiety stand out due to their poor social performance, being less liked by their peers, being victimised and having fewer friends. Earlier stages of anxiety also create an impact on their academic performance as they are seen to have poor attendance, little to no engagement, poor class performance, and lower rates of graduating. An Australian study was conducted and concluded that between grades 3 and 9, students with anxiety disorder fall behind in their studies, on average performing two years behind their expected skill.
2.5 Demographic correlates
Similar to other anxiety disorders, pediatric anxiety disorders are linked to very low demographic predictors. For many different types of anxiety disorders, the family status and socioeconomic state are not directly associated with the cause of the disorder, however, some research contradicts the statement with studies showing an association between the anxiety disorder and family status. With sex being the most common reason behind paediatric anxiety, females are seen to be marked at higher risk than males, as this difference is mostly shown to be higher during the evolving stages of puberty.
3. Risks for developing anxiety disorders
3.1 Genetics
Genetic and neurophysiology provide context on the different factors that operate with the brain and cause the many risks of developing anxiety disorders. Studies on these genetic risks provide behavioural and molecular approaches, and research on behavioural genetics concludes the estimates of overall genetic effects. Molecular genetic research relates specific risks for developing anxiety disorders.
3.2 Behavioural genetics
Adults with prescribed anxiety or mood disorders have a higher risk of raising children who will develop such disorders as compared to adults who don't show signs of mood or behaviour disorders. Social anxiety disorder and panic disorder are usually affected by genetics rather than the environment. In contrast cases such as mood disorder and major depressive disorder are usually a consequence of the environment the individual is being surrounded with. However, due to the scarce studies on this topic, there hasn't been an exact map of the genetic risks of anxiety and other mental disorders.
3.3 Social/ Environmental factors
Apart from genetic studies, a lot of research has shown the substantial environmental influence on certain anxiety disorders. Of these influences, many of them lie in the parental response and how likely parents with anxiety disorders are to have offspring with similar conditions. Therefore, the environment the child is surrounded with is also a risk factor for the disorder, with children focusing more on their circumstances and experiences around them, leading to the feeling of threat and the loss of confidence when facing a challenge.
3.4 Negative life events
The correlation between positive and negative peer relationships that leads to socially anxious children forming fewer close connections with peers compared to those with more confidence is imperative. Anxious children start to believe that they are less liked by their peers. A research conducted shows that negative peer relationships predict social anxieties at a later point in life and that social anxiety leads to negative peer relations, cultivating a repeated negative cycle in one's social life. Adding to the negative peer relations, youngsters with social anxiety disorders are more likely to experience peer victimisation, this has been supported by elevated anxiety symptoms for those experiencing peer victimisation.
Further research on anxious young people who have many social experiences has shown to have a further increase in anxiety as they are seen to engage in many upward comparisons. Helping young people avoid upward comparisons will help reduce the development of an anxiety disorder.
4. Treatment and prevention of paediatric anxiety disorder
4.1 Psychological treatments for paediatric anxiety disorders
Cognitive behavioural therapy (CBT) is known to be the most intensive psychological intervention for paediatric anxiety disorders, as there have been limited treatment methods apart from CBT. Treatment research usually groups young people with a broad age range, including Western populations. Ethnicity doesn't affect treatment outcomes and results have been proven to be positive in multiple countries. Treatment must be adapted for it to be successful across multiple cultures.
4.2 Treatment outcomes
In a review conducted by Cochrane of CBT for child anxiety disorders, it was concluded that there is quality evidence of CBT leading to greater remission of primary and all anxiety disorders than passive controls in the short term, this is supported by the fact that 49% of patients have been free of their primary anxiety disorder after CBT relative to the 18% in the waitlist. Few studies include active controls where evidence is said to remain tentative despite as it outperforms many other treatments. Other limitations in the low literacy rate include the lack of studies that evaluate the treatment in younger children. However, there is still a limit to the data provided for children with intellectual disabilities that would help in their further improvements.
Another limitation regarding the treatment of anxiety disorders is the lack of controlled data on long-term outcomes. Findings are derived from the Child/ Adolescent Anxiety Multi-model (CAM) trial. The initial results from CAM show similar outcomes for both CBT and SSRI. However, studies from long-term outcomes suggest that only 22% of the patients were found to be in stable remission, of those 30% had chronic anxiety disorder and 48% were relapsing at a point. This concludes that CBT is effective, but there remains room for improvement.
4.3 How to improve outcomes for CBT?
In a recent review, it was seen that the research findings regarding CBT are inconsistent when it comes to treatment outcomes as there are mixed findings of variables regarding age, gender, race, socioeconomic factors, anxiety severity and comorbidity. A recent study shows that patients with social anxiety disorder had a recovery rate of 35% while there was a recovery rate of 54% for other anxiety disorders.
Models of anxiety disorders have mainly focused on the development of risk factors that help in guiding prevention but provide limited information on which base treatments. It is shown that maintenance models are needed to incorporate development considerations
including the potential for different mechanisms to be influential at the different stages of development.
4.4 Increasing Access to CBT
Despite the evidence of the great effectiveness of CBT, there are still very few people who seek access to treatment. Only a few per cent of those diagnostically anxious patients receive help, of which only a small portion receives empirically validated treatment. A study conducted in England concluded that with the 65% of families who have sought help, 2% of the children identified to treat their anxiety disorder through CBT.
A barrier to the implementation of CBT is the limited availability of trained practitioners within often highly stretched clinical services. There is emerging evidence that incorporating brief, therapist-guided interventions into a stepped-care model of treatment delivery brings potential good clinical outcomes whilst considering the cost. In a survey of clinicians providing treatment to children with anxiety disorders in the USA, despite 80% endorsing CBT as their therapeutic orientation and exposure having been identified as a key therapeutic ingredient, only 5% endorsed providing exposure-focused treatment.
5.0 Conclusion
Research into paediatric anxiety disorders has seen a great increase in the past 30 years. This results in a greater knowledge of the characteristics and prevention of anxiety disorders. With the current programs of treatment for young people with anxiety disorders, less than half are still not seen to be free of their disorders following any treatments. This portion is set to increase in the coming months but there is a great proportion of young people who meet the criteria of anxiety disorders even with the best efforts at treatment.
Researchers would need to listen to relevant stakeholders which include the young people who experience the anxiety disorder, their caregivers, teachers and mental health providers. Similar research should also be conducted on the entire population to help draw reliable conclusions. This large sample size would help in raising concerns for improvements in any areas regarding paediatric anxiety disorder.
Bibliography
“Impact of Anxiety and Depression on Student Academic Progress.” IBCCES, 1 May 2019, ibcces.org/blog/2019/05/01/impact-anxiety-depression-student-progress/#:~:text=. Accessed 8 Apr. 2024.