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Hello,

My niece, who has recently turned 15, has always been shy since very early childhood and it has become increasingly clear that she is struggling with severe anxiety. This anxiety in children turned into the fact that she is afraid of going to school and has described symptoms that I have no doubt are anxiety attacks to me.

Unfortunately, I don't think her parents are dealing with this as well as they could be. They tend to err on the side of seeing my niece as intentionally dramatic and have even described her as having entitlement issues... this is heartbreaking because it is so very clear that this is not at all the way things are to me.

My niece is experiencing severe anxiety around tests and particularly math right now, as well as about contact with peers. Her school performance is also suffering greatly. 

I want to gently bring the issue up with my sister but in a way that she'll listen to. So I want to suggest something very concrete that might bring immediate improvements. What are the best treatment options for severe anxiety attacks in teens? 

Thanks in advance

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That does sound like a tough situation. I am glad you are there for your niece. This will really help her. 

I agree that scolding a teenager with severe anxiety is not the right approach. It will only make a person feel more anxious and force them to turn away from their own family, which at that age can only make things much worse. I would suggest that she sees a therapist for starters. Cognitive behavioral therapy is very effective, alongside antidepressant therapy where necessary. 

You can't really get more politically correct than "let a professional evaluate her", can you? 

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The thing that stands out in this story, to me, is that yes, it strongly appears that your niece is dealing with some form of anxiety, but what form? Is it social anxiety? Is it performance anxiety? Could it even be anxiety triggered by a specific learning disability because you are mentioning she is particularly anxious about math?

External displays of behavior do not tell the full story of what is going on inside the mind. Whatever happens next, what your niece really needs is a full psych evaluation so that she and everyone around her have a clearer idea about what is happening to her, rather than just guessing.

Each form of anxiety is different and treatment isn't the same for every form. Say she does have a learning disability. That would need to be addressed together with the anxiety. The anxiety would not go away without solving the underlying problem.

See what I mean? I'd recommend an eval.
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Have you ever thought of the possibility that she might be doing badly at school, like having problems with bullying, maybe not doing too well on her school work, maybe a problem with a teacher...? Sometimes anxiety is situational rather than a disorder. Anyone would feel anxious about going to a place where they don't feel safe day in, day out.

Talk to her and find out some more about her life. Just be straight: do you think you'd feel better if you tried a different school? Are people bullying you? Is the material hard for you? The more information you get, the easier it will be to find a solution.
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Oh, that sounds rough! I'm an auntie too and I'd do anything for my niece and nephew. I think they sometimes feel more comfortable opening up to aunties and uncles 'cause they know they're... I dunno, there to provide unconditional love without the consequences that might take place when they say stuff to parents, who of course make all the decisions at the end of the day, as much as they can when you're dealing with teens. My niece and nephew are younger than your niece, so I can't really speak from experience yet... but what I'd say is that you have a valuable role right there, as someone safe she can always talk to. I'd not share stuff with parents if they are already aware that is going on just 'cause you want your niece to always have that safe space available, you know? Perhaps offer to buy her some books and of course always listen. That alone is a great thing. 

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The best treatment for severe anxiety attacks in teenagers is a combination of therapy and antidepressants. Sometimes, quick working anxiety medications are also offered. People who are not sure where to start looking for anxiety treatment in teenagers should know they have a wide variety of options at their disposal. Social workers, school counselors, school nurses, primary care doctors, psychologists, psychiatrists, all of these can help. Not all of them can prescribe medication but they can all get you in touch with someone who can.
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Your niece is clearly struggling right now. I feel sorry for her. It's such a shame that her parents are not able to see what she is experiencing clearly. Dismissing anxiety or depression, or other mental health issues, as entitlement issues or laziness, or being overly dramatic, can be so damaging. It can only add to whatever it is your niece is going through right now. Honestly, I'd be that boring person who sends your sister links to articles about teenage anxiety and panic attacks. I am not sure that would do much good, but I know I'd be trying. 

It is great that you are there to listen to your niece, but she obviously needs more than that right now. And to get that more, her parents need to be on board. 

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Hello,

Talking to my sister and her partner does not seem to have any effect. I am trying to get through to them, but they always seem to be taking further steps that seem so bad that they almost appear to intentionally make things worse. At best, they are clueless.

For instance, my niece finds music to be a great comfort. Now my sister told me the other day that my niece did not complete her school work and in response, she took her phone and headphones away. When I called her out on that saying she needs something for comfort, she replied my niece could listen to the radio in the bathroom while she is showering, but because she has not asked, it must be she is not experiencing anxiety. (?)

It all seems so backwards and I am really not sure what to do. Anything I say falls on deaf ears and my niece suffers for it.
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Ugh, sounds like things are getting worse, not better, in that household. I'm not sure. You're in a tough position. If I were you though I might suggest that your niece writes a letter to her parents explaining what she feels as best as possible. That way they don't have to reply right away and feel all defensive but get the chance to really think it over before replying. If she struggles with anxiety and panic attacks, let her explain she's not doing it on purpose it's just how she feels. And if you can get it in your niece's head that psych people can be really helpful then maybe you can encourage her to go in that direction, to ask to get therapy....? It's a thought anyways.
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Thanks for listening! I don't feel I have anyone to talk to about this other than total strangers on the internet. If I talked to other relatives, things might get ugly.

I love my sister. They've been through a lot with her giving up a career she hated and going back to college for a second chance and that has taken up so much of that family's energy that the kids, my niece and there's a younger nephew as well, have taken the back burner. That's life. But all the while, her anxiety has just been building up and up, and when I look at the diagnostic criteria for anxiety disorders I recognize her in a lot of them. Panic disorder maybe? Performance anxiety? Generalized anxiety disorder? Social phobia?

And that's where therapists ought to enter the picture. What is crystal clear to me and everyone who wants to actually look is that it IS anxiety of some kind, and severe anxiety, and during such a rough period of life too!

As a minor, you can't just go out and see a therapist or get anxiety medication though. There would be insurance issues and her parents would have to give their permission. And I have no idea how to contribute to making that happen.
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