From Cathleen Henning Fenton,
Your Guide to Panic Disorder.
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About.com Health's Disease and Condition content is reviewed by Steven Gans, MD

Dateline: 03/01/00

Kids who skip school are bad. They don't respect authority. They don't care about their futures. They're lazy. They must be out doing drugs or stealing. That's what we think, right? Kids skip school and are grounded by their parents. Kids skip school and are suspended by their schools. They are lectured and yelled at and punished. The adults in charge make assumptions about the skipping, but rarely does anyone ask why or try to get a straight answer.

Dr. Gail A. Bernstein, a researcher at the University of Minnesota Medical School, decided to ask. Her team of reseachers discovered that about half of the teenagers who skip school are suffering from anxiety and/or depressive disorders. The goal of the researchers' study was to determine the best course of treatment for these teenagers.

The study compared the use of imipramine vs. a placebo, each in combination with cognitive-behavioral therapy. Sixty-three teens, with a history of skipping school, were involved in the study. By the final week of the study, the attendance rate for teens taking the imipramine was 70% while only 28% for those on the placebo. The researchers did point out that by definition, remission would have to be a 75% attendance rate, which only 54% of teens on imipramine managed to achieve. However, one should also note that only 18% on the placebo reached the remission standard. The researchers plan on studying the long term effects of these treatments.

The published study of anxiety (and depression) in teens is welcome. Researchers have been studying anxiety in teens and children, but most exciting is to see the information picked up by a major newswire (Reuters) and published on the Web site of a major news broadcasting organization (FOX). How long has anxiety in teens not been taken seriously? How many teens have self-medicated with alcohol and other drugs because they don't know how to feel better and don't know how to explain their pain to adults? How many adults with anxiety disorders have been told that the disorders must have started in adulthood because children don't get these disorders?

While the reports on the Bernstein study didn't go into teens' experiences with skipping school and anxiety, one might speculate that skipping school is a cry for help. Just as adults with agoraphobia may have found themselves slowly avoiding more and more situations, teens who skip probably begin with one day of staying at home in bed before slowly working into a more obvious pattern.

It is wonderful that researchers like Bernstein are working to determine the best ways to treat teens with anxiety and depression. What is worrisome, though, is that there are so many teens who will never have the opportunity for treatment. They will be suspended from school. Maybe they will drop out. Parents are encouraged, these days, to discuss so many issues with their children: drugs, smoking, alcohol, sex. Perhaps it's time to add emotions to the mix. How many parents discuss self-esteem with their children? How many parents truly know how their children are feeling emotionally? Anxiety and depression are difficult subjects even for adults to discuss. Many adults don't seek treatment for years for such problems. Imagine how difficult it is for teens. Let's open some doors for them, and let them know it's OK to tell us when their emotions become overwhelming -- before they decide ways in which they can handle these problems themselves.

Reference: Bernstein GA, Anderson LK, Hektner JM, Realmuto GM (2000). Imipramine compliance in adolescents. J Am Acad Child Adolesc Psychiatry 39(3): 284-91.