School Anxiety

Source: This is from Leslie Packer, Ph.D. from the website http://www.schoolbehavior.com

Some children experience fear or panic when they think about going to school in the morning. These children may tell their parents that they feel nauseous or have a headache, or may exaggerate minor physical complaints as an excuse not to go to school. When the child or adolescent exhibits a developmentally inappropriate and excessive anxiety concerning separation from their home or from those to whom they are attached, they may be experiencing a Separation Anxiety Disorder. Separation Anxiety Disorder is characterized by the child exhibiting three or more of the following for a period of more than four weeks:

1. recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated
2. persistent and excessive worry about losing, or about possible harm befalling, major attachment figures
3. persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped)
4. persistent reluctance or refusal to go to school or elsewhere because of fear of separation
5. persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings
6. persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home
7. repeated nightmares involving the theme of separation
8. repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated

As with Panic Disorder, separation anxiety is most likely to emerge during stressful times associated with major transitions such as entering elementary school or switching to middle school. It is also more likely to occur following an extended amount of time with the parent (such as being home for weeks on vacation, a holiday break, or following a lengthy time at home due to illness). In some cases, separation anxiety may emerge following a major trauma in the child's life, such as the death of a family member or a move to a new neighborhood and school. some children or teenagers might have sudden-onset or acute worsening of separation anxiety following an infection, even a mild or short-lived one.

In addition to the symptoms described above, children with an unreasonable fear of school may also:

• feel unsafe staying in a room by themselves and frequently go check to find their parent or have a need to be able to see their parent (e.g., a teenager in a shopping mall who feels a lot of distress if they can't always see their parent may be exhibiting a symptom of separation anxiety)
• display clinging behavior
• have difficulty going to sleep
• have nightmares about being separated from their parent(s)
• have exaggerated, unrealistic fears of animals, monster, burglars
• fear being alone in the dark, or
• have severe tantrums when forced to go to school

Separation Anxiety Disorder may be a precursor of other anxiety disorders in adulthood, and early recognition and treatment are important to prevent the development of Panic Disorder and Agoraphobia.

IMPACT OF SEPARATION ANXIETY DISORDER

Separation Anxiety Disorder can be exhausting and frustrating for the parents to deal with, but it is worse for the child who feels such intense fear and discomfort about going to school. If parents are unable to get the child to school, the child may develop serious educational, emotional, and social problems. As we saw with Panic Disorder, Separation Anxiety Disorder is also associated with an increased risk of Major Depression.

Because the anxiety is about separating from the parent (or attachment object), once the child or teens get to school, they usually calm down and are OK. It's getting them there that is the real challenge.

SCHOOL REFUSAL

Separation Anxiety Disorder can result in a child avoiding or refusing to go to school, but the terms "Separation Anxiety Disorder" and "School refusal" are not synonymous, as the latter is not a formal diagnosis. That said, children and teenagers who exhibit school refusal often suffer from significant emotional distress, most notably anxiety and depression. The most common diagnoses associated with school refusal are separation anxiety, social phobia, simple phobia, panic disorder, post-traumatic stress disorder, major depressive disorder, dysthymia, and adjustment disorder. In one recent study looking at school refusal vs. truancy, anxious school refusal was associated with depression and separation anxiety disorder, while pure truancy was associated with oppositional defiant disorder, conduct disorder, and depression. In those cases where both anxious school refusal and truancy were exhibited, almost 90% of cases had a psychiatric disorder, with increased rates of emotional and behavior disorders.

School avoidance or school refusal may serve different functions in different children or teenagers. For some children or teens, it may be the avoidance of specific fears or phobias triggered in the school setting (e.g., fear of school bathrooms due to contamination fears associated with Obsessive-Compulsive Disorder, or fear of test-taking). For other children or teenagers, it may serve to help them avoid or escape negative social situations (e.g., being bullied by peers, or having a very critical teacher). School avoidance or refusal can also serve to (temporarily) reduce separation anxiety, or to avoid settings that might be associated with panic attacks, or to gain attention for any somatic complaints (e.g., "Mommy, I can't go to school because my tummy hurts!"). In one study of school refusal, anxiety-related diagnoses were correlated more with negatively reinforced school refusal behavior (i.e., avoidance behavior), while separation anxiety disorder was associated more with attention-seeking behavior. Oppositional defiant disorder and conduct disorder were associated more with pursuit of tangible reinforcement outside of school.

When school refusal is anxiety-related, allowing the child to stay home only worsens the symptoms over time, and getting the child back into school as quickly as possible is one of the factors that is associated with more positive outcomes. To do that, however, requires a multimodal approach that involves the student's physician, a mental health professional, the parents, the student, and the school team. The same therapeutic modalities that are effective with Panic Disorder and Obsessive-Compulsive Disorder are also effective for school refusal, namely, exposure-response prevention (a form of cogntive-behavior therapy that may include relaxation training, cognitive alterations, and a graded hierarchy of steps towards the goal).

There is some research that suggests that education support therapy may be as effective as exposure therapy for treating school refusal. Working with the school psychologist, the student talks about their fears and is educated in the differences between fear, anxiety, and phobias. They learn to recognize the physical symptoms that are associated with each of these states and are given information to help them overcome their fears about attending school. The student is usually asked to keep a daily diary where they record their fears, thoughts (cognitions), strategies, and feelings about going to school. The time of day that they arrived at school is also recorded, and the record is reviewed each morning with the school psychologist. Although it might seem like a good idea to incorporate positive reinforcement for school attendance, that may backfire and merely increase the student's stress levels and anxiety.

Parent training in strategies to work with the child in the home is also an important piece of any school-based plan to deal with the student with school refusal.

Throughout this web site, I have included reasonable accommodations for different conditions, but when it comes to school refusal, accommodating the child by letting them stay home is generally contraindicated, unless there are other issues.

Dr. Rachel Klein of the NYU Child Study Center has provided some good tips to share with your student's parents, including:

• Do not deny the child's anxiety or worries, but acknowledge them and reassure him/her. For example: "I know you're worried I won't be there to pick you up, but there's no reason to worry. I'll be there."
• Try to find ways to enable the child to go to school. For example, a child is likely to feel reassured if times are set for him or her to call the mother from school. In extreme cases, mothers may stay with the child in school, but for a specified length of time which is gradually reduced.
• It is most important to tell the child exactly what s/he is to expect. There should be no "tricks" or surprises. For example, a child may be told that he should try to stay in school for only one hour, but after the hour he is encouraged or asked to stay longer either by the school or parent. This will backfire. The child will eventually refuse future arrangements for fear that they will be modified arbitrarily. Part of being anxious is anxiety about the unknown and the “what if?”.
• Punishment does not work, but kind, consistent, rational pressure and encouragement do.
• Do not quiz the child about why s/he feels scared. The child often does not know why. By not being able to provide an explanation, in addition to being anxious, the child feels guilty about not making sense of what is happening. Better to acknowledge that the fears make no sense and that the child has to fight them.
• Be open to hearing about how your child feels. However, lengthy discussions about the child's problems are not always helpful and can be experienced as a burden by the child. The focus must always be that you want to help your child be free of worries and fears.
• A child's reluctance to go to school can be irritating to parents. Expressing resentment and anger is counterproductive. And you won't feel the urge to do so if you adopt specific strategies to assist your child.

Moving from Middle to High School

Source: This is from School PTA website, http://school.familyeducation.com/high-school/anxiety/37641.html

Moving Up

The move from middle to high school is one of those times when your child needs you most, but is often too embarrassed to ask for support. You may have noticed that your child is beginning to push away from you. Try to respect this. On the other hand, it's important to balance a respect for your child's desire for independence with a very real need to stay involved in his life and education.

Starting high school is a major rite of passage for adolescents, says George White, associate professor of educational leadership at Lehigh University in Bethlehem, Pennsylvania, and a former middle-school principal. The social and emotional fears that incoming freshmen deal with can have a direct impact on their academic performance.

Changes at School

The difference in size of your child's old and new schools can have a big impact on her transition, says school psychologist Sal Severe, author of How to Behave So Your Child Will, Too! Kids from smaller school districts may face a kind of culture shock in large, regional high schools. Larger class sizes, more students, a bigger campus, and teaching styles more focused on the subject matter than the needs of individual students can be difficult for incoming freshmen.

"Parents should expect schools to provide a protective growth environment" for incoming freshmen, George White says. The developmental divide between ninth-graders, who could be as young as 14, and upperclassmen, who could be over 18, can be extreme. Exceptionally bright ninth-graders can end up in classes with much older teens and may be unprepared socially. "There's a wide range of social development in high school. What you have to have is a socially safe place for younger individuals."

Ninth-graders also face a big step down in social status, going from the top of the heap in their previous school to the lowest rung in high school. They arrive as the new kids, the young ones, the ones who don't know what's what and who's who.

Tips for Parents

It's important to keep the lines of communication open with your child throughout this period. White likens this to the experience of learning how to ride a bicycle. "When I learned to ride a bike, my father ran behind me with his hand on the seat. When I could ride without his support, he still ran behind me for a while." Although your child is becoming independent, she needs support during the process that only you, as a parent, can provide.

Sometimes parent involvement drops off because parents feel their children don't want them to be around so much. "Kids want their parents involved; they just want them to be involved in a different way," White says. For example, your teen may not mind if you act as a chaperone on a school trip, as long as you ride on a different bus than him.

Parent involvement can also take a number of forms at home. There are plenty of ways to spend time with your child and get to know her friends. Suggest that she invite her friends over to watch movies or hang out. As the kids drift in and out of the kitchen for snacks, take the opportunity to ask your child's friends casual, non-intrusive questions to get a sense of who they are, and to send your child the message that you care.

Freshmen: New Kids on the Block

The first year of high school. It's a defining moment for teens but oh-so-hard to define in terms of individual experience. The heady adventures and awakenings that constitute the beginning of high school affect different students in different ways. Nevertheless, a few recurrent themes characterize these new kids on the block.

Friends and social activities rule. Cliques and peer groups take the place of family, and more often than not parents find themselves scorned and rejected. This is entirely normal and – if you're lucky – passes sooner rather than later.

Individuality gives way to conformity: "Everybody's doing it" becomes a mantra. Many parents watch helplessly as ninth graders spurn anything that might set them apart from the pack. What appears to be social bondage, however, is actually more like a social refuge where kids build confidence and self esteem.

Confrontation is inevitable, encompassing everything from the ridiculous to the relevant. At this stage, kids are learning to think in abstractions and are often desperate to test out their advanced thinking in the form of endless debate. "I hope she grows up to be a lawyer," remarks one father. "Then she can be paid to argue!"

Along with all the bravado, ninth graders are also likely to be insecure, moody, and painfully self-absorbed. As one psychologist says, "Imagine trying to work or give a small, intimate dinner party in a department store window and you'll know how self-conscious your young adolescent feels much of the time."

Entering high school brings drama to the smallest events. The rumor mill is in high gear, mundane occurrences assume huge proportions, and the repercussions are endless. It's an ongoing spectacle of tragedy and comedy. Who needs to spend money on theater tickets?

Sophomores: Independence-Bound

No longer the smallest fish in the high-school pond, tenth graders are on the move. With increased age comes increased responsibility, self-knowledge and -- most prized of all -- freedom. From driver's ed to dating, sophomores are independence-bound.

Juggling freedom with responsibility can be tough going. You and your son agree on a curfew, then he "forgets" and comes home an hour late. Or your daughter has friends over and they leave soft drink cans all over the place. There are endless discussions about consequences. When will they understand that privileges have to be earned?

A typical tenth grader is likely to bounce from one extreme to another, changing enthusiasms, attitudes, hair, clothes – you name it – with dizzying frequency. Causes are passionately taken up and abruptly dropped. Today's fad is tomorrow's fizzle. Identities are adopted and discarded like Halloween masks. It's all part of answering the big question, Who Am I?

Does your adolescent tend to over-analyze? Spend big chunks of time obsessing about small things, such as what to wear to a party or exactly what so-and-so's passing comment really meant? Lots of kids this age are still learning the distinction between the kind of thinking that's helpful and the kind that's counterproductive.

Conversation – like oxygen – is key to teenage survival, and not surprisingly, the telephone becomes a rich source of family friction. A good rule of thumb? No socializing until homework is finished. But keep in mind that every rule has exceptions. If you have several children, a second phone can help eliminate the hair-tearing.

Despite their social excesses, teens crave privacy. They disappear into the bedroom and lurk behind closed doors, doing nothing for hours on end. Or is there more to it? Maybe it's the best way to regress a little and be a kid again – to daydream, fantasize, grab a favorite stuffed toy. Being a sophomore is, after all, exhausting.

Coping with Back-to-School Anxiety for High-Schoolers

High-School Fears

Am I good enough to make the team this year? Am I smart enough to take AP Biology? Those seniors seem so much older than me! Each year of high school brings new concerns for your teen. Follow our suggestions on how to help ease those worries.

Where Do I Fit In?

Your teen is most worried about belonging – finding a group of like-minded peers who will accept him and call him their friend. These safe havens come in many forms: sports teams, clubs, extracurricular activities, and friendship circles.

As you might recall from your own high-school days, every student body is fractured into distinct cliques – jocks, geeks, nerds, goths, preps -- and while the labels may change with the times, the pressure to fit in seems eternal. Encourage your child to follow extracurricular activities based on his own interests, curiosities, and abilities, not on whether a certain pursuit will grant him automatic acceptance to a clique.

How Do I Look?

What kids wear and how they look is very important in high school, and even in middle school. Certain fashions and brand-name clothing become the uniforms for particular groups. Hairstyles (and colors), makeup, body piercings, and tattoos also give kids both an individual and group identity.

There's considerable pressure on girls to emphasize their sexuality in the way they present themselves and communicate. For boys, achieving average height and a sufficiently developed physique by the mid-teens is often equated with their masculinity.

Particularly for mothers and daughters, sarcastic or critical remarks about a girl's appearance is shaming, harmful, and puts an unnecessary strain on a relationship that may be stressed already. If it's tempting to comment on your daughter's outfit or hairstyle, try pulling back -- and pulling out some of your own high-school pictures instead. Besides giving you both a good laugh, you can use these photos to start a discussion on how you both coped with anxieties about your appearance. Pictures can be a vivid reminder that Mom also struggled with these same issues.

Am I Smart Enough?

A nervous freshman once told me, "Everything starts to count freshman year. From here on in, if you goof up at all, no colleges will want you." This abiding panic can continue until the end of junior year, when kids believe their futures will have been decided. For many, college acceptances dictate whether they have any future at all.

Academic competition heats up in high school; coursework gets measurably tougher, homework gets much longer, teachers don't spoon-feed kids. The challenge is "Are you smart enough to handle all this, on your own?"

Remind your teen that college acceptances are based on many factors. Kids who challenge themselves with difficult courses and do well are considered better candidates than students who receive higher grades but take the easiest classes. Freshmen grades are not considered as relevant as grades in later years.

Assure him that his study and test-taking skills will improve. Encourage him to come to you if he begins to become confused or overwhelmed about any of his schoolwork.

Keep up with the specifics of his coursework and homework. Don't wait for his first term's grades to find out how he's doing academically. Tell him that you will do whatever it takes to help him succeed, including finding him a tutor if necessary.

What If They Ask Me To?

No doubt, your child has heard stories about kids' smoking, taking drugs, and drinking at school. Maybe she's even caught a glimpse of these activities. What should she do if she sees kids smoking or taking drugs in the bathroom or on school grounds? What if they ask her to join them? These are pressure-packed questions, especially when kids don't want to be rejected by anyone or any group.

Your teen might not voice concerns about being pressured by peers to smoke, drink, take drugs, and have sex. It might be up to you to initiate these discussions. You could say, "I've heard stories about kids smoking in the school bathroom. Is that all they do in there?"

Whatever your child's response to questions like these, it's an opening to discuss your rules and limits about these behaviors. Your discussion must include the rationale behind your rules. This isn't the time to merely recite that old slogan, "Just say no." While your teen is developing her own beliefs and values regarding these behaviors, it's vital that you provide her with yours.

How Do I Stop the Teasing?

Freshmen frequently have nightmares about being shoved in their lockers or intentionally jostled in the corridors by upperclassmen. Kids who've been rejected by the strongest cliques fear the sting of endless taunts and slurs.

If your child has been a former target of bullies or teasing, he may be seen as easy prey in high school. A withdrawal from the social and extracurricular world of school, or a generally dejected attitude, may be signs that he is being bullied or harassed.

Make sure that you know the high school's policy regarding bullying. Federal and state laws demand that schools create written school policies and practice good-faith efforts to provide all students with an environment free from any harassment.