Back to school anxiety remedies

Transitioning from carefree summer days into a structured school day can be stressful for children. From a change in environment to new names and faces, heading back to school can be a stomachache-inducing, palms-sweating time for many kids and teens.

Many parents wonder if kids are faking these feelings to get out of going, but back-to-school anxiety is a real phenomenon, says Dr. Christopher Min, a pediatric psychologist at CHOC Children’s. Back to school anxiety occurs when nervousness goes into overdrive, causing physical, behavioral or cognitive consequences that can impact a child’s mindset and ability to perform in school.

“It’s easy for us as adults to forget what it’s like to be a kid,” Min says. “It can be really scary.”

psychologist-tips-back-to-school-anxiety
Dr. Christopher Min, a pediatric psychologist at CHOC Children’s

A child’s job is to go to school, Min says, and their workload doesn’t simply include academics. School is where they learn and practice everything from social skills with peers and authority figures, to learning boundaries and appropriate behavior, to practicing physical activity, to selecting food on their own and eating without their parents.

“The likelihood that at least one of these things will create apprehension or anxiety in kids is great,” Min says. “So many things are packed into one environment.”

It’s important for parents to remember that children are just starting to learn these life skills when they’re in school.

“Not only are kids asked to encounter a multitude of new situations at school, but they’re still developing the skills necessary to succeed,” Min says. “They don’t have mastery of these skills yet; they’re still learning them.”

For parents struggling to determine whether their child is creatively avoiding school responsibilities or dealing with legitimate back-to-school anxiety, Min suggests looking for patterns in behavior.

Look back at their history with school, he says. What tends to happen in the weeks or days leading up to a new school year? How does your child adapt to changes? Does the behavior dissipate as the school year progresses?

“I like to empower parents and remind them that they are the expert on their children,” Min says. “Parents know their own children best. They know what their children do in provoking situations.”

Children are at increased risk for anxiety-based school refusal during periods of transition, such as when they start kindergarten, or move to a new school for junior high or high school, Min says.

“Every kid deals with school-based anxiety differently,” Min says. “However, boys tend to externalize their behavioral, such as acting out. Girls tend to internalize their behavior, which can be interpreted as being moody.”

Once their behaviors are identified, Min encourages parents to help their children cope with their anxiety by practicing easing into the school year.

“As adults, we wouldn’t go into a presentation at work, or show up for a marathon without preparing,” he says.

Kids tend to have a different sleep schedules and less structure during summer months, so in the weeks leading up to the first day of school, start to adjust their sleep and wake schedules.

Min also encourages graduated exposure, where parents can slowly introduce new routines in their child’s day.

“Practice their morning routine before school starts. You can even practice driving to school and show them where you will drop them off and pick them up,” he says.

Making small adjustments at home to help them prepare for the new school year will help them ease into the other transitions that come when school starts.

Although it can be stressful for parents to see their child struggling with a school transition, they shouldn’t immediately jump in to “rescue them,” Min says.

“With school avoidance, if you “rescue” a child or keep them home, that is detrimental because it reinforces their anxiety, and teaches their brain that school is a threat and something to be avoided.”

He encourages parents to partner with their child in managing their anxiety— while still going to school —and over time the anxiety will decrease with repeated exposure.

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6 major types of anxiety disorders

Anxiety is a normal human emotion and is part of life. Anxiety is only considered a disorder if it causes significant distress and/or keeps a person from keeping up with at least one part their life, including school, work, relationships, responsibilities or enjoyable activities. Anxiety disorders often persist over time and generally do not go away on their own. When anxiety disorders are left untreated, many people develop depression because of the toll that the anxiety has taken on their life. Anxiety is treatable by a mental health professional with short-term therapy if there are no other challenges or concerns.

We spoke to several pediatric psychologists at CHOC Children’s for an overview on the six major types of anxiety disorders.

 Phobias are intense fears of specific animals, objects or situations. This would include a fear of dogs, spiders, heights, blood draws, the dentist, or anything else. A person with a phobia either goes out of their way to avoid the feared objected or situation, or they face it, but they experience extreme distress. The fear has to last at least six months before it is considered a phobia. Children with age-appropriate fears are not the same as phobias; e.g., a 3-year-old who is afraid of the dark.

 Generalized anxiety is when someone worries about a range of different topics, which may include school or job performance, finances, world events, natural disasters, relationships with others, and other topics. These worries are hard to control and keep popping up, making it hard for people to focus on their activities. Worries happen often and intensely enough that they make it difficult to concentrate and may cause or worsen headaches, stomach aches, muscle tension, and irritability.

 Panic disorder is when someone experiences panic attacks that get in the way of their life in some way. Panic attacks can include any combination of sensations, including racing heart, rapid breathing, chest pain, dizziness, nausea or abdominal pain, blurred vision, sweating, shaking, feelings of doom, feeling like the world isn’t real (as though you are in a dream or a movie), or experiencing the moment as though you are outside of yourself. The person may also experience fear of losing control, or fear of dying or going crazy. Panic attacks can be triggered by something specific, or they can occur seemingly out of the blue. They usually reach their peak intensity within 15 minutes. It is important to note that someone can have panic attacks without having panic disorder. When someone has panic disorder, they either avoid situations that they think will cause a panic attack (such as going to the mall, going to the movie theater, or driving), or they experience ongoing worry that they will experience another attack. In the case of panic disorder, panic attacks should not be better explained by a specific phobia or by social anxiety.

 Social anxiety disorder (also known as social phobia) is a persistent fear of being judged or evaluated by others, accompanied by intense discomfort interacting with others. Someone may be intensely afraid of saying the wrong thing or feeling stupid or embarrassed. This anxiety can happen in just one specific situation, such as giving presentations at school, or in many situations wherein a child is very uncomfortable interacting with peers and adults. As a result, the person with anxiety may avoid interacting with others but still feel comfortable with close friends and family. The person with anxiety may also request that others speak for them, such as ordering food for them at a restaurant. There is a difference between shyness and social anxiety disorder. Shyness involves some minor discomfort interacting with people in certain situations, whereas social anxiety disorder actually gets in the way of the individual’s functioning at home, school, work or in their social circle. Occasional, fleeting discomfort in social situations is not necessarily an indicator of social anxiety disorder.

 Obsessive compulsive disorder (OCD) and Post-traumatic stress disorder (PTSD) used to be grouped with anxiety disorders, but now they are classified under their own category because they have unique causes, unique brain structures involved, and unique treatments that make them separate from anxiety disorders.

Separation anxiety disorder is when someone has persistent and excessive worry about being separated from or losing a caregiver or attachment figure. Separation anxiety can be a normal part of a child’s early development, but when the anxiety becomes excessive it can impair their development. Separation anxiety generates thoughts about what will happen to their caregiver when they are separated, such as whether the caregiver die or become ill. The individual also worries about what would happen to themselves if they are separated from their caregiver, such as will they get hurt or will something bad happen to them. Due to this heightened level of anxiety, the person can come across as “clingy” toward their caregiver and have difficulty leaving their side to go to school, be home alone, or go to sleep by themselves. Often, separation anxiety can occur after a stressor or loss. For example, for a young child after the loss of a pet, or for a young adult when they move out of their parent’s home for the first time.

The important thing to remember is that anxiety is both common and treatable. If your child is experiencing anxiety that is getting in the way of their activities or responsibilities (like school or chores), medical care, or relationships with others, consider reaching out to their primary care physician or a mental health provider about available treatment options.

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative.

Related posts:

  • Back to school anxiety remedies
    Transitioning from carefree summer days into a structured school day can be stressful for children. From a change in environment to new names and faces, heading back to school can ...
  • How to help your child with anxiety
    Anxiety is a feeling everyone experiences at some point but for some children, it grows too strong or too frequent. These tips on how to help your child with anxiety ...
  • Tips for Kids and Teens on How to Manage Anxiety
    Anxiety is a feeling everyone experiences at some point. In some situations, anxiety can be helpful; it keeps us alert, protects us from danger and helps us notice problems around ...

 

How to help your child with anxiety

Anxiety is a feeling everyone experiences at some point. In some situations, anxiety can be helpful; it keeps us alert, protects us from danger and helps us notice problems around us. But for some kids and teens, that sense of anxiety grows too strong or too frequent and can get in the way of their normal activities.

One in four adolescents have mild to moderate anxiety, making it the most common mental health disorder among young people, according to the National Institute of Mental Health. It is more common among girls, often overlaps with depression and can be seen even in young children. Because it can look different in each person and may or may not be triggered by a specific event or setting, it can be difficult for parents to recognize at first.

Whatever the symptoms, anxiety can really interrupt day-to-day life for both your child and you. Knowing the symptoms and learning some coping skills can support you in how to help your child with anxiety. 

Common symptoms of adolescent anxiety can include:

  • Feeling overly worried, nervous or afraid
  • Sleep problems
  • Muscle tension
  • Avoiding certain situations
  • Difficulty concentrating
  • Increased heartrate
  • Upset stomach
  • Headaches
  • Irritability
  • Becoming easily tired

Seven tips to help you manage your child’s anxiety:

Help kids recognize their anxiety

Children and teens often don’t know they are anxious. Help them learn how their body responds to feeling worried or fearful; talk through their emotional and physical feelings with them so they can better identify it when it happens again.

Listen and show support

Encourage your child to open up about any fears and worries they have. Even if their fears seem irrational or exaggerated, let them know you care and think that what they feel is important.

Stick to a routine

Schedules and routines create a sense of structure, security and comfort. Try to make things seem normal for your child, even though they may not be.

Praise small accomplishments

Notice when your child follows through with trying something new or approaching something that makes them nervous. Tell them how much you admire them for trying and that trying is key regardless of the outcome.

Notice your own reactions

Pay attention to your own thoughts and feelings during stressful times. Try to stay calm and positive when your child is anxious.

Find treatment for your child

If worry is getting in the way of normal, daily activities, your child may benefit from therapy, counseling or medication. Talk with your doctor to decide what will work best for your family. If you’re having a hard time with your child’s anxiety, it may also help you to seek therapy or counseling, as well.

Get help

If your child expresses thoughts about wanting to harm themselves or is saying unsafe things, call 911 or bring them to the nearest Emergency Department.

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative.

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Tips for Kids and Teens on How to Manage Anxiety

Anxiety is a feeling everyone experiences at some point. In some situations, anxiety can be helpful; it keeps us alert, protects us from danger and helps us notice problems around us. But for some kids and teens, that sense of anxiety grows too strong or too frequent and can get in the way of their day-to-day activities, and these tips on how to manage anxiety can help.

One in four adolescents have mild to moderate anxiety, making it the most common mental health disorder among young people, according to the National Institute of Mental Health.

Anxiety can feel different to each person and may or may not seem to be triggered by a specific event or setting.

Whatever the symptom, anxiety can really interrupt your day-to-day life. Knowing what the symptoms are and learning some coping skills can help anxiety feel much more manageable.

Common symptoms of anxiety can include:

  • Feeling overly worried, nervous or afraid
  • Sleep problems
  • Muscle tension
  • Avoiding certain situations
  • Difficulty concentrating
  • Increased heart rate
  • Upset stomach
  • Headaches
  • Irritability
  • Becoming easily tired

Five tips to manage anxiety:

1. Find ways to relax

When you feel anxious, your muscles tense up, your heart rate increases, and your breathing gets shallower. Take deep breaths for a while to try to get your body back to a resting state.

Try This: Pretend your belly is a balloon. Breathe in to make it bigger, then breathe out and watch it shrink. Count slowly to four when you breathe in and then to four when you breathe out.

2. Face your fears

It might sound scary, but facing your fears is proven to help. It’s called exposure, and it involves taking small steps to getting yourself used to things that make you anxious.

Try this: Get the help of a parent or adult you trust and start with something small. They can help guide you through exposure to it until you start to become less anxious. Using the deep breathing exercise above will also help.

3. Take charge of your thinking

The tricky thing about anxiety is that it’s easy to think negative thoughts when you’re anxious. Pay attention to what you are saying to yourself, and avoid thinking negatively, jumping to conclusions or assuming the worst.

Try this: Ask yourself, “What would I tell my friend if they were in this situation?” or try thinking of times you’ve been able to handle a tough problem.

4. Get enough sleep

Anxiety can cause a frustrating cycle. When we’re anxious, it can be hard to sleep. But not getting enough sleep can make us feel more anxious. Try to eliminate the things that keep you awake and focus instead on setting aside some relaxing time before bed.

Try this: Dedicate the hour before bed to quiet time. Stay away from your phone, TV and computer—the bright lights trick your brain into staying awake longer. Try listening to calm music or meditating instead.

5. Get support

You never have to go through anxiety alone. Having people to turn to for support makes a big difference. A therapist, such as a psychologist, social worker or counselor, can help you understand and manage your feelings. This might be through talk therapy (also called Cognitive Behavioral Therapy or CBT), medication or a combination of both.

Always remember to call 911 if you are in a crisis or are feeling like you want to hurt yourself or others. Helplines are available by calling 1-800-273-TALK or texting “CONNECT” to 741741.

Stay Informed about Mental Health

CHOC Children’s has made the commitment to take a leadership role in meeting the need for more mental health services in Orange County. Sign up today to keep informed about this important initiative.

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Managing and Combating Test-Taking Anxiety in Children

By Jonathan E. Romain, Ph.D.

Many parents know the disappointment of seeing their bright child score poorly on an exam even after hours of studying. girl with test-taking anxiety

“I knew the answers before the test!” and “My mind went blank when I saw the test!” are common refrains from these frustrated children.

These aren’t excuses. What these children are experiencing can likely be attributed to test anxiety, a real phenomenon that occurs when nervousness goes into overdrive, causing physical, behavioral and cognitive consequences that can impact test scores.

Fortunately for parents and children alike, test anxiety can be managed and even conquered.

When Anxiety Takes Over

Anxiety at its best provides a bit of nervousness that keeps people sharp and making sound decisions at key moments.

However, the problem occurs when anxiety becomes more intense than what is necessary for the situation. Many people – more than 30 percent – have difficulty keeping anxiety at a manageable level. For these people, excess anxiety can lead to poor performance, low self-esteem, and school avoidance and social isolation.

Anxiety symptoms usually first develop during the school-age years, when tests are introduced and awareness that classroom performance is monitored increases. During these formative years, children need good coping skills and strategies to manage anxiety.

Symptoms of Test Anxiety

To best manage test-taking and classroom anxiety, first identify the symptoms:

  • Physical symptoms include increased heart rate, trembling or a shaky feeling, muscle tension, and feelings of lightheadedness.
  • Behavioral symptoms include irritability, restlessness, rapid speech and fatigue.
  • Cognitive or thought-related symptoms include difficulty focusing and concentrating, memory problems, poor problem solving, and persistent worrying.

Test anxiety can also self-perpetuate or reinforce itself. So, if a child had a bad experience on one test, it’s likely they will have similar feelings again. After several experiences, the child may feel that all tests are miserable and to be avoided.

Managing Test Anxiety

Parents, teachers and students should work together to control anxiety.

Parents should reward success and reinforce good effort, but know that too high expectations and unrealistic goals may have a negative effect. They should also ensure they control their own anxieties, as children can sense emotions and model learned behaviors.

Parents and schools should work together to identify test-taking anxiety as it occurs and ensure realistic expectations. Teachers can modify time constraints and put equal emphasis on homework, projects and classroom tests. Additionally, they can grade more for effort than output. Less emphasis on grades can diminish anxiety and improve grades.

Finally, children can manage their anxiety by identifying symptoms and practicing progressive relaxation and other deep breathing techniques to calm down. They should also be encouraged to talk to parents and teachers when feel overwhelmed.

They can also try journaling: A recent study at the universities of Colorado and Chicago suggested that writing about anxiety before taking a test reduced anxiety’s impact on performance. The idea is that by writing about the anxiety, test takers let go of symptoms and can concentrate better on the task.

Anxiety has a protective factor in dangerous or life-threatening situations, and a reasonable dose of nervousness can help one perform at their peak. But it is essential to know the symptoms of anxiety and to keep them in check so they do not take over. Learning to manage anxiety in the school-age years is the first step to an anxiety-free adulthood.

Dr. Romain is a board-certified clinical neuropsychologist at CHOC Children’s. Dr. Romain completed his pre-doctoral internship at Franciscan Hospital for Children in Boston and a two-year American Psychological Association accredited fellowship in pediatric neuropsychology at Medical College of Wisconsin. Learn more about Dr. Romain.

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