Pre-corona pandemic, the crowds of kids or the fear of not knowing where to sit during lunch could have induced panic in many kids from preschool to high school age.
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In trying times like these, whether kids are starting their school year virtually or in person, they could still harbor a lot of nervousness and anxiety (maybe even more?) as kids learn to maneuver through new routines and expectations. As the early weeks unfold, most kids quickly gain confidence and settle into a routine.
However, for some students — and their families — the anxiety continues to build. Psychiatrist Joseph Austerman, DO, offers guidance on what to do if your child has school-related anxiety and how to help them.
School-related anxiety and school refusal
School refusal is the term used to describe the problem of children whose anxiety keeps them from attending school on a regular basis. This could stem from a variety of things such as starting a completely new school, finding new friends, transitioning from middle school to high school or being afraid of other students.
About 2% to 5% of children have school-associated anxiety, according to the Anxiety and Depression Association of America.
School refusal refers to students who:
- Skip school or refuse to go.
- Frequently visit the school nurse complaining of illness and asking to go home.
- Often call home during the day and ask to be picked up.
- Go to school only after crying, tantrums, defiance or other problem behaviors.
- Complains of physical symptoms like nausea, headaches or stomach pain.
Most kids have periods of time when they resist going to school, and in most cases, they’ll get over it on their own. However, if the behavior continues for two weeks or longer, it’s time to get help.
When it’s time to seek treatment
“Many times a child’s anxiety does not need to be treated with medication,” says Dr. Austerman. “The first step is to look for what’s triggering their anxiety and see if we can intervene. If the child is being picked on at school, for example, medication won’t fix anything.
Your child’s doctor will first discuss whether it’s possible to change the environment or circumstances triggering your child’s anxiety. Then, they will move forward with cognitive behavioral therapy (CBT). CBT is a goal-oriented talk therapy where counselors will help your child talk through their thoughts and emotions.
“If the anxiety is extremely impairing — when children can’t sleep, go to school, or manage themselves — or if we’ve tried therapy and changing the environment but nothing has helped, then we look at medications,” he says.
When anxiety is severe and other methods haven’t helped, selective serotonin reuptake inhibitors, or SSRI drugs, may be used to treat anxiety in children and teens. Common SSRIs include fluoxetine (Prozac®), sertraline (Zoloft®), paroxetine (Paxil®), fluvoxamine (Luvox®), citalopram (Celexa®), and escitalopram (Lexapro®).
When people have low levels of serotonin, a neurotransmitter, they can’t feel safe or see the positive in a situation. SSRI drugs affect the neurons in a way that makes more serotonin available. Talk to your child’s doctor to determine if, and which, medication is right for your child.
“About 50 to 60% of the time, an SSRI can provide relief from anxiety, especially when the child is also in cognitive behavioral therapy,” says Dr. Austerman.
Build a support team
Communication is the key to managing a child’s anxiety before it gets out of hand. After school, make a habit of asking how their day went and tuning into their emotions. This will help figure out what’s going on at school and how you can help alleviate any anxiety for the future.
“Establish communication with teachers and other people at school who can be a support system for your child,” says Dr. Austerman. “Keep the lines of communication open — make sure they know you’re in their corner no matter what and you will support them through this.”
During the coronavirus pandemic, it’s important to provide your child with clear guidelines on how you as a family are going to manage COVID precautions.
“Provide reassurance that children are at low risk for significant complications but that they need to adhere to the simple instructions to wash hands, wear a mask, and socially distance and they will be safe,” he says.
Some children will be starting the year virtually but at some point will transition back to in-person school. Being away from school for long periods of time can worsen school anxiety. If you plan on having your child return to school at some point, make that a clear expectation. Take trips to the school, even just the parking lot, to keep them familiar with the environment.
“Continue to work with school staff to alert them of this potential struggle and plan to have a reintegration plan prior to going back in-person,” he adds.
Finally, he urges parents to be proactive.
“If you see a difference in your child’s behavior, don’t minimize it — explore it,” he says. “It’s always better to tackle an anxiety disorder when it is small and manageable before it builds into something big.”