It’s normal for kids from preschool to high school age to experience some nervousness and anxiety early in the school year. 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.
Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services. Policy
School-related anxiety and school refusal
“School-associated anxiety is something I commonly see in my practice, but it is fairly uncommon overall,” says psychiatrist Joseph Austerman, DO.
Only around two percent of children have school-associated anxiety, according to the Anxiety and Depression Association of America. But Dr. Austerman says, “That’s still a significant number of kids.”
School refusal is the term used to describe the problem of children whose anxiety keeps them from attending school on a regular basis.
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
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.
Do you need 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.”
Insomnia in Children
“If the child is being picked on at school, for example, medication won’t fix anything,” he adds.
“First we look at whether we can change the environment or circumstances triggering a child’s anxiety, and then we move forward with cognitive-behavioral therapy,” Dr. Austerman says.
“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.”
Kids, Headaches and School Attendance
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. Dr. Austerman says that 50 to 60 percent of the time, an SSRI can provide relief from anxiety, especially when the child is also in cognitive-behavioral therapy.
Build a support team
Dr. Austerman says that communication is the key to managing a child’s anxiety before it gets out of hand.
“Establish communication with teachers and other people at school who can be a support system for your child,” he says. “And keep the lines of communication open between you and your child — make sure they know you’re in their corner no matter what, and you will support them through this.”
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.”