While it is developmentally normal for younger children to be anxious about school, this normal anxiety typically resolves quickly as the child adjusts. Most parents are able to provide the support needed to help their children overcome their initial anxiety. However, when anxiety about school causes a child significant distress intervention is often needed. This is particularly true for adolescents, who, from a developmental perspective, should have resolved normal fears about school.
Working with school anxiety and refusal can be very challenging. Children and teenagers can, in more extreme instances, be very resistant to going to school. It may be difficult, even impossible, initially, to engage some children and adolescents in therapy and establish that the goal of therapy is to return to school. In these instances, more family focused treatment may be necessary, with the emphasis on how parents can more effectively respond to their defiant and anxious child.
Family work is essential, even the best intentioned parents can inadvertently respond, out of their own frustration or anxiety, in ways that intensify and exacerbate problems, such as the frustrated parent who yells at the anxious child, or the anxious parent who does too much reassuring rather than pushing their child to work to reassure themselves. Moreover, most children and adolescents need parental support to help them overcome their anxiety. Finally, if there are significant family concerns, or if the child is struggling with more significant emotional involvement, family involvement is critical. When significant parental conflicts are present, it is incumbent on the therapist to identify and attempt to address these issues. When a child or teenager is struggling with major depression or other serious psychological problems, parents need to understand their child’s needs and how to best respond to them.
How to Spot Signs of Anxiety
Sometimes anxiety doesn’t look like anxiety at all. Symptoms of serious stress can be both behavioral and physical. In little kids, panic often erupts into tantrums. Older kids may act out, using aggressiveness as a way to cover up a fear of being judged by classmates. Physical symptoms can include restlessness, fatigue, back pain, sweating, and — most commonly — head- and stomachaches.
When to Go to the Pros
If anxiety prevents kids from going to school and making friends, it’s time to see an expert. Cognitive behavior therapy (CBT), which replaces negative thoughts with targeted coping strategies, is typically the first line of treatment. But when a child is so anxious she can’t focus on the therapy, clinicians may also turn to medication.
Anxious Behavior: What’s Normal and What’s Not
It’s perfectly okay when kids worry about an upcoming test, want to be tucked in at night, hang back for the first half-hour of a party, keep an eye out for bees or dogs. It’s a red flag when they vomit, lose sleep, or cry from stress, wind up in your bed every night, refuse to go to parties or leave your side, need to be coaxed outside because they’re afraid of being stung or attacked.
Anxiety Soothers to Try Now
1. Have the child tense and relax each muscle group, working up from the toes.
This releases tension, and when the body relaxes, the brain does, too.
2. Tell the child to pay attention to the noises around him until he hears five different sounds.
Focusing his thoughts helps the child stay in the moment rather than worry about the future.
3. Grade-schoolers can write down, or dictate, their fears and stash them in a shoebox.
Writing worries helps minimize them and gives kids permission to let ’em go.
4. Tell the child to remember a time he faced a scary situation and overcame it or learned something hard.
Picturing a previous success makes anyone feel more confident.
5. Tell the child to pretend holding a slice of pizza, inhale the aroma by breathing in deeply through the nose and cool the pizza by blowing out through the mouth.
Focused breathing sends the brain a message that it’s time to relax.

6. Download some anti-anxiety apps. Try the Meditation Jar, iTunes, free. Set the timer, shake the phone, and watch the particles settle.
This app gives kids something to gaze at as they quiet down, or breathe.

Submitted by John Berkowitz, LCSW, MSEDS, Clinical director at the Family Healing Center.