eNewsletter - October 2018

Behavioral Health Partners




Identifying and Addressing School Anxiety 
Heather Treat, Psy.D. and Laura Koehler, Psy.D.

As mental health providers, we’re familiar with anxiety, one of the most basic human emotions. In general, anxiety serves to motivate and protect individuals from harm or unpleasant consequences. Its symptoms, including heart palpitations, chest tightness, numbness or tingling, fidgeting, dizziness, nausea, headaches or difficulty concentrating, range from disconcerting to disabling, leading to avoidance behavior related to anxiety sources.

Identifying school anxiety. School anxiety is described as severe emotional distress about attending school. In these situations, parents are aware of absences and the child typically tries to persuade parents to allow them to stay home where they feel safe and secure. Children may also demonstrate a willingness to complete homework, but anxiety surfaces while doing it.

According to the Anxiety and Depression Association of America, 2 to 5 percent of school-aged children experience school anxiety. There are several reasons children refuse to go to school in these cases:

  • To avoid school related stimuli that provoke negative affectivity (anxiety, depression or somatic complaints)
  • To escape aversive social and/or evaluative situations (social phobia or performance anxiety)
  • For positive reinforcement with intangible rewards, such as attention or sympathy (separation anxiety disorder)
  • For tangible rewards outside of school (oppositional defiance disorder, conduct disorder or substance abuse) – we often call this school truancy rather than school anxiety

The following common signs may be present in cases of school anxiety:

  • Intense physical sensations, like stomach aches or headaches
  • Staying home or isolating in the bedroom
  • Leaving class, taking frequent trips to the guidance office/nurse, or asking to stay home from school
  • Unwillingness to engage in hobbies or extracurricular activities
  • Struggles with concentration/focus/retrieving information
  • Seeking reassurance from support
  • Repetitive behaviors
  • Sleeping difficulties
  • Lack of appetite or overeating
  • Constant fidgeting

Skill-based tips for dealing with school anxiety. For students suffering from school anxiety, behavioral based techniques can be helpful in keeping them in the classroom and/or bringing the anxiety down and getting them back into the classroom. Consider using the following methods and determine what’s most helpful based on the student’s preferences.

  1. Change focus with these distraction-based techniques. Distraction techniques call a child to move attention from upsetting emotions to something more pleasant.
    • Activities: exercise, hobbies, games, sports, dance, jumping jacks, bike ride, jump rope, walk dog, play with animals, yoga
    • Contributing: volunteer, make a gift, surprise someone, chores, cook/bake, help team mate, coach, babysit, call friend/talk about them
    • Thoughts: reading, homework, puzzles, paint, ABC game, word searches, Sudoku, crosswords, count backwards by 13, 20 questions, I Spy, extreme connect the dots pages, hidden pictures
    • Shock the senses: cold shower (touch), spicy food (taste), loud music (sound), spices (smell), optical illusions (sight)
    • Imagery: relaxing scene, imagine coping, fantasy, nature, memories, vacations, family, friends, sport plays 

  2. Self soothe using the 5 senses. Self-soothing allows children to manage their own emotions by focusing on sights, sounds, tastes, smells and textures that encourage calmness. Consider the following ways to incorporate all five senses:
    • Vision. Look at a candle flame, flowers, food, art, pictures of family/friends/pets, YouTube videos, dance performances, television, movies, celebrities, or nature. Star gaze, walk/drive mindfully or read books.
    • Hearing. Listen to soothing music, sounds of nature (waves, birds, rainfall, leaves rustling), sing favorite songs, play a musical instrument, listen to friends’ and family members’ voices, or enjoy audio books.
    • Smell. Smell a favorite perfume or cologne, lotion, scented candles, home fragrances, wax melts or potpourri. Bake cookies/bread/cupcakes, cook a favorite meal, mindfully walk in nature, or take in the outdoor scents.
    • Taste. Enjoy the tastes of a favorite meal, soothing drinks (herbal tea, hot cocoa, chocolate milk), dessert, mints, gum, water, hard candy or chocolate. Remember to eat and/or drink mindfully.
    • Touch. Tactile sensations like taking a bubble bath, petting a dog/cat, wearing fresh clothes from the dryer, getting a massage, soaking feet, putting on lotion, placing a cold compress on forehead or back of neck, touching soft material, brushing or running fingers through hair, hugging family members or friends, using a fidget toy, stress ball, bendy stick or soft stuffed animal can all be soothing activities. 

  3. Build a self-soothe kit. A self-soothe kit is a small, portable bag (e.g. a pencil bag or other small bag) of items that can help children soothe themselves when they are struggling with anxiety and may help children stay in the classroom. We recommend having items in the kit that soothe all five of the senses. Consider the following items when building a kit:
    • Crosswords/word searches/Sudoku/logic puzzles/Extreme Dot-to-Dots/hidden pictures
    • Pictures of family/friends/pets/nature
    • Favorite smelling lotion/perfume/cologne
    • Chap stick/lip gloss
    • Gum/mints/candy
    • Fidget toy (stone/squishy toy/cloth/coins)
    • Ear buds/playlist of high energy songs/soothing songs
    • Deck of playing cards
    • Silly putty/Play-Doh/thinking putty
    • Pen/paper/journal
    • Coloring pages/markers/crayons
    • Cinnamon stick/tea bags/wax melts
    • Book/magazine/jokes/poetry
    • Shell for ocean sound plus fidget
    • Inspirational quotes/lyrics/poems
    • Travel sound machine
    • Water bottle

When to get help. When dealing with school anxiety, it’s important to keep encouraging the child to attend school throughout treatment, adjusting schedules if needed. If the symptoms are significantly impacting the child’s daily functioning, seek support from a mental health provider and consider talking to school staff. Mental health providers can provide the one-on-one care and family support needed. For assistance in finding a mental health provider, call Linden Oaks Help Line. Our assessment professionals are available to assist you 24 hours a day at (630) 305-5027.

  • Fremont, Wanda P. “School Refusal in Children and Adolescents.” American Family Physician, 15 Oct. 2003.
  •  Kearney, Christopher A, and Wendy K Silverman. “Measuring the Function of School Refusal Behavior: The School Refusal Assessment Scale.” Journal of Clinical Child Psychology, Taylor & Francis, 7 June 2010.
  • “School Refusal.” Anxiety and Depression Association of America, ADAA.