DEALING WITH BACK-TO-SCHOOL ANXIETY IN YOUNG CHILDREN

a guest blog post originally posted on SitterCity.com

As parents prepare their children for the school year to begin, it’s easy to get swept up in all the details: Are the school medical forms filled out? What’s left on the school supplies list? Have you found an after-school sitter yet?

Ticking off all the items on your family’s back-to-school checklist is important, but it’s equally important to pay attention to your child’s behavior during the weeks leading up to school. Anxiety about advancing to a new grade or starting a new school is normal; after all, people of all ages need time to adjust to a new situation. Here are a few ways you can turn those back-to-school jitters into excitement.

(Please note: If you suspect that something more than garden-variety jitters is going on, call your pediatrician who can refer you to a child psychologist for a consultation.)

Get some sleep.

A well-rested kid is a happy kid. While it’s fun to stay up late and sleep in during the summer, it’s important to get bedtime on track at least a week before school starts. Kids can feel grouchy, upset or fearful when they’re sleep deprived. Start practicing normal school day wakeups a week or two in advance so they get used to their new schedule.

Attend the open house. 

Schools often host an open house a couple weeks before classes begin. Be sure to clear your schedule for it — it’s an invaluable chance for your child to meet their new teacher and start feeling comfortable with them, as well as a chance to check out their new classroom.

Plan play dates. 

If you’re new to a school, open houses are also a chance for kids to mingle with their new classmates a little with the safety of you still being around, so they’re not making as many introductions on the first day of school. As you chat with the other parents, see if any of them are open to the idea of a play date, even if it’s just meeting up informally at the playground so your kids can continue to get to know each other.

Do a practice run. 

If your child is starting at a new school, take the time to do a dry run of the morning commute. On one of the mornings they’re waking up early, be sure to get them dressed and out the door on time, too. Practice walking or driving to school — whatever your normal commute will entail. If your child is taking a bus to school for the first time, drive along the bus’s route and answer any questions they might have about what school buses are like.

Eat at a cafeteria. 

Is this the first time your child will be eating a hot lunch at school? Go to a cafeteria-style restaurant to help them practice holding a tray, waiting in line, selecting from multiple options and sitting at a bench-style table. Even if you’re planning to pack a bag lunch, it’s doesn’t hurt to get your child used to a cafeteria-like environment.

Visit the library.

It’s time to do a little back-to-school reading! There are plenty of great children’s stories that address back-to-school anxiety. A few worth checking out are First Day Jitters by Julie Dannenberg; The Night Before Kindergarten and The Night Before First Grade, both by Natasha Wing; The Kissing Hand, by Audrey Penn; and Miss Bindergarten Gets Ready for Kindergarten, by Joseph Slate. Talk to your librarian to see if they have any other recommendations as well.

Take care of the details.

Pay attention to little things that will help make the first week of school smooth sailing. Have them pick out some new clothes and a new backpack for the first few days of school so there are no morning wardrobe meltdowns. If they’re bringing their lunch, plan out a few of their favorite meals ahead of time. Create a morning “launch pad” for backpacks and coats. These may seem like little things, but they can add up to a lot of stress for a child, and they’re easy to prepare for in advance.

Listen to them.

Keep those lines of communication open! Ask you’re child if they’re excited for school, what subject they’re looking forward to most and what friends they’re excited to see. If they’re experiencing social anxiety this is a good time to start talking it out and reassuring them. Being understanding and supportive is the most important thing you can do to ensure your little one has a great back-to-school experience.

"Mommy, My Tummy Hurts": Anxiety and Kids

by Jan Estrellado, M.A.

No one wants to think about children struggling with anxiety.  However, anxiety disorders are the most common psychiatric disorder in teens and tend to start around the age of 6 (Merikangas et al., 2010). 

Image source:  http://www.indusladies.com/parenting/10-tips-to-help-your-child-overcome-her-pre-examination-stress/

What does anxiety look like in children and adolescents?  Does it differ from adults?  To find out these answers, one can look to the research and to mental health clinicians with experience in these areas.  

How Common is Anxiety in Kids?

Anxiety disorders are the most common psychiatric disorder of 13 to 18 year olds (40.2%; Merikangas et al., 2010).  Of the teens with anxiety disorders, 8.3% are severely impaired by their anxiety disorder.  However, 80% of kids with an anxiety disorder do not receive treatment.  Interestingly, kids tend to develop anxiety disorders at the age of 6 (versus age 11 for ADHD and age 13 for mood disorders, like depression).  

Why might it be that the most common psychiatric disorder in young people goes largely untreated?  One reason may be that parents, caregivers, and teachers may not know some common signs of anxiety in kids.

What Does Anxiety Look Like in Kids?

All kids feel anxious at one time or another, as stress is a normal part of life.  In addition, many kids with shy personalities may tend to feel more nervous in general than their peers.  So how does a parent know when their child’s anxiety becomes a problem?

When stress starts to get in the way of life’s activities, like withdrawing from friends, avoiding school, having trouble sleeping, experiencing difficulty being away from parents, or lashing out at loved ones, then unmanaged stress can damage the child or teen’s physical and mental health.  Kids who suffer from anxiety tend to see their fears as catastrophic (Miller, 2012), which can be puzzling and confusing to some parents.  Children may get extremely upset when parents or caregivers prepare to leave and may cling very tightly to their parents.  

Anxiety in children may look different than in adults because kids may lack skills to express their fears and stressors.  They may experience symptoms that take place in the body, also known as somatic symptoms.  In young children with anxiety disorders, the most common somatic symptoms are restlessness (74%), stomachaches (70%), blushing (51%), palpitations (48%), muscle tension (45%), sweating (45%), and trembling/shaking (43%) (Ginsburg, Riddle, & Davies, 2006).  Children who experience these somatic symptoms are more likely to have severe anxiety and higher levels of impairment.

What can parents and caregivers do?

Image source: http://www.intentionallife.me/slowmotion/

Parents often know if their child is facing high levels of anxiety because they observe the child to be more anxious than his or her peers (Miller, 2012).  In addition, the child’s anxiety gets in the way of everyday functioning, such as school, sleepovers, and swim class. Parents, teachers, and significant caregivers play important roles in a child’s ability to manage anxiety successfully.

“The best advice I have for parents is to remain calm and focus on self-care. ”

— Dr. Starr MacKinnon, CSAM psychologist

Parents whose children present with these symptoms may feel their child is being manipulative or lying in order to get out of school or other activities.  Learning more about your child’s fears, what management strategies you can teach your child, and how you can be supportive are successful keys to helping kids overcome their anxiety.  CSAM’s own child/teen specialist, Dr. Starr MacKinnon shares that it’s important for parents to take care of themselves: “The best advice I have for parents is to remain calm and focus on self-care. The truth is, your children will predominantly learn from the model you provide them and are less impacted by your words.  Children and adolescents are sponges and they will often grow up and engage in the same self-talk, behaviors, and coping that you do. So the more that you can take care of yourself and be the person you want your children to be, the better it will be for all of you.”

There are additional strategies parents and caregivers can use when helping kids cope with anxiety (Miller, 2012):

• Explain to the child that his or her feelings of worry or dread are caused by a condition called anxiety.
• Help the child notice the connection between anxiety and shallow, rapid breathing. Teach the child how to breathe slowly and into the belly.
• Encourage the child to replace anxious “red light” thoughts (“that dog will bite me”) with more helpful and realistic “green light” thoughts (“most dogs don’t bite kids”).”

Another way that Miller encourages parents to support children is through gradual learning and patience.  If a child has intense fears about making a speech in front of his or her class, consider having the child read it in front of one parent first, then the family, followed by a few close friends, and so on, until the child feels confident enough to speak in front of a larger group.

If a child’s anxiety symptoms persist despite their caregivers’ best efforts, seeking professional help is recommended.  Mental health professionals who specialize in anxiety treatment with kids can help train the children to develop coping strategies to manage anxiety, but can also coach caregivers to reinforce these strategies while the child is in school and at home.  

Help is Here!

Parents and caregivers are the most important factor influencing whether kids develop effective coping skills to manage anxiety.  The Center for Stress and Anxiety Management is here to help.  Starr MacKinnon, PhD, is a licensed psychologist with a specialty interest in working with children and teens with anxiety disorders.  Dr. MacKinnon shared what she enjoys about working with kids and teens: “I love working with children and teens because often they are more flexible and open to self-exploration and growth…I love helping kids and adolescents to gain insight into who they want to become so that the barriers to living that life can be addressed."

Click here to speak with Dr. MacKinnon or another professional at the Center for Stress and Anxiety Management.  

References:

Ginsburg, G. S., Riddle, M. A., & Davies, M. (2006). Somatic Symptoms in Children and Adolescents With Anxiety Disorders. Journal Of The American Academy Of Child & Adolescent Psychiatry, 45(10), 1179-1187. doi:10.1097/01.chi.0000231974.43966.6e

Merikangas, K. R., He, J., Burstein, M., Swanson, S. A., Avenevoli, S., Cui, L., & ... Swendsen, J. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the National Comorbidity Survey Replication-Adolescent Supplement (NCS-A). Journal Of The American Academy Of Child & Adolescent Psychiatry, 49(10), 980-989. doi:10.1016/j.jaac.2010.05.017

Miller, L. (2012).  Early screening for anxiety disorders in children helps prevent mental health concerns: UBC study [Press release].  Retrieved from http://news.ubc.ca/2012/04/16/early-screening-for-anxiety-disorders-in-children-helps-prevent-mental-health-concerns-ubc-study/

Anxiety in Children

Have you noticed that your child seems to be experiencing a significant amount of anxiety? Learn more about the anxiety disorders that can develop at a young age and the support that is available. If you would like to seek the help of a professional, contact us to schedule an appointment with our child anxiety specialist now.

Childhood Anxiety Disorders

Generalized Anxiety Disorder

Learn more about GAD.

Things to look out for:

·      Excessive worry about a variety of things in your child’s life

·      Perfectionism and self-criticism

·      Constant need for approval or reassurance

Obsessive-Compulsive Disorder (OCD)

Learn more about OCD.

Things to look out for:

·      Obsessions: Experiencing unwanted and intrusive thoughts

·      Compulsions: Repeatedly perform rituals and/or routines in order to ward off anxious feelings

Panic Disorder

Learn more about panic disorder and panic attacks.

Things to look out for:

·      Panic/anxiety attacks that come on for no reason or out of the blue

·      If your child is concerned about or afraid of having another panic attack in the future

Posttraumatic Stress Disorder (PTSD)

Learn more about PTSD.

Things to look out for:

·      Experiencing or witnessing a traumatic or life-threatening event

·      Intense fear/anxiety

·      Emotional numbness

·      Easily irritable

·      Avoidance of places, people or activities

Separation Anxiety Disorder

Learn more about separation anxiety disorder here.

Things to look out for:

·      Your child is slightly older (common in ages seven to nine)

·      Unable to be separated from loved ones or takes significantly longer to calm down compared to other children

·      Experiences extreme homesickness/misery at being separated from loved ones

Social Anxiety Disorder

Learn more about social anxiety disorder.

Things to look out for:

·      Intense fear or anxiety related to social interactions

·      Anxiety about performance and activities

·      Extreme shyness or inhibition

·      Difficulty making new friends or speaking with peers

Selective Mutism

Visit online: Selective Mutism Group

Things to look out for:

·      Refusing to speak in situations that make your child anxious

·      Standing motionless/expressionless

·      Avoiding eye contact, chewing/twirling hair, turning heads

Specific Phobias

Learn more about phobias.

Things to look out for:

·      Intense irrational fear of a specific object or situation (such as animals, storms, blood, needles, medical procedures, etc.)

Treatments Offered at CSAM

Cognitive Behavioral Therapy (CBT)

Cognitive Behavioral Therapy (CBT) is an empirically supported treatment that focuses on modifying problematic thoughts & behaviors that contribute to & maintain emotional problems like anxiety, stress, & depression. Like traditional forms of therapy, CBT emphasizes a warm, safe, & empathic therapeutic environment. CBT is different from some approaches in that it focuses on present-day problems & learning skills to overcome symptoms. It teaches children to identify thoughts & behaviors that are keeping your child stuck, so your child may develop more adaptive ways for navigating life.

Acceptance and Commitment Therapy (ACT)

Acceptance and commitment therapy is an empirically supported treatment that focuses on reducing experiential avoidance and accepting internal experiences (thoughts and feelings) in the service of living a valued, vital, meaningful existence.  Mindfulness, metaphors, and experiential exercises play a central role in ACT.

Biofeedback

Biofeedback is an empirically supported treatment that focuses on balancing the nervous system. Biofeedback is shown to be extremely effective at helping patients reduce anxiety and stress, lower blood pressure, reduce chronic pain (including migraines), increase focus and attention, and reduce hyper-vigilance commonly experienced after trauma.

How Can I Respond to My Child?

ADAA provides the following suggestions in their article “Tips for Parents and Caregivers”

Source: http://www.adaa.org/living-with-anxiety/children/tips-parents-and-caregivers

Here are things you can do at home to help your child manage his or her anxiety disorder:

Pay attention to your child’s feelings.

Stay calm when your child becomes anxious about a situation or event.

Recognize and praise small accomplishments.

Don’t punish mistakes or lack of progress.

Be flexible and try to maintain a normal routine.

Modify expectations during stressful periods.

Plan for transitions (For example, allow extra time in the morning if getting to school is difficult).

Keep in mind that your child’s anxiety disorder diagnosis is not a sign of poor parenting. It may add stress to family life, however. It is helpful to build a support network of relatives and friends

Resources:

The Anxiety and Depression Association of America, ADAA

www.ADAA.org

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Are you interested in scheduling an appointment with our child specialist? If you'd like to speak with a professional at the Center for Stress and Anxiety Management for help with anxiety, please click here.

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