Wheeler's Special Education Spotlight: Understanding Anxiety in Students

Michael Russo, Psy.D. (email)
Vice President of Education and Early Childhood Services

October 2017

The start of each school year brings excitement and anticipation for many students, but students who struggle with anxiety may find this time of year particularly stressful and overwhelming. Anxiety is a common and typical reaction to stress. However, for some students, anxiety can be consuming, very difficult to control and may negatively impact their functioning at school.

The National Institute of Mental Health (NIMH) estimates that by the time children reach adolescence, approximately 25 percent experience anxiety and five to six percent experience it at a serious level. Symptoms of anxiety can manifest in many ways: physical complaints, cognitive distortion or confusion, emotional instability, and behavioral dysregulation. Depending on the type of anxiety disorder experienced, symptoms may include persistent worries, specific fears, nervousness, extreme avoidance, and/or physical distress.

In the classroom, students who experience anxiety may appear inattentive or restless, have difficulty answering questions, demonstrate disruptive behavior, have a need for control, make frequent trips to the nurse’s office, avoid socializing with other students, avoid test-taking, miss assignment deadlines, and/or miss school altogether. It is not unusual for many of these behaviors to be misinterpreted as oppositionality, disinterest, or lack of preparedness.

From a mental health perspective, the Diagnostic and Statistical Manual 5th edition (DSM-5) specifies that there are a wide variety of anxiety-based disorders, including:

• Separation Anxiety Disorder: fearful or anxious about separation from parent(s), siblings or others one is close to due to concerns about harm coming to those they care about or even loss of that individual
• Selective Mutism: refusal to speak in social situations in which one is expected to speak (i.e., school, work, home, etc.)
• Specific Phobia: intense fears (often disproportionate) about certain animals, objects or situations that are distressing or intrusive, which may lead to avoidance (e.g., spiders, snakes, needles, heights, open spaces, small crowded spaces, germs, public speaking, flying in airplanes, etc.)
• Social Anxiety Disorder (a.k.a. Social Phobia): fear and/or avoidance of social situations in which one may feel scrutinized, embarrassed or judged
• Panic Disorder: recurrent sudden panic attacks that include symptoms such as sweating, trembling, shortness of breath, a pounding heart or rapid heart rate, and/or feelings of dread
• Generalized Anxiety Disorder: persistent worry or anxious feelings about a variety of concerns, such as family circumstances, health problems, changes in life circumstances, or a general sense that something bad is going to happen to oneself or someone close
• Substance/Medication-Induced Anxiety Disorder: may result from the use of medication or other illicit substances (i.e., alcohol, cocaine, marijuana, caffeine, inhalants, opioids), as well as from withdrawal from these substances

It is important to note that cultural factors may impact behaviors that are viewed as anxiety related. For example, some cultures value minimizing separation between parents and children, and language proficiency may impact a child’s willingness to speak in class. Religious or cultural beliefs may also influence certain fears. It is critical to maintain open communication with students and their parents/guardians and discuss how these beliefs or experiences may be impacting their functioning both in and out of school.

In school, anxiety in children and adolescents is often an underlying cause of chronic absenteeism, work avoidance and educational disengagement. Students who struggle with anxiety in school settings may be responding to issues at home, school or community, including concerns regarding bullying (in person and though social media). It is essential that students who experience anxiety receive support and intervention.

When a student’s anxiety begins to impact their functioning in school, it is important to develop a clear plan with the student, his or her parent/guardian and any involved community providers. Informing school personnel who work with student of the student’s plan will be key to ensure that all can be supportive when an issue arises. Depending on the basis for the student’s anxiety, the plan may include:

• Teaching the student how to use anxiety-reducing skills such as:
  
  • verbalizing how they are feeling and what they are experiencing
  • journaling or writing down their worries or concerns that are leading them to feel anxious
  • using progressive muscle relaxation exercises
  • using deep breathing exercises
  • taking a walk or using another form of physical exercise
  • listening to music
  • drawing or coloring
  • utilizing a variety of clinically-based cognitive strategies
• Providing the student with a mutually agreed upon quiet, non-stimulating space to go to within the building when needed
• Collaborating with community providers
• Having the student go to a trusted staff who the student identifies as soothing or calming
• Arranging for early or delayed transitions at the start or end of the school day, as well as between classes
• Making home visits if absenteeism is an issue
• Providing regular feedback to the student, their parent(s)/guardian(s) and any involved community providers

Intervening early and quickly can prevent symptoms from progressing but, when left untreated, anxiety disorders will likely persist and may intensify. If you believe you have a student who is struggling to cope with anxiety, it may be important for that student to receive an assessment by a trained mental health professional and determine the best course of treatment. There are several approaches that have proven effective in treating anxiety disorders, including:

• Stress reduction techniques such as meditation, yoga, physical exercise and other types of relaxation techniques, as well as maintaining good sleep habits
• Maintaining a healthy diet by limiting or avoiding high-sugar, caffeinated, and processed foods and drinks
• Therapy with a trained clinician (Cognitive Behavioral Therapy has been found to be particularly effective)
• Medication prescribed by a primary care physician, psychiatrist or psychiatric APRN

If you have concerns about a student who is struggling with anxiety and you have questions about how best to help, please contact us at Wheeler at 860.793.3717. We will be happy to be of assistance.