DEALING WITH SCHOOL ANXIETY

"I don't want to go to school!" It's an age-old complaint from children. But a growing body of research suggests that this protest can signal a deeper problem: school anxiety. Recent studies show that anxiety disorders are one of the most common psychiatric conditions among kids, with as many as 10% suffering from them and requiring medical treatment. No studies have been conducted on how common school anxiety is, but some experts believe it's on the rise among younger kids, including preschoolers.

"Our society is expecting more and more from our kids at younger ages," says Sucheta Connolly, M.D., a child psychiatrist and director of the Pediatric Stress and Anxiety Disorders Clinic at the University of Illinois in Chicago, which treats children as young as 2. "And not all of them can handle it." But how do you know whether your child's protests are a ploy to avoid an uncomfortable situation or a genuine cry for help? In an interview with Child, Dr. Connolly explained how to tell the difference and outlined what parents can do to ease every child's entry into school.

Q: Why do you think school anxiety is becoming more common? A: To be sure, the war and September 11 made some children temporarily anxious about leaving their family. But there have also been cultural changes. In past generations, kids weren't expected to separate from their parents all day until they were in first grade. Now many toddlers are taking that step in daycare, but some aren't ready for it. I know this is difficult for parents because often they both must work to meet the needs of their family.

Also, though, schools expect more of children. In some school districts, a child's ability to move from one grade to the next is tied to a lengthy, timed test. Today, many fourth-graders are given two hours of homework a night, and without direct input on how to pace themselves and study, some kids struggle. Before long, they're complaining they're sick and saying they don't want to go to school.

Back to School: Handling Worries

Some children we see have undiagnosed learning disabilities; they've had difficulty with a certain subject, but the teachers may not be aware of their problems or think that the students aren't applying themselves. As a result, these kids develop anxieties around school.

Q: Lots of children resist going to school. So how can parents recognize true anxiety? A: Usually, kids who have school anxiety will show a range of stress- or anxiety-related symptoms. Young kids, especially preschoolers, frequently talk about their fear of school and may ask for repeated reassurance from parents: "Can you stay at school with me?" "Do I have to go?" Often they'll complain about stomachaches or headaches or become unusually clingy. Many children suddenly have difficulty sleeping and may begin asking to sleep with their parents. Some also develop school refusal or phobia -- a fear so intense that the children can't be coaxed onto the school bus or into the building. If they manage to get to school, they cry, complain of aches and pains, and can't be calmed down by the teacher. These kids aren't just being oppositional; they're trying to avoid a situation that makes them scared.

Also key: Children with school anxiety struggle with it every day of school. It's not something they have one day but not the next.

Q: What can parents do at the beginning of the school year to help their children avoid developing school anxiety? A: If your daughter is going into preschool, take her on a tour a few days or weeks before school starts. (She likely won't remember a visit that occurred months ago, and you also risk making her anxious if you start talking about school so far in advance.) If she's a kindergartner or older, tour during the summer. Also, talk to your child about what the routines will be at school. If she tends to have trouble with new social situations, arrange for playdates with some new classmates before school begins. If she's too young for drop-off playdates, step into the other room for a few minutes while the kids are playing. You want to put her in a situation that makes her just a little anxious so she can see that she can handle it.

With preschoolers, you can role-play at home. Many children are cognitively ready for school but struggle with how to assert themselves socially. Using puppets, dolls, or stuffed animals, act out social situations that make them anxious, such as meeting the teacher for the first time.

If you think the transition might be hard for your child, talk to the principal during the spring before school starts; you may be able to choose a teacher who is a good match for your child. Then check in with the teacher throughout the school year. Let her know what she can do to help your child relax at school.

School Anxiety

Q: How should parents handle it when their child says he's sick and wants to stay home? A: Always have recurrent physical symptoms checked out by a pediatrician to rule out medical problems. But assuming kids are physically healthy, parents need to be firm about not allowing them to miss school. Just as it's our job to work and raise our family, it's part of a child's job to go to school.

So tell your child that it's normal to feel a little scared in new situations. But nervousness doesn't mean he should stay home or that he won't enjoy himself. Remind him of new situations he's dealt with, such as sleeping at Grandma's house for the first time without you. Stress that although it was difficult at first, later he was glad he did it.

Finally, rule out problems at school or at home. Ask your child and his teacher if something upsetting happened, such as bullying or teasing -- both are very common causes of school anxiety. Or has there been a change at home -- a move, a divorce, or even the death of a family pet -- that is distressing him? He may need to talk through his concerns with you.

Q: What about preschoolers? If your child cries every day, should you make her stick it out? A: It's normal for preschoolers to have some separation anxiety at first, but it should subside after a few weeks if you've tried all the strategies we've discussed. If it doesn't, ask the teacher whether your child is showing age-appropriate behavior. It may be that your 3-year-old's language isn't developed enough yet. Or she might have a speech or language disorder that prevents her from communicating well and following rules. In such cases, it may help your child to remove her from school and wait until next year.

Q: Do parents ever trigger school anxiety? A: Sometimes I see parents who rely too much on their kids emotionally. One mother of a third-grade boy I was treating, for instance, had been mistreated as a child, and so, when she needed comforting she leaned on her son. He didn't want to separate from his mom because he felt she needed him and he worried about her.

Often, if parents have a child who is shy or was emotionally needy as a baby, they see him as vulnerable and they become overprotective. I had one patient whose parents picked her up from preschool whenever she showed any distress. When the parents had adopted her as an infant from an abusive home, she'd had lots of emotional struggles and needed them to dote on her. They were still treating her that way although she was now a preschooler who needed to learn independence.

School Anxiety

It's okay to reward children for taking positive steps toward independence. For example, put a sticker on your son's chart every day he attends school without tears or clinging, and when he earns a certain number of stickers, take him on a special outing.

Q: When should a child get professional help? A: If for several weeks you've tried everything we've discussed and the anxiety interferes with your child's enjoyment of other areas of her life -- she's having difficulty sleeping regularly, is isolating herself, or is always worried or sad, for instance -- then it's time to have her evaluated by a mental health professional. School anxiety is not a psychiatric diagnosis. But when the condition is severe, it may be a symptom of an anxiety disorder.

We commonly see separation anxiety disorders, for example, which occur when a child has difficulty being away from those who are closest to him. A child with a social phobia, also common, fears social situations. Often these kids feel intensely scrutinized and worry that they'll do something embarrassing. Some are fearful of speaking in front of the class, while others have trouble even walking up to the blackboard. And many kids have generalized anxiety: chronic, excessive worrying about a range of subjects. These kids are often perfectionists, so their struggles may be internal. After a while, though, many kids with anxiety disorders try to avoid school because that's where they feel most overwhelmed. When anxiety is untreated, it can lead to depression.

For kids with mild to moderate anxiety symptoms, treatment usually begins with cognitive behavioral therapy, which teaches relaxation and coping skills to reduce anxiety and can result in improved behavior over several months. If symptoms are severe, doctors may prescribe medication, which can produce some results within two months.

Whether you consult a social worker, a psychologist, or a psychiatrist, choose someone who specializes in working with kids your child's age. And be sure that this expert, your child's teacher, and you work together as a team. Finally, remember that kids see their friends attending school; they want to be able to do that too. Some just need extra help to overcome their fears.