School Anxiety: Identification & Support

This week's blog was contributed by Jeremy Sharp, PhD, licensed psychologist and clinical director at the Colorado Center for Assessment & Counseling and the host of the Testing Psychologist Podcast. Dr. Sharp earned his undergraduate degree in experimental psychology from the University of South Carolina and earned his master's degree and doctorate in counseling psychology from Colorado State University. He specializes in psychological and neuropsychological evaluation of children and adolescents and provides private practice consulting for psychologists and other mental health professionals who want to start or grow psychological testing services in their practices. He lives in Fort Collins, Colorado with his wife (also a therapist) and two kids.

Upon returning to school in fall 2021, my 8-year-old daughter started showing signs of separation anxiety almost immediately. She would not go into the classroom on her own and developed a compulsive habit of checking the weather before school each day to see if it was going to rain. Over the course of a couple of weeks, we spent hours on the playground before (and during) school, attempting to cajole her into feeling safe. We eventually enlisted the help of the fantastic school psychologist who helped our daughter get over her fears and go in on her own within another two to three weeks.

Though her separation anxiety seemed to come out of nowhere, hindsight would say otherwise. The biggest clue was that she started a new, much bigger school this year. She was also having trouble making friends, which was different for her. The final piece of the puzzle was learning that a classmate had shared information about a flood warning with my daughter, and she became scared that there might be a flood while she was at school—hence the checking of the weather every morning.

Related post: Jeremy Sharp on Trauma-Informed Assessment

My daughter is not alone. Depending on what you read, estimates on prevalence of anxiety disorders in kids ages 3–17 range from about 2% to more than 30%, with a recent meta-analysis settling on about 7%. That's two kids in your average classroom who are experiencing clinical anxiety, with even more who have subthreshold anxiety.

There are many reasons that kids might feel anxious at school, but let's break it down into three areas for the sake of simplicity. Those areas are:

• Separation from caregivers
• Social interaction
• Academic demands

Separation anxiety is the most common form of anxiety in kids under 12. The core theme of separation anxiety is excessive distress when separated from or thinking about separating from a primary attachment figure or caregiver. At school, this looks like unwillingness to get out of the car, clinging to a parent's leg, not leaving the caregiver to go into the classroom, and other similar situations. As in my daughter's case, it can also show up as a fear of an event that would cause separation from the primary attachment figure. Separation anxiety often ramps up after breaks, like when returning to school after the holidays or summer vacation. Even a typical Monday can increase anxiety, as kids have gotten used to being with caregivers over the weekend.

Social interaction is another area of potential distress in kids. The clinical diagnosis of social anxiety disorder is estimated to occur in about 9% of adolescents (ages 13–18 years). Social anxiety is characterized by the fear of being judged by others paired with avoidance of certain situations that cause anxiety. An example is eating lunch alone due to a fear of saying something dumb while sitting with peers.

Lastly, academic demands can lead to anxiety in kids. Research suggests that around 20% of students experience test anxiety overall, though it differs depending on several demographic factors. For instance, female-identifying students and ethnic minority students are more likely to experience test anxiety. Regarding personality factors, there is a consistent negative relationship between self-esteem/self-concept and test anxiety. Students with disabilities (i.e., ADHD) are more likely to experience test anxiety than students without an identified disability. Additionally, test anxiety's negative impact on performance is highest in middle school and decreases in high school. It's important to note that text anxiety is not the only form of performance anxiety in school, however. Some students feel a variation of social anxiety or fear of being called on in class as well.

This information confirms what we already intuitively know: as front line workers in pediatric mental health, school staff plays a very important role in kids' social and emotional wellbeing. Indeed, the research is clear that kids learn better when they also have skills to manage their emotions. But it's not always easy to know which students need help! Anxiety is an internalizing disorder, meaning that kids tend to feel it in their minds or bodies without necessarily expressing it overtly to others. What we do know is that kids from lower income homes and ethnic minority kids are at greater risk of flying under the radar and not receiving the support that other kids get. We also know that school is a great place to implement interventions given that so many barriers to accessing treatment are removed when kids are already there.

So, what school-based interventions actually work? A recent meta-analysis of prevention programs showed that cognitive-behavioral strategies make up the vast majority of interventions in the academic environment. The effect sizes across all forms of intervention were small but statistically significant, indicating that prevention programs are certainly helpful in addressing anxiety. The study looked deeper into whether the type of program (universal vs. targeted) made a difference and found that it did not. Similarly, it didn't matter whether school staff (i.e., teachers, school counselors) or an external mental health professional delivered the intervention. The research suggests, however, that intervention be delivered as early as possible, in a preventative context, given the relatively early age of onset of anxiety.

To summarize, a substantial minority of kids will experience some form of anxiety at school before finishing high school, but there are ways to help. School counselors and teachers are in a great place to do so. Being mindful of anxiety as an internalizing disorder and paying attention to kids who tend to fly under the radar are excellent places to start. Knowing the different types of anxiety and the places they show up are valuable as well. On a broader scale, prevention programs are helpful and effective, especially when delivered earlier rather than later.

Catch up with the Testing Psychologist podcast on their website, via Apple Podcasts, Google Podcasts, or on Spotify.

Related: School resources to help you address trauma, anxiety, and more.