Back-to-school anxiety: how much is too much?

Many children experience some degree of “back-to-school anxiety” as the school year begins. Typical stressors may include worries about making new friends, managing new or difficult teachers, increased academic workload, or being away from parents, or transitional issues, such as starting at a new school or moving into middle or high school. Whereas some school-related anxiety is normal, excessive anxiety and worry can negatively affect a child’s functioning at school, as well as with peers and at home.

In general, the sources of school-related anxiety vary on the basis of the age and developmental level of a child. Younger children often experience anxiety about separating from parents or being away from home. A common worry might be, “What if something bad happens to me while I am at school and away from my parents?”

Some children and adolescents may struggle with schoolwork owing to undiagnosed learning disabilities. As a result, these kids develop anxiety regarding academic performance.

Adolescents transitioning to middle or high school may worry about being in a new school environment and coping with increased school and homework demands. Common worries might include, “What if my new teacher is mean?” or “What if I can’t understand the new schoolwork?”

Adolescents may also worry about social acceptance and making friends. Such concerns as “Will any of my friends be in my class?” “Will I look stupid in front of my peers?” or “Who will I sit with at lunch?” are common. Often, these adolescents feel intensely scrutinized and worry that they are embarrassing themselves. Even college students moving away from home for the first time may experience increased homesickness and fears about being independent.

Overall, the most common diagnoses for youth with school-avoidance behaviours include separation anxiety disorder (22s4%), generalised anxiety disorder (10,5%), oppositional defiant disorder (8,4%), depression (4,9%), specific phobia (4,2%), social anxiety disorder (3,5%) and conduct disorder (2,8%).

Tell-tale signs of school-related anxiety
Children and adolescents with school-related anxiety usually exhibit a range of behaviours that may indicate excessive fear of school. Young children, especially pre-schoolers, frequently talk about their fear of school and may ask for repeated reassurance from parents: “Can you stay at school with me?” or “Do I have to go?”

Most children will occasionally complain about attending school, but daily complaints, or a child resisting getting out of bed or getting ready for school, may suggest high levels of fear. Some children may manifest physical symptoms of anxiety, such as headaches or stomach-aches.

Children may even vomit in the morning in anticipation of going to school. Additional symptoms of school-related anxiety include excessive clinginess with parents, difficulty sleeping, or fear of sleeping alone.

By Samantha Morrison, PhD and Anthony C. Puliafico, PhD for www.medscape.com

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