Mental Health

Anxiety And School

Delaney Ruston, MD
April 27, 2021
Boy with backpack walking in covid
I tell my kids when they hit rough roads, “All of this is so hard —  I love you, and I want you to continue to know that I am here for you always. I am not going anywhere.” 

These are tough times for lots of kids and teens, and high on the list is anxiety concerning school. 

You might be dealing with a teen opting to continue to do remote learning because of anxious feelings. These feelings may be from social anxiety that existed before but accelerated during Covid or perhaps anxiety around possible virus transmission. I just heard about a situation where a school called a mom to say that her 9-year-old was so worried about the possibility of getting her parents ill and that she needed to get picked up from school. 

To help kids and teens, here are some ideas from me and two incredible psychologists that I recently interviewed for an upcoming Screenagers Podcast episode.

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For children:

Elizabeth Englander, Ph.D., has spent years researching kids and teens, and she has a new book out titled, The Insanely Awesome POST Pandemic Playbook: A Humorous Mental Health Guide For Kids. 

One of the key points in the book is the importance of talking about “mixed emotions.” Normalizing the fact that it is normal to be both happy that things are opening up while also being worried.

I love the analogy the book uses to explore this. England prompts readers to recall a time they went into icy cold water, and they wanted to jump out, but you stayed in, and over time, they got used to it. It became comfortable, so much so, they didn’t want to leave it (i.e., home), but at some point, they had to, and there was a new adjustment period.

Another critical point of the book is the idea of anticipation and not just waiting for kids to say what they may be concerned about but to offer ideas. Some kids can easily discuss what they are anticipating, while others have a harder time. Throwing out ideas can help. You might ask something like, “I wonder if any of these things are passing through your mind: Which friends will you sit with at lunch? Maybe something about what people will be wearing?”

For a child, like the one who has had to go home because of her intense worry, it is the perfect time to create a support network. Is there a teacher who the child can go to when they get to school to do a quick check-in? Perhaps a current teacher, but maybe a former one, or another administrator or educator that the student knows?

If the school has a nurse, consider going to see them along with your child. At that time, everyone can create a plan of how the student can go to the nurse’s office if they need to and do something like deep breathing or coloring. 

Of course, if a child’s anxiety is overall causing ongoing suffering, seeing a counselor or therapist can be incredibly helpful. Anxiety is very treatable. It takes time, but major progress can happen.

For Teens:

When I talk to teens about mild anxiety, I find teaching them the idea of “reframing” is very helpful. I let them know that sometimes to think of anxious feelings as an asset rather than a detriment, those feelings are their bodies’ way of helping them get focused. 

An interesting research study put college students in two groups before going to give a presentation. They were all told that peers would see their presentations eventually — this was done to make sure they would feel that much more nervous. One of the groups was directed to repeat to themselves “I'm calm” before giving their presentation, while the other group was prompted to repeat “I'm excited.” The people rating the talks didn’t know what each presenter was told to do. The researchers found that if a person said, “I am excited,” they were more likely to be given a higher rating of their presentation and feel good about their performance. 

When I am in clinic taking care of teens with anxiety, and I know it is serious when they are avoiding things in their life, such as school, I tell them we need to sort out new ways of tackling the situation. I say, “If it were so easy, you would have already done it.” I go on to talk about how miserable, anxious feelings are. My patients’ eyes always light up when I say all of the above because they see how I really understand how intensely uncomfortable anxiety can be.

Parents can do this, too, by validating what their child or teen is feeling. 

Laura Kastner Ph.D. says she wants every parent of teens to know how key validation is. She says, “Of course, the parent wants to reassure, but a better thing to do is to validate that they're worried. You don't agree with them when they say something like,  ‘I don't have friends.’  But, instead, say something like, “Hun, I can relate; it feels awful not to feel close to anyone.”

Brainstorming with teens

It is always the best situation when our teens develop their own strategies around dealing with their anxious feelings. Yet sometimes they will get stuck, and brainstorming with them can help. Here are some questions Laura suggests you might toss into such a session,  

“Do you want to go visit the school? Do you want to go with a friend in the morning? This is one of those times that you should maybe email the teacher? Or do you want to talk to a couple of friends? Do you want to arrange for an after school thing, just to sort of, you know, have a detox after the day? Do you think you should consult another friend on that? Do you think you should write down five options that you can sleep on?”

Laura works with her teens to create a “Toolbox” of healthy coping strategies for anxious feelings. Paced breathing is one she makes sure her patients have in there. Here is how it might work--breathing in for 3 seconds, hold for 3 seconds, and out for 6 seconds. The magic is the long exhale because research has shown that this activates the parasympathetic nervous system, which I call the “soothing system.” I have many more tools for helping with anxiety on our Screenagers Movie resource page.

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Finally, when kids and teens have opted to stay home, yet their parents believe that going back to school would be better, getting outside input can be so valuable and, at times, truly a necessity. I say this because tensions can get so high in the home over this situation, which might lead to greater adversity to the child than whether they go to school or not. 

Ideas for getting the discussion going

1. As a parent, can you talk with your kid about what you have in your Toolbox when it comes to coping with anxious feelings?
2. What ideas does your child have about what they could have in their Toolbox?
3. As a family, can you do some paced breathing one night this week? Make it an experiment by taking everyone’s heart rate before doing paced breathing and then afterward. This is easiest to do by having everyone feel their radial pulse and count pulses for 15 seconds and then multiply by 4.
4. What paced breathing counts work best for each person? Try, 3 in, hold for 3, 6 out. Try 2,2,3. Try all sorts of variations.
5. When has anyone “reframed” feelings of anxiousness?

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Mental Health

Anxiety And School

Delaney Ruston, MD
April 27, 2021
Boy with backpack walking in covid
I tell my kids when they hit rough roads, “All of this is so hard —  I love you, and I want you to continue to know that I am here for you always. I am not going anywhere.” 

These are tough times for lots of kids and teens, and high on the list is anxiety concerning school. 

You might be dealing with a teen opting to continue to do remote learning because of anxious feelings. These feelings may be from social anxiety that existed before but accelerated during Covid or perhaps anxiety around possible virus transmission. I just heard about a situation where a school called a mom to say that her 9-year-old was so worried about the possibility of getting her parents ill and that she needed to get picked up from school. 

To help kids and teens, here are some ideas from me and two incredible psychologists that I recently interviewed for an upcoming Screenagers Podcast episode.

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