The Unwanted Visitor: Anxiety in the Classroom

Guest contributor Katherine Martinez, PsyD, is a registered psychologist specializing in cognitive-behavioral assessment and treatment of anxiety, mood, and childhood disorders. In the following post, Katherine graciously shares research findings and resources for anxiety among children and youth.


anxiety_educationThe lifetime prevalence of childhood anxiety is about 15 to 20%, although this estimate may be conservative, with rates perhaps closer to 20 to 25%. In comparison, consider the lifetime prevalence of asthma at approximately 10%; learning disabilities at about 10%; and, autism at around 1.5%. Despite the rates of childhood anxiety being greater than the rates of asthma, learning disabilities, and autism, combined, far less attention is given to anxiety in the classroom setting.

Anxiety in the classroom
In a typical elementary school of 500 children, anywhere from 75 to 125 kids will have an anxiety disorder. That means there are about five children in an average classroom of 30, struggling with significant anxiety. Yet very few rstandard1esources are given to support the needs of anxious youth in school. For example, many teachers are insufficiently educated about the signs of anxiety and often are unsure about what to look for in their students. Even when teachers are informed a student has an anxiety disorder, they often lack the supports to help those students. And sadly, some teachers do not believe that an anxiety disorder is deserving of classroom modifications. Earlier this year a teacher told me he did not think it was fair to the other students for him to give my client a test with reduced questions, simply because she had three anxiety disorders. His decision was made despite knowing that this student’s anxiety prevented her from studying for more than an hour a day, daily panic attacks, and severe insomnia. I wonder if he would have been more accommodating if these symptoms were due to a physical illness?

Out of sight, out of mind
Anxiety is an invisible disorder as the signs easily can be hidden. A teacher may have no idea a student is experiencing elevated heart and respiratory rate, nausea, and thoughts of impending doom –all signs of a panic attack. The only clue might be the student’s request to leave the classroom. Furthermore, many youth are ashamed of how they feel and believe being anxious makes them “bad” or “weak.” After all, the Number One goal in the teen years is to be “normal,” and having an anxiety disorder is perceived as anything but “normal.” As a result, students may try to hide their symptoms. Finally, because anxiety is a universal emotion, teachers may believe that students simply need to work harder and stress less to conquer anxiety. While this logic may work for occasional anxiety about minor matters, for students with discrete anxiety disorders the solutions are far from simple. So the big question is, what can we do to better help our anxious youth?

students-writingRecognizing anxiety in the classroom setting
The first step is learning how to identify the signs of anxiety in students. Younger children often struggle to provide a clear explanation for what they are feeling and why, and thus are more likely to report physical feelings of anxiety (e.g. stomach ache or headache), or display setbacks in skills they have previously mastered, such as bladder control or fluid reading. Older children and adolescents are often better able to describe their experience of anxiety, and may be quite sophisticated and self-aware about how and why anxiety affects them –if they are willing to open up. The following are some examples of how anxiety can present in youth:

Common physical examples include:
• Chest pain or choking sensation
• Stomach ache and/or nausea
• Dizziness or lightheadedness
• Feeling foggy, unreal, or detached from oneself
• Headaches
• Numbness or tingling
• Rapid heart rate
• Rapid breathing (hyperventilating) or feelings of shortness of breath
• Sweating, trembling or shaking

Common behavioural examples include:
• Difficulty raising a hand in class or reading out loud
• Excessive fear of making mistakes, or desire to be “perfect” in school
• Peer isolation or having few friends because of social fears
• Extreme fatigue, exhaustion, or falling asleep in class
• Unexplained changes in academic performance
• School refusal or skipping school
• Excessive washroom breaks

Common examples of thoughts include:
• I’ll fail my exam
• My Mom might forget to pick me up after school
• My teacher will yell at me and the kids will laugh
• I’m a complete failure and worthless
• What if I throw up at school?
• What if my Mom or Dad dies?

thEBSJDYSCBuilding support
Once parents, guardians, and teachers know what to look for, the next step is locating services. Schools may benefit from providing a psychoeducational assessment of the anxious student, and developing an Individualized Education Program based on the results. In addition, school counselors can provide counselling during school hours. Furthermore, schools can sponsor mental health training as a topic for professional developmental days. Alternatively, parents can speak with a family physician to learn about resources covered by provincial health care, as well as local therapists skilled in working with anxious youth. Finally, there are many quality self-help books, websites, and mental health apps for youth. Examples include:

The American Psychological Association’s Magination Press 
New Harbinger Publications

AnxietyBC
teenmentalhealth.org 
The Anxiety and Depression Association of America

The Mayo Clinic Anxiety Coach app
The AnxietyBC MindShift app
The Smiling Mind app

In conclusion, it is important to understand that anxiety doesn’t go away on its own. Left untreated, anxious youth become anxious adults. The Canadian economy loses approximately $6.4 billion in revenue because of mental health conditions in adults, of which anxiety ranks high on the list. We depend on educators to prepare our youth to be the leaders of tomorrow, so it is high time we start targeting mental health needs as a part of that preparation.


Katherine Martinez, PsyD, is a registered psychologist at the Vancouver Cognitive Behaviour Therapy Centre and co-author of the book, Your anxious mind: A teen’s guide to anxiety and panic (Magination Press, 2009). She is also a writer for AnxietyBC. Dr Martinez specializes in cognitive-behavioral assessment and treatment of anxiety, mood, and childhood disorders. In addition, she provides parent-effectiveness training to parents.

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