How to Help Your Anxious Child Return to School During a Pandemic

How to Help Your Anxious Child Return to School During a Pandemic

The days are growing shorter, and the leaves are gradually turning from brilliant greens, to the brown, orange and red that we readily associate with fall.

The seasonal changes are upon us, and as all parents of school aged kids, and all kids, know, the shorter days, and turning leaves, signals our return to school.

For the retail world, back to school, seems to start earlier and earlier. Staples recently started displaying their back to school supplies as soon as the old school year ended! By August, back to school bags, pens, pencils, and paper are stacked in huge piles in the isles of all the main grocery stores.

It as if the whole community is picking up steam and preparing to launch our offspring into the new school year – and perhaps push us back into the fast lane of our own careers.

We all have our own unique schedules and routines around going back to school. For some families there is a long weekend at the cottage, for others a family picnic, for some the hallmarks of the return to school are not as sweet, or as seamless.

For all, there is an anticipation of change, and of transition that is accompanied by a wide range of mixed emotions. As parents we may be breathing a sigh of relief, some even hum brightly anticipating the relief of a childfree house for a few hours a day. Other parents, may feel the dull ache of sadness that the summer has once again come to an end, some may notice their abdominal muscles tensing with a slight twist of pain, as they mentally revisit their concerns for themselves and their kids during this transition period – tears, tantrums, daily battle to get their child to school, to eat, to do homework.

Your parental responses may, or may not, mirror that of your child’s, though usually your emotional response to your child returning to school is in some way related to your child’s experience of going back to school. It is much easier to say goodbye to little Amy if Amy skips delightedly down the front path to the bus. Everything changes when little Ethan turns green and clings to your leg, whilst sitting staunchly on the kitchen floor and refusing to move.

All children will experience an emotional response to the beginning of the school year. But their emotional responses to school vary greatly. They may range from excitement, and joy to full blown acute anxiety, nightmares, crying, vomiting, and school-refusal. For some children their emotional responses may be mild and create small waves in the family pond, for others the child’s emotional response to school may represent more of a tsunami threatening the stability of the family unit.

These ‘tsunami’s’ can easily overwhelm the strongest of families, they set parent up against parent about the best way to parent their child. The trigger distress in the other children who are usually fairly easy going. The milk inevitably gets spilt, the toast burnt, someone yells, another cries, and the already anxious child beats a hasty retreat under their bed.

How Does a Pandemic Affect School Anxiety?

This year, 2020, we facing an unprecedented escalation in the return to school anxiety, with a multiplicity of uncertainties, unknowns, stressors, and fears. Should we let our kids return to school? If we don’t what will we do about work? Who will care for the kids? If we don’t work will we lose our jobs or not be able to pay our bills? Should we consider an education pod? Should we downsize and have a parent stay home? What are the schools doing to keep our kids safe? Is it enough?

There is so much that we don’t know about returning to school during a pandemic. There are so many unanswered questions. So many escalating worries and fears associated with this decision, and so many different expert opinions being expressed. It is no wonder that parents are left feeling overwhelmed and unsure about how to proceed.

Our kids will invariably pick up on some of that parental stress. It is extremely difficult for parents to keep all that emotion ‘hidden’, and to prevent kids from seeing and hearing what is going on. And kids know, they know about the virus, they know the word ‘pandemic’, and they hear the conversations in the house, on the news, and among their friends.

The usual build-up of anxiety that occurs at this time of year, is significantly escalated by the current pandemic.

Parents and kids who typically ride out the return to school with ease, may find that this is not too much of a challenge for them. They may do their due diligence, check that the school is safe, set up new protocols to ensure they minimize risk of contagion, and move forward towards going back to school with a certain amount of confidence, and ease – perhaps their hearts are beating a little faster inside, but few know it.

But for families who are already familiar with the heightened stress and distress that accompanies their return to school each fall, or for families starting school for the first time, things are not quite so easy-going.

If your child is already showing signs of distress, or expressing anxiety about going to school this fall, this transition period may be far more difficult.

Without doubt, the COVID 19 pandemic, will exacerbate your anxiety as parents separating from your child and leaving them at school, and your child’s anxiety about leaving you, and going back to school. The stakes are so much higher. The separation of parent and child is now accompanied by the risk of a significant illness and death.

That is where we can help.

But first here’s a little more information about the anxiety that you and your child are experiencing.

What is Separation Anxiety?

Separation anxiety is normal among pre-schoolers. It is developmentally normal for a young child to exhibit distress about being separated from their primary caregiver. Some children exhibit more distress than others, but some degree of distress about being dropped off at school for the first time, or going back to school for the first time is normal.

Knowing that this separation anxiety is normal and being able to successfully negotiate the transition is key to helping your child to develop the confidence they need to move away from you, and begin to develop their own independence and autonomy.

How to Cope with Separation Anxiety

(in addition: How to Treat Separation Anxiety Disorder)

  1. Kids take their emotional cues from you. If you become distressed when your child is anxious about going to school, the child’s anxiety will increase. When you are able to stay calm, reassure, and encourage your child that they will be okay, your child’s anxiety will come down.
  2. It can be beneficial to ask the parent/caregiver who is less involved in the child’s care to take the child to school. This will trigger less anxiety in the child, and in the parent, who is dropping the child off.
  3. Create routine and familiarity. Child thrives on routine. Have a routine for the night before school, and for the morning of. Create a big bright poster and ask your child to help you make a list of the tasks they need to do to get ready for school the night before, and what they need to do in the morning when they wake up. Praise the kids – stickers, dollar jar, extra story at night, cartoon with dad – anything little that creates connection between parent and child, and gives the child a sense of success.
  4. Be prepared to adjust your child’s routine to meet their needs. Anxious children (and adults) need more time. They need to know what is going to happen before it happens, and they need to have lots of extra time to move through the tasks assigned to them whether the night before, or the morning of going to school. You cannot rush an anxious child. It will almost certainly back fire, in tears and everyone arriving late and exhausted to work and school.
  5. Allow your child to do things their way. I have known several anxious children who sleep in their clothes to reduce their anxiety about being able to get up and get to school on time. Other children may present similar rather unusual variations of this, wanting to do something in a way that might seem bizarre to you as a parent, but which gives your child a sense of control or confidence, in the face of significant anxiety. Roll with it. The priority is getting your child to school with a strong confident heart ready to run with the day. If that means they wear their clothes to bed, or brush their teeth before or after they eat, or wear rainboots in the summer, or a cowboy hat on their head – let them! As long as that child has ‘adequate’ sleep, ‘adequate’ nutrition and feels strong and confident you are good to role, even not so strong but good to roll is enough. After all, bravery is doing what we are scared of, not doing what we find easy.

NB adequate may mean they got up 2 hours early, or ate dry cornflakes. The key is getting to school, not getting their perfectly rested, fed, and dressed according to our standards.

Please see below for new therapy options running at The Story Isn’t Over that address the prevention and early intervention of anxiety in children 6-13 years.

What is Separation Anxiety Disorder?

Separation anxiety disorder is not the same as separation anxiety. Separation anxiety disorder (SAD), is an anxiety disorder that occurs in middle-childhood, between the ages of 6-8 years old. It is characterized by significant anxiety that prevents the child from doing what they want to do, and inhibits them from developing their own autonomy. For example, a child with SAD, might be unable to engage at a birthday party, when they really want to, and instead cling to their parent’s leg watching the other children play and wishing that they could join in. They might want to join the gymnastics team but be unable to leave the changing room to join the group.

Any feelings of anxiety, or stress, become problematic, and clinically significant, when they prevent the person experiencing the anxiety from doing what they want to do. For a child with SAD, the anxiety about separating from their primary care giver prevents them from moving away from their care giver, and getting involved in other activities. It is highly significant because being unable to separate and engage interferes and undermines the child’s own development, socially, emotionally and cognitively.

This is one of the principle reasons why it is so important to seek help. It is vital to be proactive in recognizing the early signs of anxiety and getting out there and getting help – rather than hopefully believing that it will all be alright once they hit puberty.

Children with SAD, will experience significant separation anxiety, social anxiety, and generalized anxiety about going back to school. This separation anxiety is frequently accompanied by physical symptoms, such as abdominal pain, nausea, vomiting or diarrhoea. In many instances what occurs is an entrenched cycle of abdominal pain, emotional distress, and school absence. Parents are usually more concerned about the physical symptoms the child is exhibiting, than the emotional distress. It is easier to see/believe the physical pain than the emotional distress. The physical pain is genuine, it is not made up by the child; any parent seeing their child in pain, believes that there is something physically wrong with their child, and takes them to the nearest medical clinic/doctor. For this reason, many children with separation anxiety are first seen in a family doctor’s, or paediatrician’s – not in a school guidance counsellors office, or a by a psychotherapist. Child and parents sincerely believe that there is something physically wrong with their child, and will take their child to see their paediatrician or family doctor to find out what is wrong.

Many mental health complaints present with physical symptoms. Anxiety, in particular, is characterized by significant physical distress. In adults these physical symptoms can include acute chest pain, shortness of breath, numbness, abdominal pain, vomiting, diarrhoea, and chronic headaches. Adults with anxiety frequently present in their doctor’s clinic with complaints of physical symptoms, and may not even be aware that their physical symptoms are accompanied by emotional distress. Adults who experience panic attacks, frequently call and an ambulance to go to ER or ask a family member to drive them there. Anxiety is a mental health issue that presents with significant physical symptoms.

Given that adults frequently confuse the physical symptoms of anxiety with a physical illness, such as a heart attack, or stroke, or cancer, and not a mental health concern or simply emotional distress, it is no surprise that children will do the same, and will often tell you about their physical symptoms, such as abdominal pain, or feeling sick, or headaches, and not say that much about feeling stressed or anxious about going back to school.

Best practice always dictates that all physiological causes of the physical symptoms are ruled out before a doctor considers the possibility that it is a mental health issue that is triggering the physical distress.

This is why an adult who attends ER with chest pain, will be given an X-ray, ECG, and bloods, to rule out a heart attack, before the physician diagnoses their symptoms as a panic attack.

The most common complaint with children 6-9 years is abdominal pain. When a child presents at their family doctor, or paediatrician, with abdominal pain the doctor will always carry out all the tests necessary to rule out any physical illness. Only after all those tests have come back negative will the doctor diagnose the child with what is referred to as Functional Abdominal Pain, (FAP). It is important to know that there are no tests for FAP, it diagnosed after all other diagnoses such as food poisoning, or appendicitis, have been ruled out, and the diagnosis is based on the presenting symptoms.

Recurrent physical complaints are a critical aspect of separation anxiety disorder. Abdominal pain is often the primary compliant. Only after thorough medical testing, is the abdominal pain is diagnosed as functional abdominal pain. The pain is functional, in that it functions to help the child avoid school and stay home – because the child is experiencing significant fear about separating from their care giver and going to school.

Remember the anxiety guideline: Anxiety always leads to checking or avoiding – and checking/avoiding always make the anxiety worse. (We can look at the latter half of that ground rule another time).

Approximately 3.2 % – 4.1 % of all children develop separation anxiety disorder. Sadly, the research shows that only one-fifth of those children receive any treatment for their emotional distress before the age of 18 years old.

While there is a growing awareness of the mental health needs among adolescents and young adults, there less awareness and attention given to the mental health needs of children.

Although statistically there are far more adolescents presenting with symptoms of anxiety, than children, there is still a critical number of elementary aged children who are experiencing debilitating anxiety that is often going unaddressed, and untreated. Most children with anxiety, will go on to experience anxiety as adolescents and all the research indicates that the earlier the intervention the better – whether it is in childhood, or early adolescents.

What Puts You at Higher Risk of Developing an Anxiety Disorder

There are a number of risk factors that may indicate your child is more at risk of developing SAD and/or FAP than other children. Many of these risk factors are common to all types of anxiety, and ages.

Genetics

Current research has demonstrated that anxiety is a heritable condition. Scientists now state that a ‘genetic disposition to anxiety is undoubted’. They have been able to identify the particular chromosomal regions associated with anxiety disorders, and are continuing to drill down to discover just how far our genetic material contributes to anxiety disorders, and how effective treatment can be developed to address these factors.

This means, that if you or your partner have experienced symptoms of anxiety, and/or depression, then your child is more likely to experience symptoms of anxiety, if they have inherited the genetic material related to anxiety from you. It does not mean that all your children will have anxiety or depression, because you do. Not all your children, possibly none of your children, will inherit that particular genetic material, and not all who inherit that material will develop anxiety. There are a number of different factors that go into who gets anxious, and why.

Inheriting a genetic disposition to anxiety, is not the same as a child learning, or modeling, anxious behaviour exhibited by the parent. That is something quite different.

Personality

The Big Five Personality Theory has influenced psychological understandings of personality for years. This theory identifies five personality traits that make up a personality. One of the five personality traits is assessed based on a spectrum from emotional stability to neuroticism. At one end of the spectrum there is emotional stability that refers to a person’s ability to remain calm, and emotionally regulated. At the other end of the spectrum is neuroticism which refers to a person’s tendency to experience negative emotions.

Independent of inherited genetics, all our children are born with particular personalities. We may not notice the key aspects of our child’s personality when our first child is born, particularly if we spend most our time with just our one child. When our second child is born, or when we start to mix with other parents and children, we quickly compare and contrast and notice the key personality of our child that stand out when they are seen alongside other children. You may notice that one child holds back, while the other/s rush forward. Or that one child is loud and bubbly and jumping all over the place, rather than the other child that is far more reserved, and quiet.

The research has shown that children who are shy, or have more of an inhibited personality type, are more prone to separation anxiety, and separation anxiety disorder.

Parenting Style

There is a wide range of parenting styles, and these parenting styles shift across time and space, with trends in parenting changing from one generation to another, and from one culture to another.

Parenting styles are often placed on a continuum from authoritarian, authoritative, and permissive.

Basically, at one end of the spectrum you have very strict parents who show little empathy or emotional engagement with the child, and prioritize authority, respect, and obedience rather than relationship. This parenting approach may reinforce a child’s dependency on their caregiver and fear of separation.

At the other end of the spectrum are parents who are overly permissive or indulgent. Parents may parent this way if they are feeling unable to cope, struggling with a lot of other issues, or philosophically believe that children should be free to make the rules up as they go along.

Children who experience their parents as authoritarian, or permissive, are at a higher risk of developing anxiety disorders at some point in their lives.

Children of authoritarian parents lack the emotionally intimate relationship with their parents, and emotional validation, empathy and emotional coaching that they need to develop into emotionally healthy adults.

Children of permissive parents lack the stability and security that children need to guide them, and help them to negotiate the morally complex world that we live in.

‘Parents of anxious children are over-controlling express excessive regulation or children’s activities and/or routines, high levels of parental vigilance and intrusion, and discourage independent problem-solving; parents are also over-protective and concerned’.

(Butnaru, Simona, Perceived Parenting Styles and School Anxiety in Preadolescents, CBU International Conference Proceedings 4:483, September 2016 (p484))

In the middle of that range, between authoritarian and permissive, is authoritative. Authoritative parents are able to find the middle ground, providing both the emotional intimacy, and emotional coaching, and the stability and security of firm guidance.

Remember there is a wide variation in good parenting, and a wide variation in authoritative parenting – the key is not be to be the perfect parent 100% of the time, the goal is to be a ‘good enough’ parent 80% of the time.

Situational Factors

There are other situational factors that increase the risk of a child developing separation anxiety disorder. These include, but are not limited to, any loss, such as loss of old home, old school, and move to new school, loss of the established family unit, when parents separate, and death of a family member, or close friend. Other factors that increase the risk of anxiety developing include stressors, such as academic stressors, poor peer relationships, and bullying.

If you, as a parent, are aware that any of your children are experiencing any of these challenges it is a good idea to stay connected to you kid, check in regularly, and be alert for any changes in the child or teens mood, behavior, sleep schedule, grades, appetite, etc., and if you notice any significant changes be ready to be there and gently provide support and offer services as needed.

How to treat Separation Anxiety Disorder – middle childhood?

Paediatricians and researches have now developed a treatment plan that they refer to as a ‘process of rehabilitation.’ Having ruled out all possible physiological diagnoses and diagnosed the child with SAD, the doctors prescribed a treatment plan that is all about rehabilitation.

Rehabilitation occurs while the child is still experiencing the symptoms, such as abdominal pain and anxiety. The medics recommend that the treatment starts as soon as all physiological diagnoses have been ruled out, without waiting for the symptoms to disappear before starting the rehabilitation treatment.

This changes your role as parent from, protecting your child from harm while looking for the cause of the pain; to coaching your child to return to normal activities. This can be very difficult for you as the parent, and your child, but is critical to ensure a successful outcome. You are now the child’s key coach, believing in your child when they don’t believe in themselves, supporting and encouraging your child to go back to school, even when they are still experiencing abdominal pain.

Home-schooling is not recommended for children with anxiety – for numerous reasons. It reinforces and escalates the anxiety, it focuses everyone’s attention on the anxiety, it prevents the child from developing age appropriate autonomy, and engaging in cognitive, emotional, and social activities that enhance development.

Pain in School

It is good to have a plan to address how your child is going to cope when the abdominal pain returns or intensifies when they are in school. This might mean working with the school to allow your child to visit the nurse or guidance counsellor and sit quietly for a while before returning to class. It is ill-advised to take your child out of school when they are experiencing pain. It is far better to provide extensive support, encouragement and words of praise each time they return to the classroom, and stay in school the full day.

Getting to School

It may be necessary to allow the main caregiver/parent to step aside, and invite the other parent/caregiver to play a more active role in the morning transition to school. Many parents already do this, recognizing that their child is more intensely bonded to one parent they make the other parent responsible for the school/daycare drop off. Obviously, this option isn’t always available in some households, such as single parent households, or where the other parent leaves very early to go to work.

Missed School

If your child has missed school due to sickness, arrange for the work to be done in bite-size-chunks, such as 30 minutes a day to allow your child to catch up without being overwhelmed.

Specific Concerns About School

It is important to understand what your child is finding is most troubling, or anxiety invoking about the school – and then be proactive about addressing those concerns.

This is critical when bullying is involved. If a child is anxious about going to school and avoiding school because they are being bullied in the school this must be brought to the school’s attention and addressed sufficiently. This is a task in itself, as many schools continue to offer limited, and ineffective responses to bullying that often leave the child worse off than before the intervention.

Other concerns may be easier to address, such as fear of the toilet, or gym, or social isolation. The key is to find out what is troubling the child and effectively address it.

Reduce Attention to Symptoms

Distraction is one of the best strategies for reducing the abdominal pain caused by anxiety. It is worth investing time and energy in your child’s other interests – explore what appeals to them, from the obvious sports and dance, to the less obvious collecting stamps, or cacti. Having something else to focus on, that excites your child will go a long way to reducing the pain your child is experiencing and the anxiety they are feeling.

If your child is frequently complaining or referring to their stomach ache, then it is a good idea to schedule a specific time, when your child can tell you how they are feeling, such as setting up 5 minutes to check in on the pain around the time of the evening meal. These times can be adjusted to the needs of the child and gradually reduced as the child improves. When your child comes to you to talk about their stomach ache between those times you can acknowledge that they are experiencing pain, and then gently redirect to another activity, reminding them that they will be able to report their experience of the pain at ‘check-in’.

It is important for you as a parent to resist repeatedly asking your child if they are in pain. The questions are almost always motivated your anxiety as a parent (anxiety makes us check), and will draw your child’s attention to the pain and demonstrate to the child that their stomach ache is a cause for concern. This can be very hard for parents. If you are finding this difficult, try to check in just once a day during the ‘check-in’.

Know When to Keep Your Child Home

After being told that you should encourage your child to go to school even when they are in pain, it can be difficult to know when you should keep your child home from school. It helps to have specific guidelines to let you know when you should keep your child home and what your child should do during the day when they are at home. The research into SAD and FAP recommends that children are kept home when their temperature is 102F or higher, with repeated vomiting, diarrhea and inability to keep down clear liquids. When your child stays home from school they should rest in their bed without television or other entertainment such as computer games, and return to school during the day if they feel better. That’s tough! Responding to your child’s illness this way, may be very difficult to begin with, but in the long term you will be setting your child up for a successful return to school, and preventing your child from developing a chronic pattern of sickness and school absences.

How to treat an Anxiety Disorder – all ages?

Prevention and early intervention for anxiety, directly relates to how well your child learns to understand and manage their own anxieties.

Whatever the age of the child, teen or adult experiencing anxiety, the earlier the intervention the better. Intervention starts with the most basic option and works up from there according to need.

For example, if you have a tooth ache, you may start by taking an Advil. If it goes away you might not do anything else about it. If you were still in pain you would see your dentist and your dentist might fix a filling, or other small concern and send you home. If the pain continued you would go back to your dentist. Your dentist would probably take an x-ray, and if she didn’t know what was wrong she would refer you to an oral surgeon. When you got to the oral surgeon, the oral surgeon might start running a gamut of tests to ascertain what was causing the pain in your mouth – and so on and so forth.

The process is the same with any other medical concern, including anxiety.

  1. Read about anxiety on web – practice some self-help tips
  2. Buy a book, or take an online course on anxiety
  3. Buy appropriate supplements/see naturopath for specifically natural ways to reduce/treat anxiety
  4. See a psychotherapist/psychologist/social worker
  5. See your family doctor/paediatrician
  6. Carry on with treatment under your doctor and therapist
  7. Ask for a referral to a psychiatrist (a medical doctor who specializes in mental health)
  8. Attend full consult with psychiatrist and carry on under treatment of psychiatrist, doctor and therapist
  9. Need to attend out-patient program at the hospital
  10. Need to attend in-patient treatment at the hospital
  11. Look for longer term specialize care options such as Homewood

Most people will find that their symptoms and/or their child’s symptoms are well managed by the time they reach 5 or 6. Writing out the various options for care like this, helps us to see the big picture of what treatment can look like and what it can include. And of course, everyone has their own particular preferences for treatment, such as naturopathic medicine or pharmaceutical medicines, medical (medications) or non-medical options such as exercise, meditation, diet.

A few will need more help. And that is where we can help. At The Story Isn’t Over, with have a number of therapists who specialize in treating anxiety whether anxiety in a 3 yr old, or a 93 yr old. Please do not hesitate to reach out to us and ask for help. We have a wide range of different services available.

Of particular note are our new groups that will start running in October:

At The Story Isn’t Over we are running groups to address the prevention and early intervention of anxiety in children and tweens. These groups are being run at both the Bolton and Brampton office.

In Bolton they are being run by Aneliya Saley, a music therapist, and will include lots of music and games.

In Brampton the groups are being run by Tiffany Chinapen, an art therapist, and will include paints of all colors imaginable, glitter and glue.

Stay Calm & Tootle On: Prevention and Early Intervention for Anxiety

For 6-9 yr olds, 10-11 yr olds, and 12-13 yr olds.

Book early to avoid disappointment as these groups will only include 4-5 kids in each group.

Help! My kid does not want to go to a group?

Please don’t be surprised if your anxious, school avoidant, child does not want to attend group therapy. Why would they, they are experiencing anxiety about leaving you to go to school, and/or socialize, and group therapy will of course trigger the same anxiety. Individual therapy would also trigger anxiety, but less anxiety than a group, because a group involves the added complication of other kids in the group – which is what many kids are anxious about.

Why do I encourage group therapy for anxiety? Because group therapy is precisely the therapy or choice, and the very best therapy option for any one with any social anxiety.

Remember: Anxiety leads to AVOIDANCE, and Avoidance makes the anxiety worse.

If your child is anxious about separating from you, or being with other kids, they will not want to attend group therapy, any more than they will want to attend school.

Remember: Avoidance makes anxiety worse, so if you want to reduce anxiety you have to start DOING what you want to avoid.

When you do what you don’t want to, and stop avoiding what you are scare of, you begin to discover, that it it’s okay to do those things – the world doesn’t end – and your anxiety starts to come down.


SOURCES:

Butnaru, Simona, Percieved Parenting Styles and School Anxiety in Preadolescents, CBU International Conference Proceedings 4:483, September 2016 (p484)

Chahal, Jaskirat Kaur, Prekshar, Effect of Music Therapy on Anxiety, 10.21088/ijpn.2347.7083.7119.4, December 2019

Mynbayeva, Aligerim, Prevention of School Anxiety Among First Graders Through Art Technology, Conference: 6th icCSBs, October 2017, The Annual International Conference on Cognitive – Social and Behavioural Sciences

Walker, Lynn S., Functional abdominal separation anxiety: helping the child return to school, Pediatric Annals 38(5):267-71, May 2009

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