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Recognizing and Managing Anxiety in the Classroom

Debra Stokan, M.D. :: May 31, 2012 ::

Recognizing and Managing Anxiety in the Classroom

       Anxiety is one of the most common disorders seen in outpatient clinics. Anxiety is worth discussing, as it wears many different hats and disguises. In the classroom, anxiety has many presentations. When evaluating students for any reason, anxiety symptoms need to be covered.

       As a Child Psychiatrist, many students present for evaluation and treatment of ADHD. With or without a true diagnosis of ADHD, excessive anxiety will always lower a students’ ability to pay attention in the classroom. High anxiety also decreases short-term memory, making the time in the classroom and/or studying less efficient. Anxiety can very easily be confused with ADHD in young children where the anxiety can present as hyperactivity. The student may appear restless, fidgety and have difficulty sitting still. The student with social anxiety is particularly distracted by their peers and their peers’ activity. The student with social anxiety may also appear inattentive as they avoid eye contact secondary to their anxiety. In another example, the anxious student may blurt out answers or questions. This blurting is considered a top symptom in ADHD. Incomplete work is another common symptom as the anxious student may ‘freeze up’ or be unable to complete a test or assignments as anxiety skyrockets.

       The anxious child can also appear extremely oppositional. This may come out as procrastination due to stress that can be confused with purposeful avoidance. When confronted, an extremely anxious student may become even more embarrassed and desire a quick retreat. This retreat may end up with a student leaving the classroom or even hiding under the desk. Rather than a ‘flight’, the high anxiety student may react with a ‘fight’ when confronted by either teachers or peers. This can lead to an otherwise well behaved student acting out in an impulsively aggressive manner. The aggression can either be verbal or physical. For this type of student, I would want the school, teachers and parents aware of the student’s common reaction to anxiety and allow for a ‘cooling off’ period. This ‘time out’ can be crucial in deescalating the situation with an anxious, over reactive student. 

       One form of anxiety is Obsessive Compulsive Disorder, also known as OCD. OCD can create well known difficulties in the classroom. For instance, excessive counting or other distracting mental compulsive exercises slow down the ability to process information. Another classic OCD classroom issue is excessive erasing or rewriting of work. This can make completing assignments nearly impossible. Obsessiveness can also lead to rigidity and difficulty with transitions. The obsessive student gets ‘stuck’ on things being a certain way and may lose their temper or overreact. 

      Anxiety can also present as physical complaints. Many of my anxious patients have missed excessive days of school secondary to feeling ill. Frequent trips to the school nurse with complaints of stomach aches and/or headaches are other warning sign for anxiety. Excessive fatigue, either from the anxiety or lack of sleep the anxiety causes, is another warning sign. As a psychiatrist, I would be evaluating for possible medical causes of the physical complaints before assuming they resulted from anxiety.

       Fortunately, there is a high rate of successful treatment of anxiety. Many options are available. The options range from behavioral modifications (i.e. extended time on work, isolated testing environment, cool off plan, etc.) to biofeedback therapy, cognitive therapy, relaxation techniques and medications.

       While assessing anxiety in a student, the specific symptoms elicited help to guide the treatment plan. As part of the evaluation, comorbid problems or diagnosis need to be considered. For example, 30% of patients with ADHD also have an anxiety disorder. Treating both the ADHD and anxiety creates optimum results. Depression, family conflict, peer conflict issues, learning disorders, speech-language disorders and all other mood disorders are also factors that need to be considered and ruled out. To assist with this process, information from the student, parents and teachers often combine to create the most balanced picture regarding comorbid factors. As a psychiatrist, I feel medical illnesses also need to be ruled out. The classic medical complications creating anxiety include hyperthyroidism, mitral valve prolapse and asthma. Taking all these factors into consideration, one of the best indicators for successful treatment is early diagnosis.