Overcoming School Anxiety: How to Help Your Child Deal With Separation, Tests, Homework, Bullies, Math Phobia, and Other Worries by Diane Peters Mayer, M.S.W., L.S.W.

Chapter 2: Anxiety Is a Mind-Body Experience

Most elementary school children with school anxiety cannot make sense of their anxious symptoms; they just know that they feel nervous, get physically sick, or just don't want to go to school. Many children are outwardly anxious and panicky on school mornings, like Sean, who can't stop himself from screaming to stay home and shaking all the way to school. Some children may not feel consciously anxious, but they still try to avoid school, like Tiara, who denies being anxious, but complains of a stomachache on most school mornings and sometimes throws up on test days. Other children fear their symptoms are caused by a disease, like Jaime, who believes that the heart palpitations he has in school are due to a bad heart and that he might die. No matter the reason for school anxiety or how it manifests, children who have it do suffer.

When children become anxious, they are not just feeling nervous; in fact every aspect of their physical, mental, and emotional functioning is affected. Symptoms can vary from feeling out of control and scared when walking through the school doors every morning to being unable to remember what was studied for a test to shaking and being unable to answer when called on in class.

School is a tension-filled environment with stressors that include leaving the safety of home to go to school, being judged and evaluated by teachers, fitting in with peers, or being bullied. Stressors are events, circumstances, or situations that create physical or emotional strain, frustration, and pressure. Some stressors are considered negative, for example, if a child has trouble reading and is failing second grade. However, stress is also felt around positive situations, such as a student soloing in the spring concert and feeling the pressure to play perfectly.

Anxiety is one type of a response to stress. The way children react to stress is determined by a number of factors, such as heredity, learned behaviors, life experiences, physical and mental health, and the number of stressors that are occurring all at once. Positive ways to handle stress can be learned, so teaching your school-anxious child how to cope with and adapt to stressful situations will reduce anxiety and make for a more positive school experience.

As a parent of a child with school anxiety, you know how difficult it can sometimes be to understand your child's behaviors, and how upsetting it is to watch her struggle. If you had school anxiety yourself, you can probably understand your child's experience. Parents often ask, "Why does my child feel that going to school is a jail sentence?" "Why are my child's symptoms so intense?" "Why can't my child think anxiety away?" These are important questions to have answered, and the first step in helping your child is to understand why and how the disturbing symptoms are created and how chronic school anxiety develops.

What Is the Nervous System?
The symptoms of anxiety are created by a primitive defense mechanism called the fight-or-flight response. This response is the body's way of protecting itself in situations that could result in injury or death. Every living thing on earth has a fight-or-flight response, from the one-cell amoeba to the human body, which is made up of trillions of cells. This defense is a function of the nervous system, which includes the brain, spinal cord, and other structures. The nervous system coordinates all life functions, including breathing, limb movement, organ action, thinking, feelings, and emotions. It is really a communication system, and one of its main jobs is to alert the body to external situations and events and then to prepare an appropriate response to them. For example, you want to hug your child. Your brain sends this message to the nerve cells and chemicals that control your limbs, allowing you to put your arms around your child. Or, your child's ball rolls into the street and without thinking she starts to run after it. In a split second, stress hormones course throughout your body, you yell at her to stop, but she doesn't hear you. Your respiration revs up, and nerve cells send messages to your legs enabling you to run like an Olympian to stop her. Whether it is giving your child a hug or running after her, all of this activity occurs in seconds without conscious thought.

The Fight-or-Flight Response
The fight-or-flight response is an alarm system located in a nervous system called the sympathetic nervous system. It jump-starts when real physical danger is present, but it will also activate if a situation is perceived or thought of as being threatening. For an example of a real danger, let's say your child is in the school yard playing with his friends when the school bully comes over with a group of followers. The bully begins to taunt your child and make threatening movements that he is going to hit him. Your child's fight-or-flight response kicks in to help him defend himself by either running away or trying to fight back.

For an example of a perceived danger situation, let's say your child has test anxiety. The night before a test she tries to study but feels sick to her stomach and later can't fall asleep. On the day of the test, her heart beats fast and she is irritable with a feeling of dread. Her anxiety spikes when the test is passed out to the children and the fight-or-flight response revs up to defend her from what she believes to be a dangerous situation. She has panic symptoms that make it hard for her to concentrate and do well. Of course, a test is not really dangerous, but when your child sees it as a threat, then the brain cannot distinguish between real or perceived danger and will protect her in either case.

What Happens to My Child During the Fight-or-Flight Response?
When danger is sensed, the brain immediately sends messages to the sympathetic nervous system to begin the defense, and powerful physiological changes take place all at once. These changes, which create the symptoms associated with anxiety, can be disturbing and frightening. Your child might experience the following physical symptoms from school anxiety:

Pounding, rapid heartbeat or palpitations from the increase in blood pressure when stress hormones, such as adrenaline and cortisol, are released into the bloodstream, thereby pumping more blood into the brain, muscles, and other organs. At the same time, blood flow decreases to extremities, so hands and feet feel cold.

Rapid breathing, which increases oxygen levels. However, shallow breathing may occur too, causing shortness of breath, gasping, and hyperventilation, often associated with feeling trapped and leads to sensations of being smothered. Hyperventilation is abnormal deep breathing that reduces levels of carbon dioxide in the blood, causing tingling in fingers, dizziness, and fainting.

Tension in muscles as they ready themselves for action, which may create body and chest pain, leading to fears of a disease or heart attack, and numbness in the face, head, and limbs.

Sweating as the body cools itself to prepare for physically demanding activity, either battle or flight. Sometimes a hot flush, blush, or chills are felt, too.

Vision changes when pupils dilate to let in more light to increase awareness of the environment and the danger, sometimes creating hypersensitivity to light and other visual stimuli, or distorted vision, such as tunnel vision.

Other physiological changes include a decrease in saliva production to stop digestion, creating dry mouth; voiding of bowel and bladder to empty the body for action, leading to frequent urination and diarrhea; headaches because of muscle tension in the head, neck, and shoulders; hypersensitive nerve endings affecting the delicate skin, causing feelings of numbness, rashes, hives, and other skin conditions. However, the physical symptoms are only the beginning; the emotional manifestations of anxiety pack a wallop, too.

Mental Symptoms of the Fight-or-Flight Response
The mental signs of anxiety play havoc with cognitive functions. Thought processes become distorted, making it extremely difficult to think clearly and rationally. The ability to focus and concentrate decreases, which makes learning new material difficult. Other common emotions include feeling:

• Overwhelmed and out of control
• Helpless, hopeless, and wanting to flee the situation
• Irritable and angry
• Embarrassed and ashamed

Some children feel mild electrical shocks throughout their bodies when anxiety is high, due to sensitized nerve impulses. They may feel disconnected or dissociated from their own mind and body or may be jittery and unable to sit still. Others feel physically off balance, and even think they are going crazy. Anxiety and its distressing symptoms generally do not remain at high levels for more than ten minutes at a time, although symptoms can spike up and down for hours. Fortunately, the body also has a cool-down phase.

The Relaxation Response
After the threat or danger has passed, the parasympathetic nervous system is set in motion, decreasing stress hormones, returning blood pressure and respiration to normal, ramping up digestion, and relaxing major muscle groups. This a time of rest and renewal for the body. This branch of the nervous system is not an opposing force of the sympathetic nervous system; rather the two are complementary systems that work to ensure survival by trying to maintain a perfect balance in the body, called homeostasis. Anxiety affects every aspect of the mind and the body. It runs on a continuum, from mild to severe. However, even moderate symptoms can throw a child into a tizzy, making school the last place on earth a child wants to go to five days a week for most of the year.

For children who have school anxiety, it is very difficult to turn off the sympathetic response and turn on the parasympathetic state of calm because the majority of their lives is spent trying to navigate their fears about school. Long weekends and summer vacation can't erase having to cope with nine months of feeling distressed and nervous. For these children, school anxiety becomes a recurrent condition, but the good news is that it is possible to consciously create the relaxation response and decrease anxiety symptoms.

How Does School Anxiety Become Chronic?
School anxiety can easily become a chronic state unless some kind of intervention or treatment is provided. The cycle into a persistent state of anxiety looks like this:

Tiara, a nine-year-old fourth grader, generally liked school, but by second grade she began to experience panic. When she was called on to answer an arithmetic question or go to the board to work on a problem, she would get very nervous and not be able to think.

Since second grade, after many experiences of not knowing the answer or being stumped at the board and having classmates tease her about it, Tiara feels stupid and is nervous about going to school. Now, when she is called on for a math answer, the fight-or-flight response kicks in immediately. Her heart pounds, her whole body tenses, she feels unable to catch her breath, and if her anxiety spikes higher, she may experience that scary feeling she's told her parents about, when she feels distanced from the class and can't hear the teacher. This severe anxious reaction makes it impossible for Tiara to think clearly and come up with the correct response to a math problem she does know the answer to or to learn how to work out problems she doesn't understand.

When math class is over or when she's on her way home from school, the parasympathetic nervous system activates to return Tiara's body into a less aroused state and a more relaxed one. However, her relaxed state never reaches its normal resting condition because tomorrow school looms and the worry about math is never more than a few days away. The cycle of Tiara's chronic anxiety is caused by her thoughts about past classroom experiences where she felt humiliated, and the worry that these same situations and her feelings about them will occur again in the future.

The fight-or-flight reaction is a wonderful defense system; after all it has allowed humans to survive to this day. However, its intended purpose is to act as a short-term solution to a physical threat, not as a continuous state of mind and body. A chronically anxious child, whose fight-or-flight reaction is always just below the surface, will not be able to decrease stress hormones or other anxiety symptoms to normal healthy levels, interfering with the body's balance and functioning. If not treated, a child may develop an anxiety disorder, such as a panic disorder or phobias. Along with anxiety, other ailments can develop such as depression, avoidance of challenging situations, eating and sleeping problems, or a depressed immune system.

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