Ask the Expert: School stress and separation anxiety

Anxiety disorders are the most common mental health problems for children and teenagers. In the second of a three-part series, John Sharry answers questions on school refusal and separation anxiety. Send your queries to health@irishtimes.com

Q My 13-year-old son has always been a little reluctant to go to school, but it has got much worse since he started secondary. He constantly refuses to go. The night before school he begins to get stressed and then the mornings are dominated by his anxiety. We manage to get him there most days, but it is daily stress for the whole family. He denies that there is a specific reason for him not wanting to go; he says he is not being bullied or anything like that, though he does find it hard to make friends. He is a high achiever in school so it is not academic problems. Can you help us?

A In helping your son, the first step is to encourage him to express some of the thoughts and feelings behind his anxiety about going to school. Pick a good time when he is relaxed and calm, and not anxious, to discuss this. Gently ask questions such as “When you feel you don’t want to go to school, what thoughts are in your head?” or “What do you imagine might happen?” It helps also to review his school day: perhaps go through his timetable and ask him to describe each class, rating how enjoyable each is. While there are lots of different reasons for school refusal, frequently it is a “social anxiety” with worries about friendships or fitting in being at the heart of it: these anxieties are particularly heightened starting secondary school.

Try to agree a goal with your son

A crucial step is to agree a goal about getting to school. At a calm time, help him to consider the importance of getting to school for his own life goals. Help him to describe and acknowledge the presence of the anxiety that is blocking him. It helps to talk about the anxiety as something external to him – “I appreciate the anxiety is making it hard for you to get to school,” or “Let’s not let the anxiety get in the way of you getting what you want in school.”

Strategies to address causes of anxiety

Explore with your son solutions that might make it easier for him in school. For example, you could support him making friends by helping him to invite classmates over or by joining in extracurricular activities or think of different ways he can speak up more or be assertive in class.

READ MORE

Help your son to understand his anxiety

Help him to understand the cycle of anxiety: he feels worried about school, which causes him to engage in avoidant behaviour, which in turn makes him more anxious the next time. You want to help him to break this cycle by acknowledging his feelings but not avoiding action: essentially, you want him to learn to “feel the fear and do it anyway”. There are lots of tactics for this, such as learning to be mindful of his feelings, and to accept them.

Relax his body via awareness of his breathing or progressive muscular relaxation, and relax his mind by using positive visualisation or thinking coping thoughts.

All these strategies can be learned using self-help books, in formal classes or individually with a professional. Finally, do check in with the school and his teachers and get further support if needed.

Q My daughter will be seven in the summer, and has always been an anxious child. In recent months, she has started to get distressed at the thought of being on her own anywhere. She gets distraught, for example, going into another room to fetch something; going to the bathroom; going to change out of her school uniform. While we're trying to support her, it's become so bad that she's holding the rest of the family hostage because she won't do anything on her own and she gets distressed to the point of making herself sick. Nothing untoward has happened to prompt this, and she finds it difficult to name whatever it is that makes her scared to be alone.

A Specific separation anxiety can be triggered by a distressing event, but frequently there is no trigger and it can become a habitual response. You are right to respond to her supportively, as she is likely to be feeling genuine anxiety, though you do need to help her move to more independence especially if her anxiety is impairing her – and the rest of the family.

The first step is to agree a goal with your daughter about overcoming the anxiety. As with the question above, it is important to be supportive and not to blame her for the anxiety. A useful strategy is to talk of the anxiety as separate and bothersome to her. You could say, “That anxiety [or whatever name she might pick] must be really annoying, stopping you doing things you like,” before making a plan with her: “Let’s see if we can overcome the anxiety together.”

The next step is to break down the task into small steps. For example, you might set a long-term goal of her going to her room by herself and getting dressed and then you break this down into many steps: 1) Going up to the room with Mum and getting dressed with Mum there. 2) Getting dressed with Mum there, while remaining calm and not looking for reassurance. 3) Getting dressed with Mum outside the door. 4) Getting dressed with Mum at the bottom of the stairs. 5) Mum taking me to the bottom of the stairs and then going up by myself.

The key is to pick a first step that is easy for your daughter, to have many interim gentle steps (up to 10) and to move to the next step only when she is ready. Equally, it is important to be very encouraging and supportive so that she can get lots of praise for her bravery as she makes progress. You can also reinforce her progress with a star chart or other reward system.

Dr John Sharry is a social worker and founder of the Parents Plus charity. He will be giving talks about overcoming anxiety in children in Dublin on Monday, April 27th, and about positive parenting in Kilkenny on Monday, March 30th. See solutiontalk.ie