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Simay Gökbayrak, PhD — By Zia Sherrell, MPH on June 29, 2022School anxiety is a condition that can affect students of all ages. It manifests as an excessive fear of school and the activities associated with it, such as making friends, speaking in public, or taking tests. Anxiety surrounding school is common and can affect any child, regardless of age, grade level, or academic achievement. For some students, it is so severe that it interferes with their ability to learn and function at school. This article looks at school anxiety in more detail, including the causes, symptoms, and treatment. What is school anxiety Share on PinterestJovo Jovanovic/StocksySchool anxiety involves fear and worry about going to school. Doctors may also refer to it as school phobia or school refusal. Although it is not uncommon for children to feel some anxiety about starting school or going to a new school, children with school anxiety feel an extreme amount of fear and worry regarding everyday attendance. This can interfere with their ability to go to classes or do well in school. School refusal is not a recognized mental health diagnosis. However, the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) notes that this symptom can have an association with several other diagnoses, including:depressionsocial anxiety disordergeneralized anxiety disorderspecific phobiaoppositional defiant disorderpost-traumatic stress disorder (PTSD) School refusal can be a challenge for parents or caregivers, as well as teachers and school administrators. It is sometimes difficult to manage and may require a team approach. However, it is important to take steps to address it early on, as it can have significant effects on the child’s social, emotional, and educational development. Also, the longer a child is out of school, the harder it is for them to return. Causes Mental health professionals do not completely understand the causes of school anxiety. For some children, the fear and worry associated with school anxiety are related to a specific cause, such as being bullied or having a bad experience at school. For others, the anxiety may be more general and related to social or performance anxiety. Children may develop anxiety if they have been home for a long period, such as during summer vacation or because of illness. A stressful event, such as the death of a family member or moving to a new home, may also trigger the condition. Symptoms The symptoms of school anxiety can vary, and they may be physical, emotional, or behavioral. Physical symptoms may include:stomachachesheadachesdizzinessrapid heartbeatshortness of breathsweating Emotional symptoms may include:fearfulnessworryirritabilitysadness Behavioral symptoms may include:refusing to go to school or attend classmissing school frequentlyhaving temper tantrumshaving crying spellsclaiming to be sick to try to stay at home Treatment and management There is no one-size-fits-all approach to treating school anxiety, and the best strategy may depend on the severity of the symptoms and the underlying causes. Mental health professionals may use a combination of psychotherapy, educational support, and medications to treat school anxiety. Therefore, a collaborative team approach that involves the child, their parents or caregivers, school personnel, and mental health professionals is often necessary. The first step in treatment is often to meet with the child’s school personnel to develop a plan. This may include making adjustments to the child’s schedule, providing support in the classroom, or involving the child in social activities outside of school. It is also important for parents and caregivers to provide support to children with school anxiety. This support may take the form of:talking with the child about their anxiety and fearshelping the child develop healthy coping mechanismsmodeling positive behaviorteaching the child relaxation techniquesstaying involved in the child’s education Parents and caregivers should also avoid reacting to the child’s anxiety in a way that reinforces it. This means avoiding arguments, bribes, or threats. If the child is not responding well to these measures, the mental health professional may recommend psychotherapy. Prescription medications are usually a last resort if other treatments have been ineffective. Psychotherapy These methods include cognitive behavioral therapy (CBT), which is a treatment for anxiety disorders. CBT can teach children how to identify and change unhelpful thinking patterns and behaviors to help them cope with their fears. It may take place individually or in a group setting. Dialectical behavioral therapy (DBT) is another type of psychotherapy that may help with anxiety and school refusal. DBT emphasizes mindfulness and acceptance, as well as change. It can teach children how to cope with stressful situations in a more helpful way. Mental health professionals may also recommend exposure-response therapy (ERP). ERP focuses on helping children face their fears in a gradual and controlled way. This approach can help them become less afraid of attending school. Medications If other treatment does not work, a mental health professional may prescribe medication. The most common type of medication for anxiety is selective serotonin reuptake inhibitors (SSRIs). SSRIs increase the levels of serotonin in the brain, which helps improve mood and reduce anxiety. Mental health professionals may prescribe benzodiazepines for children with severe school anxiety. However, these drugs are only suitable for short-term use because they carry the risk of side effects, such as sedation and issues with thinking and memory. Long-term use can also lead to tolerance, dependence, and other adverse effects. When to seek help It is crucial to seek professional help if a child is missing school frequently or refusing to go to school. School refusal can hurt the child’s education and social development, and it becomes more difficult to treat over time. It is also important to seek help from a mental health professional if the child’s anxiety is causing significant distress or interfering with daily life. Untreated anxiety can lead to other problems, such as depression, substance use disorders, and social isolation. Summary Students may experience school anxiety for various reasons. Some children feel anxious about tests, while others worry about social interactions or leaving home. The anxiety can trigger various symptoms, such as a racing heart, sweating, or difficulty breathing. Children may also refuse to go to school or have temper tantrums. The treatment for school anxiety may include making adjustments at school, providing support at home, and involving the child in psychotherapy or exposure therapy. Mental health professionals may also prescribe medications in severe cases. It is important to seek professional help if a child’s anxiety causes distress. Over time, it becomes more difficult to treat and can have lasting effects. Last medically reviewed on June 29, 2022Mental HealthAnxiety / StressPediatrics / Children's HealthPsychology / Psychiatry 5 sourcescollapsedMedical News Today has strict sourcing guidelines and draws only from peer-reviewed studies, academic research institutions, and medical journals and associations. We avoid using tertiary references. We link primary sources — including studies, scientific references, and statistics — within each article and also list them in the resources section at the bottom of our articles. You can learn more about how we ensure our content is accurate and current by reading our editorial policy.Any anxiety disorder. (n.d.). https://www.nimh.nih.gov/health/statistics/any-anxiety-disorder#part_155096Bakhla, A. K., et al. (2013). Anxiety in school students: Role of parenting and gender. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4085805/Kawsar, M. D. S., et al. (2022). School refusal. https://www.ncbi.nlm.nih.gov/books/NBK534195/School anxiety and refusal. (n.d.). https://www.youngminds.org.uk/parent/parents-a-z-mental-health-guide/school-anxiety-and-refusal/What to look for in the classroom. (n.d.).https://anxietyintheclassroom.org/school-system/i-want-to-learn-more/what-to-look-for-in-the-classroom/FEEDBACK:Medically reviewed by N. 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