Spotlight on Childhood Anxiety Disorders (And IEP Accommodations for Anxiety)

Anxiety disorders are the most common mental health disorders in the United States.  Anxiety is so common that it affects about one in eight children.  Left untreated, childhood anxiety disorders can result in poor school performance, poor social functioning and even substance abuse so it is important to diagnose and seek treatment at an early age.  If your child’s anxiety is affecting their educational performance, it is imperative you have a conversation with the school to consider implementing a 504 Plan or IEP to provide accommodations for your child.  Debilitating anxiety is considered a disability.

Childhood Generalized Anxiety Disorder (GAD)

A child with GAD worries excessively about a variety of things including, grades, family issues, relationships with peers and performance in sports.  This worry and fear seems to have no real cause and does not go away even if the situation is resolved.  These children tend to be extremely hard on themselves and often cope with their anxiety by constantly striving for perfection.  Furthermore, these children often seek constant approval or reassurance from others.

All children and teenagers have some anxiety and that is a normal part of growing up, but sometimes worries don’t go away and this is when GAD can appear.  By the standards set in the Diagnostic and Statistical Manual of Mental Disorders 4th Edition (DSM IV), in order to make the diagnosis of GAD, there must be excessive worry and anxiety for the majority of the time during a minimum period of six months and the worry/anxiety must not be confined to only select triggers but a wide range of activities or occasions. Furthermore, at least one of the following symptoms must be present along with the worry/anxiety for at least six months:

  • Feeling restless or on edge
  • Becoming tired with ease
  • Troubles with concentration or memory recall
  • Irritability
  • Tense muscles
  • Disturbed sleep

In addition to those listed symptoms, other symptoms associated with GAD include worrying about things before they happen, worrying about friends, school, or activities, constant thoughts and fears about safety, school refusal, frequent stomachaches, headaches or other body aches and clingy behavior with family members.  GAD can often interfere with normal activities, including school performance, so it is important to have a conversation with the school to discuss whether accommodations are necessary. 

Childhood Separation Anxiety Disorder

Separation anxiety for a young child can occur when a parent leaves the room or is out of sight.  This is considered completely normal and acceptable between 18 months and three years old.  The anxiety is often overcome with simple distractions.  It is also common for young children to cry when first left at daycare or pre-school.  This type of anxiety is also usually overcome with engagement in a new environment or activity.

Separation anxiety disorder occurs if your child is older (most often between ages 7 – 9) and is still unable to leave a family member or calm down after a family member leaves.  When separation anxiety disorder occurs, a child experiences excessive anxiety away from home or when separated from parents or caregivers. This results in being extremely homesick and feeling miserable due to not being with parents.   

School refusal is quite common with children with separation anxiety disorder.  Other symptoms include refusing to go to camp, or a sleepover, and demanding that someone stay with them at bedtime. Children with separation anxiety also commonly worry about bad things happening to their parents or caregivers.

Social anxiety disorder, or social phobia, is an anxiety disorder characterized by an intense fear of social and performance situations.  This includes fears of activities such as being called on in class, making a presentation, starting a conversation with a peer or even simple socialization.

Childhood Social Anxiety Disorder

Social anxiety disorder can significantly impair your child’s school performance and attendance.  It can also affect his or her ability to socialize with peers and develop and maintain relationships.  If this is in fact interfering with your child’s educational performance, it is important to start a conversation with the school about accommodations to boost performance.

Childhood Selective Mutism

Selective mutism occurs when children refuse to speak in situations where talking is expected or necessary, to the extent that it interferes with school and making friends.  This is often diagnosed around 5 years old, or around the time elementary school begins.

Besides refusing to speak in public, children suffering from selective mutism may also stand motionless and expressionless, turn their heads, chew or twirl hair, avoid eye contact, or withdraw into a corner to avoid talking.  Interestingly, many children with selective mutism can be very talkative and display normal behaviors at home or in another place where they feel comfortable. Parents are often surprised to learn from a teacher that their child refuses to speak at school.

Childhood Anxiety Disorder’s Effect on Educational Performance

As seen with all of these anxiety disorders, there are a number of symptoms that can interfere with learning.  Many anxious individuals find it difficult to avoid distractions and require more time to turn their attention from one task to the next.   In fact, anxious children and adolescents are often considered “inattentive” because they appear off-task within the classroom setting.

Children who suffer from anxiety disorders tend to be perfectionistic, forgetful, or unwilling to participate due to concerns about failure or embarrassment.  These symptoms affect their success in school.  More so, children with anxiety disorders often avoid difficult tasks, seeking out easy tasks.  These children usually never volunteer or readily participate in classroom activities.  Because withdrawal is a typical response to avoid feeling anxious, anxious children may be perceived by teachers as unmotivated, lazy, or uninterested in school.  For this reason, it is important to get an accurate diagnosis in order to get the appropriate modifications and/or accommodations.

It is important that you communicate with the school and inform them how your child acts at home.  Children with anxiety disorders don’t always ask for help and silently struggle during the day at school.  Once home, the child will then experience tantrums and meltdowns.  Share this information with the school. I have even suggested to clients to video tape their child in order to share the level of exhaustion or anxiety their child displays at home.  This is essential for accommodations such as less homework, assignment adjustments, etc.  If the school does not understand what the struggle is, or if they do not see it themselves, they often do not take it into consideration.  When in doubt, share the information regarding your child’s behavior with the school.

If your child meets the eligibility criteria for a 504 Plan or IEP, the next step is to meet with the treatment team to get a baseline on your child and establish accommodations and modifications specific to your child’s needs. 

Some suggestions for children with anxiety disorders include:

  • Extra time and warnings before transitions
  • Preferential seating (near the door, near the front of the room, near the teacher’s desk)
  • Clearly stated and written expectations (behavioral and academic)
  • Frequent check-ins for understanding
  • Not requiring to read aloud or work at the board in front of the class
  • Videotaped presentations or presenting in front of the teacher (instead of the whole class)
  • Extended time for tests
  • Tests taken in a separate, quiet environment (to reduce performance pressure and distraction)
  • Word banks and equation sheets: These are useful for children with test anxiety, who tend to “go blank” when taking a test.
  • “Cool down passes” to take a break from the classroom. Clearly explain this to the student. Examples might include a walk down the hallway, getting water, standing outside the classroom door for a few minutes, completing coloring pages in the back of the room, or using a mindfulness app with headphones.
  • Breaking down assignments into smaller pieces
  • Modified tests and homework
  • Set reasonable time limits for homework
  • Record class lectures or use a scribe for notes
  • Preferential group (teacher or adult child knows well) for field trips
  • Preferential seating in large assemblies (near the back of the room)
  • Identify one adult at school to seek help from when feeling anxious (school counselor, etc)
  • Buddy system: Pair student with a peer to assist with transitions to lunch and recess (these less structured situations can trigger anxious feelings)
  • Help after illness: Missed work can spike anxious feelings. Providing class notes and exempting students from missed homework can help.
  • Substitute teachers: Letting the child or family know when a substitute will be in the classroom can help the child prepare.

Once accommodations and modifications are established, your job as a parent is not finished.  It is essential to establish a positive relationship with the classroom teacher and have regular check-ins with the treatment team to evaluate what helps and what doesn’t. It can take time to develop the strategies that best help your child, but with a solid plan in place anxious children can thrive in the classroom setting and learn to manage their symptoms throughout the day.

If GAD, separation anxiety, social anxiety or selective mutism greatly interferes with your child’s ability to succeed in school, start a conversation with your child’s teacher.  Your child may be eligible for specific protections and reasonable accommodations under the Americans with Disabilities Act (ADA) or Section 504 of the Civil Rights Act.  It is always worth asking and gathering information to help your child make progress and succeed in school.