homework avoidance anxiety

Jayne Demsky

Homework strategies for helping students with anxiety.

Trouble with homework can be an early sign of your child’s anxiety. The International OCD Foundation has a new website specifically for Anxiety in the Classroom . Their following teacher recommendations can be helpful to parents when discussing ideas for helping your child with anxiety.  

Reduce the amount of homework assigned.

Ask parents how much time their student spends on homework in the evening without undue stress, and then assign homework that can be completed within that time frame.  As the student progresses in treatment, the time limit may be increased.

Give the student estimates of how much time an assignment should take.

Tell students to work on an assignment for a certain period of time and to stop when that period of time is over.  As the student progresses in treatment, the time limit may be increased.

·Do not, as a rule, send home class work that has not been completed during the school day as homework.

Suggest to the student that they try switching to another subject if they get stuck on a particular assignment.

Suggest to the student that they try doing homework with a friend, or assign them to a peer tutor/study group.

Do not penalize the student for missed work if their anxiety/OCD symptoms are interfering.

Consider various options with regard to grading homework: grade assignments on the basis of content rather than neatness, allow some ungraded assignments, be flexible with due dates, use only those part of an assignment that have been completed as the basis for assigning a grade, grade rough drafts and/or allow the student to submit additional drafts.

Attend to comments made by students when homework is not turned in (e.g. “I think I made a lot of mistakes,” “It’s not good enough to turn in”) for possible insights into their anxiety/OCD.

Visit IOCDF for more information

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Disclaimer: This site is designed by School Avoidance Alliance to assist parents, family, friends, caregivers, educators, advocates, and other professionals involved with helping children and finding resources to understand, help and cope with school avoidance, as well as to increase public awareness regarding school avoidance. The contents of this website are presented for informational and educational purposes only. Nothing on this website is to be construed as professional advice on medical, legal, technical, or therapeutic matters. By accessing and using the information on this site, you agree to waive any rights to hold the site developer(s), or any individual and/or group associated with this site, liable for any damage that may result from the use of the information presented.

Get Help Today with Exclusive Access to Leading School Avoidance Experts

Unfortunately only a small percentage of school professionals, therapists, educational advocates and policy makers understand school avoidance best practices.  So, you must become the expert to ensure your child is getting:

• Appropriate mental health treatment
• School assistance without punitive responses (truancy, failing, grade retention)
• Educated regardless of their school avoidance
• A 504 plan or IEP if needed (many school avoidant kids qualify)

The time passing slowly without progress is the worst feeling. It wouldn’t have taken five years of suffering and uncertainty if I had this expert guidance during my son’s school avoidance. We would have saved $29,000 in lawyer fees and $69,000 for private schools.

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MENU MENU I work in the school system I am a parent or guardian I am a student Learn More What are Anxiety and OCD? Impact of Anxiety/OCD at School What to Look For in the Classroom Resources for School Personnel How to Talk to Your Students How to Talk to Parents/Families How to Make a Community Referral for Treatment How to Work With your Colleagues How to Manage Personal and Professional Anxiety General Resources Profession-Specific Resources For Teachers – Sample Classroom Accommodations and Support Strategies For Teachers – Sample 504s/IEPs For Behavioral Health Staff – Anxiety/OCD Management Strategies For Behavioral Health Staff – General Information about CBT/ERP For Nurses – Medication Treatment for Pediatric Anxiety and OCD Train Others

Classroom accommodations and support strategies, accommodations for students with anxiety/ocd.

Through classroom accommodations, teachers can help students with anxiety/OCD to keep their studies on track as they work to manage their disorder(s). Which accommodations might be most useful will depend on the specific symptoms the student experiences. Thus, it is good practice to involve the student, their family, relevant school staff, and their external treatment team (if applicable) when choosing an accommodation plan.

It is important to remember that accommodations are not treatment for anxiety/OCD.  It might feel as if providing an accommodation to a student is “giving in” to their anxiety/OCD. You might also worry that it will be a “crutch” for the student that will prevent them from getting better.  This is not the case – accommodations are meant to be temporary aids to students while they progress through their treatment.  As students get their anxiety/OCD symptoms under control, classroom accommodations can be altered and/or removed entirely.

Accommodation Example:  Strategies for Over Anxious Students

In this video, Mary Kathleen Norris, LMHC, talks about strategies that teachers can use with over anxious students.

Read below for additional information about why accommodation strategies are useful and how teachers can use them for specific situations where anxiety/OCD may pose obstacles.

How Classroom Accommodation/Support Strategies can Help

The accommodation and support strategies outlined in this section may be helpful in two main ways:

• They allow students with anxiety/OCD to function in the school setting.
• They help students with anxiety/OCD to stay in school.

Chronically missing school – whether due to overwhelming anxiety/OCD symptoms or the fear of experiencing them in the school setting – can lead to school avoidance.  Providing students with accommodations and support in the classroom and school can minimize stress for students with anxiety/OCD and help prevent school avoidance.

Accommodations/Support Strategies in the School Setting

There are various situations at school where accommodation and support strategies can be used to help children with anxiety or OCD manage.

Accommodation Example:  Strategies for Re-reading

In this video, Mary Kathleen Norris, LMHC, talks about strategies that teachers can use with anxious students who re-read.

Read below for additional accommodation strategies that teachers can for specific situations where anxiety/OCD may pose obstacles.

Below are specific situations that students with anxiety and/or OCD may find more difficult in the school setting. Click the plus sign to the right of each situation to view the sample accomodations and support strategies.

• Allow the student to leave class early (e.g. 3-5min) to avoid crowded hallways during passing periods.
• Allow the student to leave class 3-5min early if additional time is needed at the locker to prepare for the next class.
• If a student’s anxiety or OCD makes transitions from class to class extremely difficult, consider allowing the student to spend longer block of time in the same classroom (if possible) until symptoms improve.
• Provide the student extra time to make in-class transitions from one activity to another. Use a timer or other auditory device to signal that it’s time to start a different task or make another transition.
• Try to keep classroom routines as predictable as possible without sudden changes. Whenever possible, plan in advance for transitions that will occur. Provide the student with cues/signals before a transition to prepare for the upcoming change (e.g. notify child of fire drill prior to fire alarm going off, etc.)
• Whenever possible, send a note home to alert the child/family about an upcoming change in schedule (e.g. substitute teacher, special assembly) to give the student time to process/prepare for change.
• Provide students with a second “work desk” to assist with transitioning between tasks, allowing them to move from one work space to the next when activities shift.
• Reward successful transitions.
• NOTE: Allow all students in class to have access to this area, so as not to make the student with anxiety/OCD feel singled out.
• Provide an alternative, quiet location for the student (such as the library, resource room, “quiet corner” in classroom, etc.)
• Allow the student to use headphones, earphones, ear plugs, etc. to block out background noise.
• Ask the student if providing a cue (such as a code word, hand signal, or standing close to them) would be helpful when they appear to get stuck in their anxiety/OCD.  If so, work with the student to develop a signal that can help them redirect their attention and focus.
• Seat the student closer to the teacher for the purpose of redirecting the student’s attention, as necessary.
• Be available to check the student’s progress and provide feedback as much as possible during the initial stages of independent seatwork.
• Allow the student to compete work in an altered sequence if the usual sequence causes them to get stuck
• Allow the student to work with a partner or in a group; student interaction may distract the student from their anxiety/OCD.
• Pass worksheets out one at a time so the student does not become overwhelmed by too much work at once.
• Use learning materials and teaching methods that provide high levels of student engagement and opportunity to respond.
• Give directions that are short and succinct rather than long and wordy.
• Provide visual aids to accompany verbal directions/instructions (e.g. write them on the board)
• Capture students’ attention prior to giving directions by telling them that they need to listen to instructions about to be given.  Watch for eye contact, modulate voice, or provide a signal such as hand clapping.
• Limit the number of open-ended choices provided to the student.
• Assign a book, topic, etc. instead of asking students to make a choice.
• Give students a choice from 2 alternatives.
• Ask students to tell you the most interesting or important facts about a given topic.
• Ask students to imagine that they are describing information about a given topic to a friend rather than thinking of the task as a graded assignment
• Ask students what questions they have about a given topic and have the student find the answers to these questions.
• Give students one minute to quickly write down as many important points about the topic as possible.  Have students circle the most important ideas, number them, put them into outline form, and begin to fill in information.
• Ask the student close-ended (e.g. yes or no) questions rather than open-ended questions.
• Ask the student opinion questions rather than questions requiring a particular answer.
• Use a signal to let the student know that their turn is coming up, such as lightly touching their desk when circulating the room.
• Call on the student for answers on topics about which they are knowledgeable or confident.
• Refrain from calling on a student who visibly appears to be experiencing anxiety/OCD symptoms.
• Prearrange with the student a system for participating in class.  When they raise their hand and show an open hand, it means “call on me.”  When they raise their hand with a closed fist, it means “Don’t call on me.”  This can help the student appear to be actively participating to help them save face.
• Allow another individual (e.g. an aide or peer) to read to the student, unless the student is uncomfortable with this arrangement.
• Photocopy a reading assignment.  As the student reads, have them draw a line through the words that have been read with a dark marker to prevent rereading.
• Reduce the amount of material to be read: assign shorter assignments, provide a summary of a chapter, allow the student to use a summarized version of a book.
• Photocopy longer reading assignments, highlight the important sections, and have the student read only those parts.
• Suggest that the student read aloud, as that sometimes prevents the intrusion of rituals.
• Give the student the page numbers containing the answers to questions in assigned material.
• Allow the student to use a card/piece of paper to cover anxiety-provoking words in reading material, but keep other words visible.
• Set time limits on the completion of reading assignments, have the student work until time is up.
• Allow the student to submit an assignment involving reading after the due date.  Establish a contract delineating the modified due dates/times with students who have difficulty turning in assignments.
• Divide reading assignments into shorter segments and allow breaks in between.
• Allow the student to use a word processor rather than write by hand.
• Allow the student to print, if cursive handwriting is problematic (or vice versa).
• Have the student use an audio recorder to record lectures instead of writing notes.
• Permit the student to give responses orally/on an audio recorder.
• Have the student use a pencil without an eraser.
• Have the student use unlined paper, if the student feels compelled to write every letter perfectly on the lines of lined paper.
• Allow the student to dictate answers to another individual (e.g. paraprofessional, peer, parent) who writes down the information for the student.
• Have the student write an outline of the lecture provided by the teacher.
• Allow the student to use a mechanical pencil if traditional pencils have to be sharpened perfectly.
• Allow the student to highlight the sentences/sections that answer the assigned question on a photocopy of a reading assignment.
• Have the student write only the answers to questions rather than the questions and answers.
• Set up a system in which a classmate provides a copy of their notes for the student, unless the student is uncomfortable with this arrangement.
• Provide the student with alternatives to written assignments, e.g. have them do a mural, model, poster, picture, diorama, etc. to demonstrate their knowledge of a topic.
• Reduce the number of items the student is required to write, or have student complete odd- or even-numbered items, starred items, etc.
• Set time limits on completion of written assignments, have the student work until time is up.
• Divide written assignments into shorter segments and allow breaks in between.
• Allow the student additional time to submit an assignment involving writing.  Establish a contract delineating the modified due dates/times with students who have difficulty turning in assignments.
• Refrain from complimenting the student on “perfect” work if they spend hours at home writing/rewriting assignments until they are “perfect.”
• Provide extra time to complete a test.
• Allow the student to take a test over periods of time.
• Provide breaks during a test.
• Permit the student to take a test in a different part of the room or in a location other than the classroom to avoid distractions and reduce the potential for ritualizing.
• Allow the student to take tests orally.
• Permit the student to write directly on the test booklet rather than fill in circles on computerized test sheets.
• Supervise the correct placement of answers if the student does use bubble sheets.
• Provide multiple choice or short answer tests in lieu of essay tests if writing is problematic.
• Encourage students to review the entire test before answering any questions and do the easiest questions first to build confidence.
• Give open-book or take-home tests.
• Allow the student to submit an alternate product in lieu of a test (e.g. project, drawing).
• Be very cautious about timed tests – they are extremely anxiety-provoking for some students.  It may be preferable to allow the student to complete the sheet without a time limit and inconspicuously record the student’s beginning and ending times.
• Have the student use an assignment book that parents and teachers check daily.  Provide space for teachers and parents to make comments, thus promoting communication between them.
• Have students use visual organizing systems, such as color-coded folders or sticky notes, to keep assignments organized.
• Help the student set up a notebook with 3 individual dividers for organizational purposes – one for “Work to be done,” one for “Completed work,” and one for “Papers to save.”
• Help the student with breaking down longer tasks into smaller, more manageable tasks.
• Try to establish limits on how much time should be spent on any part of a project; communicate with parents to enlist their help in determining and enforcing time limits.
• Write a contract with the student delineating how the project will be broken down and deadlines for each part; work with parent to carefully monitor progress.
• Provide students charts, outlines, flow charts, and/or other graphic organizers that provide cues for completing various assignments.
• Provide students an outline of a lecture; students use a highlighter pen to follow along as the teacher lectures.
• Provide partial notes containing the main ideas of the lecture, leaving space for student notes.
• Give students cues regarding the importance of specific ideas during the lecture.
• Allow students to review positive models of notes, such as those from other or previous students.
• Have the student use an audio recorder to record lectures in lieu of writing notes.
• Communicate with parents to ensure that the student has an appropriate environment for studying at home.  Encourage parents to schedule family activities, extracurricular activities, doctor appointments, etc. so they do not interfere with studying time.
• Suggest that the student study with a partner or in a study group.
• Encourage students to create various aids, such as flashcards, pictures, summaries, etc., to help them organize and remember material.
• Encourage students to study a little bit at a time instead of trying to cram the night before.
• Teach student mnemonic devices to aid in memorization, like acronyms and acrostics.
• Use a cue to signal that homework is going to be announced.
• Write homework directions on the board in addition to announcing them verbally.
• Have a peer tutor, paraprofessional, or other individual cue the student when homework is being assigned and when the assignment needs to be recorded in an assignment book.
• Post homework assignments on a homework hotline (telephone or online).
• Provide a specific time at the end of the day for organizing books and materials that need to go home.  If the student has a second set of books/materials at home, ensure that appropriate materials stay in school.
• Have a peer tutor, paraprofessional, or other individual assist the student with organizing materials to take home/leave at school.
• Create a form for the student listing materials that need to go home/stay in school each day.
• Talk with parents to ensure that the student has an appropriate environment in which to do homework.
• Reduce the amount of homework assigned.
• Ask parents how much time their student spends on homework in the evening without undue stress, and then assign homework that can be completed within that timeframe.  As the student progresses in treatment, the time limit may be increased.
• Give the student estimates of how much time an assignment should take.
• Tell students to work on an assignment for a certain period of time and to stop when that period of time is over.  As the student progresses in treatment, the time limit may be increased.
• Do not, as a rule, send home class work that has not been completed during the school day as homework.
• Suggest to the student that they try switching to another subject if they get stuck on a particular assignment.
• Suggest to the student that they try doing homework with a friend, or assign them to a peer tutor/study group.
• Do not penalize the student for missed work if their anxiety/OCD symptoms are interfering.
• Consider various options with regard to grading homework: grade assignments on the basis of content rather than neatness, allow some ungraded assignments, be flexible with due dates, use only those part of an assignment that have been completed as the basis for assigning a grade, grade rough drafts and/or allow the student to submit additional drafts.
• Attend to comments made by students when homework is not turned in (e.g. “I think I made a lot of mistakes,” “It’s not good enough to turn in”) for possible insights into their anxiety/OCD.
• Communicate regularly with parents regarding homework completion and other issues via an assignment notebook, parent-teacher log, etc.
• Provide usual consequences for homework not completed for reasons unrelated to anxiety/OCD.

Accommodations/Support Strategies Around Specific Topics or Themes

Children with anxiety or OCD may require accommodations around certain topics or themes such as contamination, doubting, and procrastination.

Below are specific topics or themes that students with anxiety and/or OCD may have difficulty with. Click the plus sign to the right of each situation to view the sample accommodations and support strategies.

• Allow the student to have a separate set of books at home and at school.
• Allow the student to have their own set of materials at school to avoid using those handled by classmates.
• Allow the student to use a locker that is removed from those of other students.
• Give the student permission to be first in line in the cafeteria to avoid other students’ “contamination.”
• Give the student permission not to be first in line in classrooms to preclude having to touch door knobs.
• Seat the student where they will be first to receive handouts.
• Provide the student with an easy exit from a trigger situation to save face.
• Allow the student to use hand sanitizer in lieu of going to the bathroom to wash.
• Allow the student to use a bathroom infrequently used by other students if they are unable to use high-traffic bathrooms.
• Provide the student with an alternative to an activity if the activity is associated with contamination.
• Permit the use of calculator to check math answers one time only.
• Permit the use of spelling/grammar checkers if the student has fears of making errors.
• Allow a time period during the school day for the student to check their backpack/other materials to ensure that all necessary items are included.
• Allow tardiness – do not apply negative consequences when the student is suffering from anxiety/OCD.  Students often experience less stress and anxiety when they know there will be no penalty for tardiness, and thus are more likely to arrive on time.
• When a student with anxiety/OCD is late, ignore their entrance as much as possible and continue with the lesson to avoid drawing attention to the student – do not react to their tardiness with negative remarks, frustration, or anger.
• Apply incentive systems for being on time when the student’s symptoms improve.
• Adapt the student’s schedule to fit their needs.
• Try to schedule classes to match the student’s energy level.

Accommodations/Support Strategies Around Specific Social/Emotional Issues

In addition to the above, children with anxiety or OCD may also require accommodations around social and emotional issues such as self-esteem and social interactions.

Accommodation Example: Strategies for Socially Anxious Students

In this video, Mary Kathleen Norris, LPC, talks about strategies that teachers can use to help socially anxious students.

Read below for examples of accommodation strategies around specific social/emotional issues.

To watch video about specific accommodation strategies for over-anxious students, click here.

Below are specific social/emotional issues that students with anxiety and/or OCD may have difficulty with. Click the plus sign to the right of each situation to view the sample accommodations and support strategies.

• Prearrange a system in which the student signals the teacher regarding the need to leave the room because symptoms are building and they are starting to feel overwhelmed (e.g. an index card, hand signal, etc.).  The signal should be as inconspicuous as possible to avoid drawing classmates’ attention to it, and time limits for the break should be established with the student in advance.
• Provide an alternate location to which a student may go when they leave the classroom to regroup or calm down, such as the nurse’s or school psychologist’s office.  It must be emphasized that this is not a traditional time-out in which the student is punished by being removed from the current activity.
• Allow the student to leave the room briefly to get a drink of water, run an errand, etc. to help clear their mind of their anxious/obsessive thoughts.
• Seat the student closer to the classroom door for an easy exit if and when one is needed.
• Provide a designated time (e.g. recess, lunch, etc.) during which the student may engage in rituals if they feel compelled to perform them at school.
• Be creative about devising “face-saving” choices for students when their symptoms become noticeable to peers.
• Seat the student in a location where their symptoms will be least obvious to classmates.
• Continue to conduct class if the student engages in anxiety/OCD behaviors that are obvious to peers.  Make advance arrangements with the student that they can join the rest of the class after they are done.  Stopping a lesson to focus on the student can be extremely humiliating.
• Try to distract the attention of classmates away from the student when they are engaging in their anxiety/OCD behaviors.
• Avoid trying to stop a ritual when the student is experiencing a high level of anxiety, as a major conflict could arise.  When anxiety levels appear lower, redirecting the student may then be helpful.
• Interact with the student as calmly and neutrally as possible when disruptions do occur – never reprimand the student or engage in public displays of anger or frustration.
• NOTE: Do not use these talents or enjoyable activities as rewards, or take them away as punishments.
• Be open to assigning the student to a teacher(s) who are more empathic to the needs of a student struggling with mental health concerns.  A particular teacher can make or break a student’s school experience.
• Be a good role model with regard to appreciating diversity, including individual differences associated with disabilities.  
• Structure classroom activities to promote social interaction among students with anxiety/OCD and their peers.  It may be helpful to assign students to work with a partner/group of students who demonstrate empathy/respect for others.
• Avoid situations in which team captains choose team players, or other situations in which students can self-select into their own groups.  This may lead to students with anxiety/OCD being the last one chosen or feeling left out.
• Establish a “buddy system” in which the student joins one or two others during recess, lunch time, and other social periods.  This may reduce anxiety and help relieve the isolation and loneliness students with anxiety/OCD often feel.

Culturally Mindful Accommodations/Support Strategies for BIPOC Youth

Educators are uniquely positioned to provide accommodation and culturally mindful support strategies that can help BIPOC youth manage anxiety, OCD, or stress symptoms.

Read on for additional accommodation strategies that teachers can implement to support BIPOC youth: 

• School staff can promote racial pride amongst students, increase awareness and acknowledgment of race, and reduce the consequences of racial trauma by creating safe spaces within the classroom that impart messages of diversity and inclusion .
• Learn about the impacts of history and systemic racism and utilize cultural references that will resonate with your students. 
• Be mindful of expressing bias or differential treatment against children of color (e.g. increased surveillance or discipline, etc.). 
• Create meaningful and authentic relationships with BIPOC students and families. Provide support to the student’s caregivers, especially those who may seem disconnected from school. 
• Encourage and empower students within the classroom and their community . Helping students feel empowered to exercise their agency can promote healing from racism-based trauma.
• Promote student-centered curriculum development and listen to the voices of students from underrepresented groups.

What if they aren't even coming to school?

School avoidance can be a common issue for students with anxiety/OCD.  The School Avoidance Alliance has come up with an intervention roadmap for educators to help bridge the gap with avoidant students, and work to get them back into the classroom.  Click here to learn more.

When Should an 504/IEP Be Considered?

In addition to the strategies mentioned above, your students OCD or anxiety symptoms may qualify as a disability if they are severe enough that they impact his/her ability to learn.  In these cases, the student who is in public school is eligible for a 504 Plan or an Individualized Education Plan (IEP). Learn more about 504s/IEPs.

Why Avoidance Coping is the Most Important Factor in Anxiety

Avoidance coping causes anxiety to snowball..

Posted March 5, 2013 | Reviewed by Devon Frye

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"Avoidance coping" refers to choosing your behavior based on trying to avoid or escape particular thoughts or feelings.

It can involve "doing" (e.g., someone who excessively washes their hands to try to get rid of fears about contamination) or "not doing" (e.g., when someone indefinitely puts off having an awkward conversation).

Avoidance coping causes anxiety to snowball because when people use avoidance coping they typically end up experiencing more of the very thing they were trying to escape.

How Avoidance Coping Leads to Increased Anxiety

Here are some examples related to anxiety disorders, but the principle applies to anxiety generally.

• People with panic disorder engage in avoidance coping (including not leaving their home in some cases) in order to try to avoid panicky feelings. The more they try to avoid situations that might trigger panicky feelings, the more almost every situation begins to trigger panicky feelings.
• People with eating disorders put tremendous effort into avoiding feeling fat, but the more they do so, the more their lives are consumed by weight and shape concern.

A non-clinical example is when people who fear abandonment act needy (e.g., they ask their partner, "Do you promise you won't leave me?" repeatedly) and their reassurance seeking (aimed at reducing their fears) creates a self-fulfilling prophecy because their partner gets sick of needing to provide reassurance.

Even rumination can be considered a type of avoidance coping. When people engage in rumination (overthinking) they are typically trying to think their way out of uncomfortable emotions. A common example is ruminating to try to escape feelings of uncertainty

How to Overcome Avoidance Coping

1. Recognize that it doesn't work.

Ask yourself: What have you been trying to avoid? Have you been feeling awkward? Feeling anxious? Have you had thoughts of not being good enough? Do you still have those feelings or thoughts?

2. Recognize the costs of avoidance coping.

Ask: What has avoidance coping cost you? How much time and mental energy has avoidance coping sucked up? How has it impacted your health? How has it affected your relationships? How has it affected your sense of yourself as a competent person?

3. Learn to tolerate uncomfortable thoughts and feelings.

You need to learn how to tolerate experiencing thoughts and feelings you'd prefer not to experience until they naturally pass (thoughts and feelings are, by their nature, temporary). If you can do this, you won't need to use avoidance coping.

Being prepared to experience anxiety will overall lead to less anxiety. Things that can help with this include:

• Learning to soften rather than tense in response to triggering thoughts and feelings or when you catch yourself doing a self-defeating behavior.
• Learning physiological self-soothing skills (for example: teaching yourself how to activate your parasympathetic nervous system by doing things like slow breathing, which in turn slows down your heart rate and makes it easier to think more clearly).
• Learning to recognize that thoughts are often distorted so you can't always trust any negative thoughts you have.
• Building up your capacity to self-regulate —e.g., if you're prone to overeating, then setting a schedule for eating that meets your energy needs. Then, only eating at these times—not eating outside these times or skipping scheduled eating times.
• Using "defusion" skills to reduce the psychological grip of intrusive thoughts. For many people, defusion skills are highly effective but at first glance they seem quite odd. For example, singing your intrusive thoughts to the tune of a familiar song.

Alice Boyes, Ph.D., translates principles from Cognitive Behavioral Therapy and social psychology into tips people can use in their everyday lives.

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Challenging Your Negative Thinking (Archived)

Classical Conditioning

Cognitive Behavioral Model Of Depersonalization (Hunter, Phillips, Chalder, Sierra, David, 2003)

Cognitive Behavioral Model Of Fear Of Body Sensations

Cognitive Behavioral Model Of Generalized Anxiety Disorder (GAD: Dugas, Gagnon, Ladouceur, Freeston, 1998)

Cognitive Behavioral Model Of Health Anxiety (Salkovskis, Warwick, Deale, 2003)

Cognitive Behavioral Model Of Intolerance Of Uncertainty And Generalized Anxiety Disorder Symptoms (Hebert, Dugas, 2019)

Cognitive Behavioral Model Of Panic (Clark, 1986)

Cognitive Behavioral Model Of Persistent Postural-Perceptual Dizziness (PPPD: Whalley, Cane, 2017)

Cognitive Behavioral Model Of Social Phobia (Clark, Wells, 1995)

Cognitive Distortions – Unhelpful Thinking Styles (Common)

Cognitive Distortions – Unhelpful Thinking Styles (Extended)

Combined Relaxation Exercise (Audio)

Compassionate Thought Challenging Record

Coping With Body Sensations (Psychology Tools For Overcoming Panic)

Core Belief Magnet Metaphor

Court Trial Thought Challenging Record (Archived)

Critical Care And PTSD

Decatastrophizing

Developing Psychological Flexibility

Disqualifying The Positive

Embracing Uncertainty

Emotional Reasoning

Emotions In Panic (Psychology Tools For Overcoming Panic)

Emotions Motivate Actions

Evaluating Unhelpful Automatic Thoughts

Exercise For Mental Health

Exposure Practice Form

Exposure Session Record

Exposures For Fear Of Appearing Anxious

Exposures For Fear Of Body Sensations

Exposures For Fear Of Breathlessness

Exposures For Fear Of Death

Exposures For Fear Of Flying

Exposures For Fear Of Heights

Exposures For Fear Of Illness

Exposures For Fear Of Losing Control Of Your Mind

Exposures For Fear Of Uncertainty

Exposures For Fear Of Vomiting

Externalizing

Facing Your Fears (CYP)

Facing Your Fears And Phobias

Fear Ladder

Fight or Flight (CYP)

Fight Or Flight Response

Grounding Statements (Audio)

Grounding Techniques

Grounding Techniques Menu

Habituation

Health Anxiety - Self-Monitoring Record

Health Anxiety Formulation

Health Anxiety Self-Monitoring Record (Archived)

Health Anxiety Thought Record

How Breathing Affects Feelings

How Does This All Add Up To A Panic Attack? (Psychology Tools For Overcoming Panic)

How Is Panic Disorder Different From A Panic Attack? (Psychology Tools For Overcoming Panic)

How Much Do You Know About Panic? (Psychology Tools For Overcoming Panic)

How Your Body Responds To Stress

Identifying The Meaning Of Body Sensations

Interoceptive Exposure

Interpersonal Beliefs And Styles

Intolerance Of Uncertainty

Introduction To CBT (Psychology Tools For Overcoming Panic)

Intrusive Memory Record

Jumping To Conclusions

Learning To Relax (CYP)

Living With Worry And Anxiety Amidst Global Uncertainty

Magnification And Minimization

Links to external resources.

Psychology Tools makes every effort to check external links and review their content. However, we are not responsible for the quality or content of external links and cannot guarantee that these links will work all of the time.

• Scale Download Primary Link Archived Link
• Reference Lambe, S., Bird, J. C., Loe, B. S., Rosebrock, L., Kabir, T., Petit, A., ... & Freeman, D. (2023). The Oxford agoraphobic avoidance scale. Psychological Medicine, 53(4), 1233-1243.
• Scale – Adult Download Primary Link Archived Link
• Scale – Child Age 11-17 Download Primary Link Archived Link
• Spence, S. H. (1998). A measure of anxiety symptoms among children. Behaviour Research and Therapy, 36 (5), 545-566.
• Scale website link Download Primary Link Archived Link
• Meyer, T. J., Miller, M. L., Metzger, R. L., & Borkovec, T. D. (1990). Development and validation of the penn state worry questionnaire. Behaviour Research and Therapy, 28(6), 487-495.
• Scale archive.org Download Primary Link
• Shear, M. K., Brown, T. A., Barlow, D. H., Money, R., Sholomskas, D. E., Woods, S. W., … & Papp, L. A. (1997). Multicenter collaborative panic disorder severity scale. American Journal of Psychiatry, 154(11), 1571-1575.
• Scale Download Archived Link
• Chambless, D. L., Caputo, G. C., Jasin, S. E., Gracely, E. J., & Williams, C. (1985). The mobility inventory for agoraphobia. Behaviour research and therapy, 23(1), 35-44.
• Scale Download Primary Link
• Reference Salkovskis, P. M., Rimes, K. A., Warwick, H. M. C., & Clark, D. M. (2002). The Health Anxiety Inventory: development and validation of scales for the measurement of health anxiety and hypochondriasis. Psychological Medicine, 32(05), 843-853.
• Hamilton, M. (1959).The assessment of anxiety states by rating. British Journal of Medical Psychology 32, 50-55.
• Spitzer RL, Kroenke K, Williams JBW, Lowe B. A brief measure for assessing generalized anxiety disorder. Arch Inern Med. 2006;166:1092-1097.
• Marks, I. M., & Mathews, A. M. (1979). Brief standard self-rating for phobic patients. Behaviour Research and Therapy, 17(3), 263-267.
• Brief Fear Of Negative Evaluation Scale | Leary | 1983 Download Primary Link Archived Link

Guides and workbooks

• Specific phobia: patient treatment manual | Clinical Research Unit for Anxiety and Depression (CRUfAD) Download Primary Link Archived Link
• Working To Overcome Anxiety (Workbook) | Lucock, Noble, Pallister, Horsefield, Padgett, Westley, Atha, Khan | 2015 Download Primary Link Archived Link
• Anxiety And Substance Use | NDARC: Mills, Marel, Baker, Teesson, Dore, Kay-Lambkin, Manns, Triningham | 2011 Download Primary Link Archived Link
• Social Anxiety (An NHS Self-Help Guide) | Lesley Maunder, Lorna Cameron | 2020 Download Primary Link Archived Link
• Phobia Self-Help Booklet | Anne Joice, Jim White | 2006 Download Archived Link
• Panic attacks: what they are and how to stop the next one | Glasgow STEPS Download Archived Link
• Coping with panic | Charles Young, Alison Hunte, Jessica Newell, Pat Valian | 2011 Download Archived Link
• Health Anxiety – A Self-Help Guide | Maunder, Cameron, Young, Leyland | 2015 Download Archived Link

Information Handouts

• What Is Panic? Download Primary Link Archived Link
• Biology and Psychology of Panic Download Primary Link Archived Link
• The Vicious Cycle of Anxiety Download Primary Link Archived Link
• Breathing Retraining Download Primary Link Archived Link
• Behavioural Experiments (Negative Predictions) Download Primary Link Archived Link
• Situational Exposure Download Primary Link Archived Link
• Physical Sensations and Panic Download Primary Link Archived Link
• What Are Safety Behaviours? Download Primary Link Archived Link
• What is health anxiety? Download Primary Link
• What are safety behaviors? Download Primary Link
• Dealing with health information Download Primary Link
• What is social anxiety? Download Primary Link
• What can be done about social anxiety? Download Primary Link
• Breathing retraining Download Primary Link
• Progressive muscle relaxation Download Primary Link
• Improving how you feel Download Primary Link
• Thinking and feeling Download Primary Link
• Analysing your thinking Download Primary Link
• Changing your thinking Download Primary Link
• Unhelpful thinking styles Download Primary Link
• What are core beliefs? Download Primary Link
• Situational exposure Download Primary Link
• Staying healthy Download Primary Link
• What is anxiety? Download Primary Link
• The vicious cycle of anxiety Download Primary Link
• Behavioral experiments Download Primary Link
• What are safety behaviours? Download Primary Link
• Stress and anxiety Download Primary Link
• Coping with stress Download Primary Link
• Anxiety and exercise Download Primary Link
• What is needle phobia? Download Primary Link
• Overcoming needle phobia Download Primary Link
• CBT for anxiety Download Primary Link

Information (Professional)

• Task Concentration Training Definition | Bögels Download Primary Link Archived Link
• Interoceptive Exposure Definition | White, Basden, Barlow Download Archived Link
• Assertive defense of the self (A more effective treatment focus for social phobia?) | Padesky | 1985 Download Primary Link Archived Link

Presentations

• Why worry? Key cognitive processes that maintain worry and Generalised Anxiety Disorder | Colette Hirsch Download Primary Link Archived Link
• New developments in exposure therapy for anxiety and related disorders: the inhibitory learning approach | Blakey, Abramowitz | 2018 Download Primary Link Archived Link
• Bringing Specificity to Generalized Anxiety Disorder: Conceptualization and Treatment of GAD using Intolerance of Uncertainty as the Theme of Threat | Robichaud | 2013 Download Primary Link Archived Link
• GAD – a cognitive model and treatment Download Primary Link Archived Link
• Desirable difficulties: optimizing exposure therapy for anxiety through inhibitory learning | Abramowitz, Jacoby, Blakey | 2018 Download Primary Link Archived Link

Self-Help Programmes

• Module 1: Overview Of Generalized Anxiety Download Primary Link
• Module 2: Overview Of Worrying Download Primary Link
• Module 3: Challenging Uncontrollability Beliefs Download Primary Link
• Module 4: Attention Training Download Primary Link
• Module 5: Challenging Danger Beliefs Download Primary Link
• Module 6: Challenging Positive Beliefs Download Primary Link
• Module 7: Problem-Solving Download Primary Link
• Module 8: Helpful Thinking Download Primary Link
• Module 9: Accepting Uncertainty Download Primary Link
• Module 10: Self Management Plan Download Primary Link
• Module 1: Understanding Social Anxiety Download Primary Link Archived Link
• Module 2: Overcoming Negative Thinking Download Primary Link Archived Link
• Module 3: Overcoming Avoidance Download Primary Link Archived Link
• Module 4: Behavioral Experiment Stepladders Download Primary Link Archived Link
• Module 5: Safety Behaviors Download Primary Link
• Module 6: The Role Of Attention Download Primary Link Archived Link
• Module 7: How I Think I Appear To Others Download Primary Link Archived Link
• Module 8: Challenging Core Beliefs Download Primary Link
• Module 9: Strengthening New Core Beliefs Download Primary Link
• Module 10: Maintaining Your Gains And Dealing With Setbacks Download Primary Link
• Module 1: Overview Of Panic Download Primary Link
• Module 2: What Keeps Panic Disorder Going Download Primary Link
• Module 3: Overcoming Thoughts About Panic Download Primary Link
• Module 4: Coping With Physical Alarms Download Primary Link
• Module 5: Facing Feared Situations Download Primary Link
• Module 6: Dropping Safety Behaviors Download Primary Link
• Module 7: Maintaining Your Gains Download Primary Link

Treatment Guide

• Cognitive behavioral therapy for anxiety: an application of the F.E.A.R. model for adults | Stephen Lenz Download Primary Link Archived Link
• The CARS cognitive behavioral treatment for anxiety manual | Center for Adolescent Research in Schools | 2014 Download Primary Link Archived Link
• Comprehensive cognitive behavior therapy for social phobia: a treatment manual | Deborah Roth Ledley, Edna B. Foa, Jonathan D. Huppert (in consultation with David M. Clark) | 2005 Download Primary Link Archived Link
• Canadian clinical practice guidelines for the management of anxiety, posttraumatic stress and obsessive-compulsive disorders (2014) | Katzman et al | 2014 Download Primary Link Archived Link
• Panic disorder: Manual for Improving Access to Psychological Therapy (IAPT) High intensity CBT therapists. | David Clark, Paul Salkovskis | 2009 Download Primary Link Archived Link
• Comprehensive cognitive behavior therapy for social phobia: a treatment manual | Ledley, Foa, Huppert, Clark | 2006 Download Primary Link
• NICE Guidelines For Social Anxiety Disorder | NICE | 2013 Download Primary Link
• NICE Guidelines For GAD And Panic | NICE | 2011 Download Primary Link
• A brief cognitive-behavioural treatment for social anxiety disorder | Eric P. Morris, David Mensink, and Sherry H. Stewart Download Archived Link
• Breathing Rate Record Download Primary Link Archived Link
• Anxiety Symptoms Download Primary Link Archived Link
• Monitoring Relaxation Download Primary Link Archived Link
• Situational Exposure Diary Download Primary Link Archived Link
• Internal Exposure Record Download Primary Link Archived Link
• Anxiety symptoms record Download Primary Link
• Breathing rate record Download Primary Link
• Monitoring your relaxation level Download Primary Link
• Weekly activity schedule Download Primary Link
• Weekly goals record Download Primary Link
• Making the connection Download Primary Link
• Thought diary 1 Download Primary Link
• Thought diary 2 Download Primary Link
• Thought diary 3 Download Primary Link
• Thought diary (tri-fold) Download Primary Link
• Core beliefs worksheet Download Primary Link
• Situational exposure: building steps Download Primary Link
• Healthy me Download Primary Link
• Goal setting: end of therapy Download Primary Link
• Anxiety Symptoms Record Download Primary Link
• Breathing Rate Record Download Primary Link
• Monitoring Relaxation Download Primary Link
• Situational Exposure Diary Download Primary Link
• Making The Connection Download Primary Link
• Thought Diary 1 Download Primary Link
• Thought Diary 2 Download Primary Link
• Thought Diary 3 Download Primary Link
• Thought Diary (Tri-Fold) Download Primary Link
• Behavioral Experiment Worksheet Download Primary Link

Recommended Reading

Health anxiety.

• Salkovskis, P. M., Warwick, H. M. C., Deale, A. C. (2003). Cognitive-Behavioral Treatment for Severe and Persistent Health Anxiety (Hypochondriasis). Brief Treatment and Crisis Intervention, 3, 353-367 btci.edina.clockss.org Download Archived Link

Social Anxiety Disorder

• Warnock-Parkes, E., Wild, J., Stott, R., Grey, N., Ehlers, A., & Clark, D. M. (2017). Seeing is believing: Using video feedback in cognitive therapy for social anxiety disorder. Cognitive and behavioral practice, 24(2), 245-255. view Download Primary Link Archived Link
• Veale, D. (2003). Treatment of social phobia. Advances in Psychiatric Treatment, 9, 258-264 Download Primary Link Archived Link
• Wild, Hackmann, Clark (2008). Rescripting early memories linked to negative images in social phobia: a pilot study. Behaviour Therapy, 39(1), 47-56. Download Primary Link
• Moscovitch, D. A. (2009). What is the core fear in social phobia? A new model to facilitate individualized case conceptualization and treatment. Cognitive and Behavioural Practice, 16. 123-134 Download Archived Link
• Clark, D. M. (2001). A cognitive perspective on social phobia Download Archived Link

Panic disorder

• Wells, A. (1997). Cognitive Therapy of Anxiety Disorders. Chichester: Wiley.
• Schmidt, N. B., Woolaway-Bickel, K., Trakowski, J. et al. (2000). Dismantling cognitive-behavioural treatment for panic disorder: Questioning the utility of breathing retraining. Journal of Consulting and Clinical Psychology, 68(3), 417-424 Download Archived Link
• Huppert, J. D., & Baker-Morissette, S. L. (2003). Beyond the manual: The insider’s guide to panic control treatment.Cognitive and Behavioral Practice,10(1), 2-13.
• Clark, D. A. (1999). Anxiety disorders: Why they persist and how to treat them. Behaviour Research and Therapy, 37, S5-S27 Download Primary Link Archived Link
• Walker, J. R., Furer, P. (2008). Interoceptive exposure in the treatment of health anxiety and hypochondirasis. Journal of Cognitive Psychotherapy, 22(4), 366-378 Download Primary Link
• Warnock-Parkes, E., Wild, J., Thew, G., Kerr, A., Grey, N., & Clark, D. (2022). ‘I’m unlikeable, boring, weird, foolish, inferior, inadequate’: How to address the persistent negative self-evaluations that are central to social anxiety disorder with cognitive therapy. The Cognitive Behaviour Therapist, 15, E56. doi:10.1017/S1754470X22000496 view Download Primary Link Archived Link
• Furer, P., Walker, J. R. (2008). Death anxiety: A cognitive behavioural approach. Journal of Cognitive Psychotherapy, 22(2), 167-182 Download Primary Link
• Asmundson, G. J. G., Abramowitz, J. S., Richter, A. A., Whedon, M. (2010). Health anxiety: current perspectives and future directions. Current Psychiatry Reports, 12, 306-312 Download Primary Link

Generalized Anxiety Disorder

• Roemer, L., Salters, K., Raffa, S. D., & Orsillo, S. M. (2005). Fear and avoidance of internal experiences in GAD: Preliminary tests of a conceptual model.Cognitive Therapy and Research,29(1), 71-88.
• Roemer, L., & Orsillo, S. M. (2002). Expanding our conceptualization of and treatment for generalized anxiety disorder: Integrating mindfulness/acceptance‐based approaches with existing cognitive‐behavioral models.Clinical Psychology: Science and Practice,9(1), 54-68 Download Primary Link Archived Link
• Mennin, D. S., Heimberg, R. G., Turk, C. L., & Fresco, D. M. (2002). Applying an emotion regulation framework to integrative approaches to generalized anxiety disorder.Clinical Psychology: Science and Practice,9(1), 85-90 Download Primary Link Archived Link
• Fresco, D. M., Mennin, D. S., Heimberg, R. G., & Ritter, M. (2013). Emotion regulation therapy for generalized anxiety disorder.Cognitive and Behavioral Practice,20(3), 282-300 nih.gov Download Primary Link
• Wells, A. (1995). Meta-cognition and worry: A cognitive model of generalized anxiety disorder.Behavioural and cognitive psychotherapy,23(3), 301-320 Download Archived Link
• Hjemdal, O., Hagen, R., Nordahl, H. M., & Wells, A. (2013). Metacognitive therapy for generalized anxiety disorder: Nature, evidence and an individual case illustration.Cognitive and Behavioral Practice,20(3), 301-313.
• Hjemdal, O., Hagen, R., Nordahl, H. M., & Wells, A. (2013). Metacognitive therapy for generalized anxiety disorder: Nature, evidence and an individual case illustration.Cognitive and Behavioral Practice,20(3), 301-313 Download Primary Link Archived Link
• Borkovec, T. D., Alcaine, O., & Behar, E. (2004). Avoidance theory of worry and generalized anxiety disorder.Generalized anxiety disorder: Advances in research and practice,2004.
• Dugas, M. J., Gagnon, F., Ladouceur, R., & Freeston, M. H. (1998). Generalized anxiety disorder: A preliminary test of a conceptual model.Behaviour research and therapy,36(2), 215-226.
• Milne, S., Lomax, C., & Freeston, M. H. (2019). A review of the relationship between intolerance of uncertainty and threat appraisal in anxiety. the Cognitive Behaviour Therapist, 12. Download Primary Link
• Hirsch, C. R., Beale, S., Grey, N., & Liness, S. (2019). Approaching cognitive behavior therapy for generalized anxiety disorder from a cognitive process perspective. Frontiers in psychiatry, 10, 796. Download Primary Link Archived Link
• Bottesi, G., Ghisi, M., Carraro, E., Barclay, N., Payne, R., & Freeston, M. H. (2016). Revising the Intolerance of Uncertainty Model of Generalized Anxiety Disorder: Evidence from UK and Italian Undergraduate Samples.Frontiers in psychology,7, 1723 Download Primary Link Archived Link
• Behar, E., DiMarco, I. D., Hekler, E. B., Mohlman, J., Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23, 1011-1023 Download Primary Link Archived Link
• Clark, D. M. (1999). Anxiety disorders: why they persist and how to treat them. Behaviour Research and Therapy, 37, S5-S27 Download Primary Link Archived Link
• Task concentration training and fear of blushing | Bögels, Mulkens, De Jong | 1997 Download Archived Link

What Is Anxiety?

Signs and symptoms of anxiety disorders.

Different anxiety disorders are characterized by various foci of concern.

• Generalized anxiety disorder (GAD) is characterized by excessive worry about hypothetical future events .
• Health anxiety is characterized by concern about one’s health or illness.
• Panic attacks are characterized by an abrupt surge or intense fear .
• Specific phobia is characterized by the ability for a specific object or situation to provoke marked fear or anxiety .
• Social anxiety disorder is characterized by a fear of social situations in which the individual may be exposed to possible scrutiny .

In addition to disorder-specific cognitive content, individuals experiencing anxiety disorders are likely to experience physical symptoms of anxiety including:

• palpitations or accelerated heart rate
• trembling or shaking
• difficulty breathing
• a feeling of choking
• nausea or abdominal discomfort
• derealization or depersonalization
• fear of losing control or passing out
• fear of dying
• hot flushes or cold chills
• numbness or tingling
• fear of vomiting
• urgency or fear of urination or defecation

Psychological Models and Theories of Anxiety

One broad conceptualization of anxiety can be summarized by an ‘anxiety equation’ (Beck, Emery, & Greenberg, 1985; Salkovskis, Forrester, & Richards, 1998):

Anxiety = (perceived probability of therapy × perceived cost or awfulness of danger) ÷ (perceived ability to cope + perceived ‘rescue factors’)

Disorder-specific ‘CBT for anxiety’ cognitive models  have been developed for all of the anxiety disorders. These are helpful in that they direct the therapist’s attention toward key interpretations and behaviors that act to perpetuate the anxiety disorders . For example, the critical mechanism that Clark identified in the cognitive model of panic (1986) is that body sensations are misinterpreted catastrophically as signs of danger , with concomitant effects upon emotions, behavior, and secondary cognitions.

Evidence-Based Psychological Approaches for Working with Anxiety

Cognitive behavior therapy has a strong evidence base for treating all of the anxiety disorders. Key components of CBT for anxiety interventions include exposure to the feared situations or stimulus, and an experimental approach to test the accuracy of beliefs .

Resources for Working with Anxiety

Psychology Tools resources available for working therapeutically with anxiety may include:

• psychological models of anxiety
• information handouts for anxious patients
• exercises for anxiety
• CBT worksheets for anxiety
• self-help programs for anxiety including a guide to overcoming panic attacks and panic disorder
• Beck, A. T., Emery, G., & Greenberg, R. L. (1985). Anxiety disorders and phobias: A cognitive perspective . New York: Basic Books.
• Clark, D. M. (1986). A cognitive approach to panic. Behaviour  Research and Therapy , 24 (4), 461–470.
• Salkovskis, P. M., Forrester, E., & Richards, C. (1998). Cognitive–behavioral approach to understanding obsessional thinking. The British Journal of Psychiatry , 173 (S35), 53–63.
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What Educators Need to Know About the Intense Anxiety That Keeps Students Home From School

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As schools deal with surges in chronic absenteeism , many educators say an increase in anxiety and mental health concerns have contributed to the problem—and those factors can be difficult to address.

Psychologists use the term “school avoidance,” also known as school refusal, to describe a fear or anxiety that makes it emotionally difficult for students to attend school or to remain there for a complete day of classes. In some cases, students may have panic attacks as they get ready or refuse to leave a vehicle in the drop-off line, said Jayne Demsky, the founder of the School Avoidance Alliance.

After her own son struggled with school avoidance, Demsky created the organization, which focuses on providing resources for parents and professional development for schools. He later attended a therapeutic boarding school to aid in his recovery.

Since the school interruptions of the COVID-19 pandemic, Demsky has seen more concern about school avoidance. For both schools and parents, early intervention, good communication, and understanding are key to tackling the issue, she told Education Week.

This interview has been edited for length and clarity.

What is school avoidance? How would you explain it to someone who isn’t familiar with it?

School avoidance or school refusal is when a kid has severe discomfort and fear about going to school. Kids might tantrum cry, they might hide under their covers, or hold on to their bedroom door or bed if a parent is trying to get them out.

It could start with a day [of absence] here and there and then gradually builds. It’s not like, “Mommy, I have a stomach ache and don’t want to go to school today.” It is really severe and disconcerting for parents—so much so that you would have to almost drag your kid out of the house to get them to go to school.

People who are unfamiliar with school avoidance might say it’s not uncommon for kids to want to play hooky occasionally. Is there a lot of misunderstanding about this condition?

Yes. I started this because I went through it with my son. You think that, for kids, their job is to go to school and, for parents, it’s like a given that your kid goes to school. No one really understood school refusal back then—and they still don’t.

We couldn’t tell people. They’d be like, “What’s wrong with you? You are weak. Send that kid to my house, and I will get him [to] school.” It’s not so simple. It really isn’t.

The kids are really suffering. It’s really scary the way they feel. When you deal with a kid like this, they almost feel like they’re going to die. They’re just so scared. And as a parent, you feel helpless.

Were there warning signs with your son that you recognize in hindsight?

My son started having anxiety early on in kindergarten, 1st grade, 2nd grade, but I didn’t recognize it. Kids don’t present classically. It’s not like sweaty palms and trouble breathing. He would have problems doing homework, running circles around the room, and having tantrums.

It grew to where a few times in 4th and 5th grade, he wouldn’t get into the car [to go to school]. In 6th grade, he would forget to bring his books home, and he stopped going more and more. The school didn’t know what was going on. They thought he was being lazy, and no one recognized it as anxiety. They treated it like a behavioral issue, like defiance.

It can be very isolating because people don’t understand.

And school avoidance is not a primary diagnosis, right? Does it relate to other issues?

Yes, they say it’s a symptom of [a] greater issue.

There are four functions of school avoidance. Two of them relate to avoiding things [distress from issues in the environment, like bullying, or fears of poor performance on tasks, like reading out loud]. The other two relate to seeking tangible rewards [receiving time with, or recognition, from a parent or remaining in the comfort of home].

Research shows there are two main factors for what helps improve outcomes. One is in school collaboration. Of course, schools are going to say they want to work with parents, but the problem is that sometimes we get into the blame game. The school doesn’t understand what’s really going on at home. Parents are doing whatever they can to get their kids to school, but they aren’t sharing everything that’s going on with the schools.

Schools are really pressured by compulsory-attendance laws. They are under pressure to get these kids back in their seats. Attendance letters are often the first interaction [a parent dealing with school avoidance] may have with their school district. Your home is in shambles, and your first interaction from your school is: “You’re going to truancy court if you don’t come back to school.”

Schools do care, and they are recognizing more and more that mental health is important, and they want to support it. But parents don’t know about student-support teams. They don’t know their school’s social workers, psychologists, and counselors. Schools should have this on their website. And schools should educate parents that there is such a thing as school refusal so they can tell you what’s going on, rather than hiding it from you.

And what’s the other factor that improves outcomes?

Early intervention, which is a ubiquitous term in education. It’s easy to say and hard to achieve. Because schools are overwhelmed, they have a million things going on, they often start [addressing absences] with threats or punitive responses.

Many schools have teams like response to intervention, or RTI, teams. We say, “Make sure there are a few people on that team who understand school avoidance.” We also work with principals and superintendents who really inform policy.

School leaders reading this would probably tell you they are pretty overwhelmed. What’s a good starting point for addressing student anxiety in a school?

They should do a school climate survey if they have not. These surveys go out to students, families, and staff to determine what is going on in a school from a child’s point of view. That should really tell schools a lot about what they should be addressing.

In terms of absence, I would really work on educating families on anxiety. A lot of schools do focus on educating families, but they focus on the value of education. But usually parents of kids with school refusal already value school; they want their kids to go. So schools are missing the mark with those people.

I would also tell principals and superintendents to reevaluate their communications with parents. Let’s make sure that attendance letter is not the first intervention.

A version of this article appeared in the September 27, 2023 edition of Education Week as What Educators Need to Know About the Intense Anxiety That Keeps Students Home

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