Month: February 2019

Anxiety Series Part 3: School Anxiety and Its Relationship to Separation Anxiety

In Part 1 of our Anxiety Series, you read about the many ways that anxiety presents itself in children, exploring the more obvious visible signs and the more subtle ways that anxiety can show up in kids. In Part 2, I provided 20 simple anxiety-reducing strategies that work like magic to integrate a child’s left and right brain hemispheres, thereby helping to regulate anxious children’s intense emotions.

Now in Part 3, we will explore two very common forms of anxiety that are found in many children and teens today: school anxiety and separation anxiety.

What is School Anxiety?

School anxiety, also sometimes called school phobia or anxiety-based school refusal, occurs when a child’s anxiety makes him reluctant to attend school or even flat out refuse to go to school.

School anxiety may be the result of a broad range of anxiety-related concerns, like social anxiety, worry, panic, separation anxiety, and/or depression. However, in your kids especially, school anxiety is almost always related, in some part, to separation anxiety, though the anxieties around school can be myriad. School anxiety is not simply a child wanting to skip school!

Other Reasons for Anxiety-Based School Refusal

Starting a new school, moving, and a number of other stressful events can trigger the onset of school refusal. Some kids fear that they won’t do well in school, have fear of another student, fear getting sick in front of peers, or might be hypersensitive to teachers’ criticisms, regardless of how well-intentioned and constructive their criticisms might be. Other kids might start exhibiting school anxiety after they’ve been out sick or during or after a parent’s illness.

Anxiety-based school refusal is seen more commonly between the ages of 5 and 6 and between the ages of 10 and 11, and also at times of transition, such as entering middle or high school, but school anxiety can really occur at any age.

Signs of Anxiety

In Part 1 of our series, I reviewed various visible signs and less obvious signs you might see in children that are indicative that they are struggling with anxiety. Let’s review those briefly.

Visible Signs of Anxiety

  • physical distress (shaking, crying, hyperventilating, screaming)
  • fleeing, escaping
  • outright statements of anxiety or worry
  • outright questions expressing fears
  • refusal to engage in activities that cause distress
  • extreme distress upon contact with feared object, person, or place
  • refusal to be alone or without a parent
  • repeated rituals
  • panic attacks

Less Obvious Signs of Anxiety

  • clingy behavior
  • irritability
  • avoidance behavior
  • complaints of physical illness or physical ailments (i.e., headache, stomachache)
  • reassurance-seeking behavior
  • argumentative behavior
  • reluctance to try new things
  • extreme shyness, sensitivity
  • being easily distracted
  • slowness, procrastination
  • overly cautious behavior, indecision
  • exacting standards
  • sleep difficulties
  • physical aggression
  • threats of suicide to avoid anxiety-provoking situations

What is Separation Anxiety?

Separation anxiety is displayed as anxiety and excessive worry around leaving one’s attachment figures and/or the home, and it is the number one reason why kids are chronically truant and/or tardy from school. In fact, as many as 75 percent of kids with separation anxiety experience some form of school refusal behavior.

The symptoms a child experiences when separated from their attachment figure(s) and/or home are so distressing, they will do uncharacteristic things to avoid feeling this distress, such as:

  • throwing a fit
  • hiding
  • refusing to move
  • saying/yelling mean things
  • become ill or pretend to be ill
  • getting in trouble so they can get suspended or expelled so that they can stay at home
  • tantruming
  • drawing out their morning routine to the point that they will be late for school

Following are common signs of Separation Anxiety Disorder:

  • Distress when anticipating or experiencing separation from the home and/or attachment figure(s)
  • Worry about losing attachment figure
  • Worry about attachment figure being harmed
  • Worry about being kidnapped, lost, or otherwise separated from attachment figure
  • Reluctance or refusal to sleep away from home
  • Reluctance or refusal to leave the house
  • Nightmares about being separated from attachment figure or home
  • Complaints of somatic symptoms when separated from attachment figure or home

How to Help

There are numerous strategies parents can use to try to help alleviate their child’s anxiety-based school refusal as well as help reduce the worries about separation. A few parent-specific tips include:

  • Manage your own state, as the parent/caregiver. Kids are highly intuitive and can very often pick up on their parent’s mood and emotions. If you are displaying anxiety, your child can pick up on it and it will most likely make them anxious too. Try to be strong when you and your child are in the process of parting, at least until after you’re out of sight and outside of hearing distance.
  • Be consistent. If you say you’re going to pick your child up at 3:30 pm, please do all you can to fill that promise to her. Of course sometimes things happen that are unavoidable, but this should be the exception, not the norm. Do what you say you’re going to do.
  • Validate their feelings. Acknowledge their worry or fear and let them know that you understand this may be hard, but encourage and assure them that they can handle this and that you will always return.
  • Create a (quick) goodbye ritual with your child, and use it every time you part. Creativity and even silliness can be a bonus here, to help your child know that separating doesn’t have to be such a bad thing and that you love them no matter how far apart you are. Remind her that you will see her again later (if you are able, tell her when that will be).
  • Whatever you do, do not sneak away when separating from your child in effort to prevent a tear fest or tantrum. This only increases the child’s worry about being apart from you.

Stay tuned for Part 4 of my Anxiety Series, where I will offer a much larger variety of tips and strategies you can use to help your child with anxiety!

Anxiety Series Part 2: 20 Brain Integration Strategies to Help Your Child Struggling with Anxiety

Anxiety disorders are the most common type of mental health disorder in childhood, affecting 8 percent of all children and adolescents.

In follow up to my last post, I want to offer some strategies your child can try to help alleviate her anxious feelings. This post will only focus on brain integration strategies and represent only a few of the techniques that can help children better control their intense worry.

The Brain Science

First, let’s start with a brief lesson about the brain. Our brain is divided into two hemispheres: the left and the right. To summarize, the right and left sides of the brain specialize in some very different things:

Left Brain:

  • loves and desires order
  • logical
  • literal
  • linear (it puts things in a sequence or order)
  • cares about the letter of the law
  • linguistic (it likes words)
  • focuses on the text
  • focuses on the details

Right Brain:

  • more intuitive and emotional
  • “gut feeling” – cares about the meaning and feel of an experience
  • nonverbal, sending and receiving signals that allow us to communicate in ways such as through facial expressions, eye contact, tone of voice, posture, and gestures
  • focuses on the context
  • cares about the big picture, not the details
  • specializes in images, emotions, and personal memories
  • more directly influenced by the body and lower brain areas, which allow it to receive and interpret emotional information

In order to live balanced lives full of connected relationships, it’s crucial that our two hemispheres work together. The corpus callosum is a bundle of fibers that runs along the center of the brain, connecting the right and left hemispheres. The communication that takes place between the two sides is conducted across these fibers, allowing the two hemispheres to work as a team.

The brain has two sides for a reason: with each side having specialized functions, we can achieve more complex goals and carry out more intricate, sophisticated tasks. The key to thriving is to help these parts work well together – to integrate them. Integration takes the distinct parts of your brain and helps them work together as a whole. Each side needs to do its individual job while also working together as a whole; integration is simply that.

Your brain can’t perform at its best unless its different parts work together in a coordinated and balanced way. That’s what integration does: it coordinates and balances the separate regions of the brain that it links together.

It’s easy to see when our kids aren’t integrated – they become overwhelmed by their emotions, confused and chaotic. They can’t respond calmly and capably to the situation at hand. We want to help our kids learn to use both sides of their brain together, to integrate their left and right hemispheres. This means we need to help them bring in the left brain to get some perspective and handle their emotions in a positive, more effective way.

Kids struggling with anxiety disorders, in addition to those who have difficulty regulating other emotions such as anger and frustration, are experiencing emotion dysregulation when they feel anxious feelings. In terms of development, young kids (very young children especially) are right-hemisphere dominant. That means their emotions take over much more easily and more intensely than when they’re able to integrate their left hemispheres too.

Integrating the Brain’s Two Hemispheres

So how do we integrate our brain’s two hemispheres? There are several ways we can do this, but some of the easiest, child-friendly ways for our children to try include something called “crossing the midline.” Teaching our kids some very simple techniques can help them to regulate their anxiety, and other emotions.

Draw a line down the middle of your body. That’s called the midline. Every time you cross over that line, you’re helping connect the hemispheres in your brain, resulting in integrating your brain. These exercises can help regulate the part of the brain that controls your emotions. They help you feel relaxed and safe, they release that fight or flight response, and they allow you to respond more rationally instead of emotionally.

Following are twenty of my favorite brain integration strategies to teach children. While the exercises can be used while they are in the midst of experiencing anxious feelings, for best results, it is recommended that these types of exercises should be practiced a few times a day, 4 to 7 days a week. Doing the exercises to music can help make them more fun! Click here for a pdf of the exercises to print them out and save: Brain Integration Strategies

Brain Integration Strategies to Help with Anxiety

  1. Simple Tap – Touch your right hand to your left knee and then your left hand to your right knee. Repeat several times.
  2. Bend and Stretch – Lift left knee and touch with right elbow. Life right knee and touch with left elbow. Repeat several times.
  3. Catch a Star – Reach with right hand up in the air to your left and pretend to catch a star. Then reach your left hand up in the air to your right and catch a star. (You can also pick apples, oranges, etc.) Repeat several times.
  4. Pat on the Back – Alternate patting the back of your left shoulder with your right hand and your right shoulder with your left hand. Repeat several times.
  5. Piddle Paddle – Put fists on top of each other as if holding an oar. Pretend to paddle on the right side of the body and then switch hands and pretend to paddle on the left. Continue to repeat.
  6. Nose and Ears – Touch your right ear with your left hand and place your right hand on your nose. Touch left ear with right hand and place left hand on your nose. Repeat several times.
  7. Hug Your Brain – Say and demonstrate these motions as your child follows along:
    1. Thumbs up. – Stick up your thumbs in front of you.
    2. Thumbs down. – Point thumbs down.
    3. Cross your arms. – Cross fists with thumbs pointing down.
    4. Clasp your fingers. – Keeping wrists crossed, hold hands.
    5. Bring your hands in. – Bring clasped hands down and in toward your chest.
    6. Give yourself a hug. – Squeeze arms.
  8. You’re the Best – Say and demonstrate these motions as your child follows along:
    1. Thumb up. – Stick up one thumb.
    2. Across the chest. – Bring thumb to opposite shoulder.
    3. Pat on the back. – Pat opposite shoulder.
    4. Cause you’re the BEST! – Child hugs himself.
  9. Push and Pull – Stand with hands on hips. Twist left and push with palms up and then pretend to pull something towards you. Twist and push and pull to the right. Repeat several times.
  10. Disco Dance – Put right index finger in the air and point to the left. Bring right index finger down by your side. Place left index finger in the air and point to the right. Then bring down by your side. Do several times.
  11. Crazy Eights – Make the figure eight in front of you with your right hand, then your left hand. Make “lazy” eights by making eight lying down, with your right hand. Make lazy eights with your left hand. Clasp fingers on your right and left hand and make large crazy eights. Lean over and pretend to draw an imaginary “lazy” eight on the floor with your right hand and then with your left hand.
  12. Bending Exercise – Take a small ball in your hands and bend over and touch the ball to the floor. Legs should be shoulder-width apart. Touch the ball in front of you, then in the middle, then behind your legs. Repeat several times.
  13. Glider Exercise – Put a piece of tape across the floor like a pretend balance beam. Have child walk across it heel to toe. While walking across it, have them raise their right hand above their head as they step, then switch to their left hand as they switch feet.
  14. Clapping Exercise – Use tape to create a fake balance beam on the floor. Have child walk across the balance beam heel to heel while clapping their hands at the same time. They must clap at the same time their feet are stepping.
  15. Bongo Drums – (may have to use stickers to match opposite hand to opposite drum, for younger children) Have child play the drums by hitting the bongo by crossing over left to right and right to left.
  16. Windmills – Stretch out feet. Touch right hand to left foot. Stand. Touch left hand to right foot. Repeat several times.
  17. Picking Peppers – Stand with your feet stretched. Bend to the left and pretend to put something beyond your left foot with your right hand. Stand. Bend to the right and pretend to pull something with your left hand. Repeat several times.
  18. Shopping – Pretend to steer a grocery cart and then reach to the left with your right hand and take something off the shelf and put it in your cart. Reach with the left hand to the right and put something in the cart. Repeat for a few minutes.
  19. Climbing – Act like you’re climbing a ladder as you reach up with your right hand and lift your left knee. Reach with your left hand and lift your right knee. Repeat several times.
  20. Put the Fire Out – Pretend to get a pail and scoop up water on the floor by your right foot. Throw that pail of water over your left shoulder. After several times in this direction, scoop water from the left and throw it over your right shoulder.

Stay up to date and follow along for more upcoming posts about anxiety in children and teens, including more tips that parents can use to help alleviate their child’s worries!


“The Whole-Brain Child: 12 Revolutionary Strategies to Nurture Your Child’s Developing Mind” by Daniel J. Siegel and Tina Payne Bryson



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