Anxiety in Schools

As the start of school approaches all school counselors will be dealing with anxious students (parents and staff). It is always helpful to have more information and resources. This website has a great 6 part podcast series "Anxiety in Schools" as well as printed resources available to download. Check out

rogersbh.org/student-anxiety

What Ifs

The hallmark of anxious thoughts is imagining al the "what ifs" that could possibly go wrong. The Key message of this children's book is "Remember to not believe all that you think, and slowly those fears will begin to shrink." Anxiety can confuse kids because it is a false prediction. Their brain is tricking them to believe something (that is dangerous) is present when it is not. It is hard to retrain a child who has chronic worrisome thoughts. This book encourages focusing on what is good and talking to a trusted adult. The books uses the metaphor of an umbrella to keep the stormy thoughts away. This book can be used in individual counseling, in an emotion management group, or sent home as a resource to families.

Let's Talk About...Your Fears and Worries

I see lots of students who struggle with stress and various types of anxiety. I recently purchased this inexpensive card game to use in individual sessions. The cards and spinner (wheel) can also be used in emotional regulation groups.  The deck is 101 cards to hep kids and teens change their irrational automatic thoughts to thoughts that are realistic and helpful. This is a skill that needs practice which is what this game is designed to do. The Wheel of Relaxation is used to help players practice relaxation and self-calming techniques so that they can more easily face their fears. The spinner can also be used as a stand alone tool. If you don't have a similar game in your office already, this is one you might want to purchase.

Grief Resources

This beautifully illustrated book can be used to discuss separation, anxiety, grief and loss. It uses nature as a way to connect with our love ones. The web site has a guided discussion plan to use with PreK to grade 2 children sunkissesmoonhugs There are also suggested art activities to use with the book. This could be used by a teacher at the beginning of the school year. The author and illustrator have collaborated on two other books you might want to check out.

Coping Skills

If you run groups for kids with emotion regulation difficulties this might be a good workbook for your collection. Janine Halloran, a mental health counselor, has organized coping skills in to 4 categories: calming, distraction, physical, and processing. For each category she offers close to 20 techniques to explore. Kids need a variety of coping skills because different types of coping skills will work at different times, in different places, and for different stressors. For example, the goal of the calming exercises is to get from "flight, fight or freeze mode" back to the "rest and digest" mode. She offers many fun types of breathing and grounding activities.  The sills in this workbook are very familiar but they are well organized and explained in a clear manner.T he book concludes with a suggestion for writing coping skills cards. I have pulled several exercises from this book for my groups and a few to send home to families to practice.

Resource for Parents of Anxious or Angry Kids

This is a new workbook for parents of children ages 6-12 to use mindfulness and brain science to help reduce anxiety and mood related outbursts. It uses the hornet-brain for the amygdala (fight-or-flight) and hippo-brain for the hippocampus (context and long-term memory). The author is a clinical psychologist who has lots of ideas to help parents develop a home routine that promotes calm and peace of mind. I am including it in one of our Family Resource Packs we loan to families. There are some cute worksheets that could be adapted for a small emotion or self-regulation counseling group. Check out the author's website hornets-and-hippos for a few free worksheet based on the workbook.

Tips to Handle Stress

These are the tips I send home to parents after my emotion management groups in grades 3-5.  We want parents to reinforce the skills we teach in our groups. I also send home the packet of activities the students have done with me in group. In grade 3 we read 7 different books and I send the title and author home in case parents want to reread the book to their child. For students with anxiety, giving parents tools is a must for the child to develop new ways of responding to unhelpful thoughts and uncomfortable feelings. I ALWAYS talk to parents about how important good food, regular sleep, and plenty of fresh air and exercise are for students who are stressed. 

These are also good tools for self-care which is so important for school counselors as testing season heats up and the end of the school year looms.

Emotion Management Group Grade 1

A high need in my school is support for students with anxiety, unfortunately even as young as first grade. Research has shown the sooner children with anxiety begin to learn tools to self regulate the better. Research continues to indicate that Cognitive Behavioral approaches and Mindfulness are effective in reducing anxiety. Using children's literature to teach strategies and normalize the fact that many children have anxiety in the primary grades is also effective. I have developed an Emotion Management group curriculum for grades 1-5. Many of the same skills are taught at each level but with increased complexity.  I think it is critical that the focus be on skill development and that parents and teachers know what skills are taught in group. Before each group I put together a packet for the 8 sessions. Each handout has the image of the book we shared and a simple explanation of the skill and activity. It really helps students see that the group is structured and how far along they are each session. If group gets cancelled one week for a special activity or schedule change, they know we will keep meeting until we complete the 8 sessions. I communicate with parents at least 3 times during a group (beginning, middle, and end). Parents give very positive feedback about the packet of work coming home at the end and being able to reinforce the skills taught in group.

My goal is to serve as many students as possible and avoid a large number of students being referred for individual counseling. Most children like the group and support one another; however, there are some children with social anxiety that can't yet speak in a group so I may see them individually one year with the hope of them doing a group at the next grade level. I always collect perception data for these groups with a simple pre-post survey. I do NOT send these home rather I use them to evaluate the effectiveness of the groups and what needs to be revised.

Great book for overcoming a fear

This Caldecott Medal Winner is a must have for all school counselors' book shelves. It tells the story of how Humpty Dumpty got back up high again after his traumatic fall that caused him to feel afraid. The book is a good size to be used as a read aloud in a classroom. I plan on adding it to my third grade Second Step lesson that addresses anxiety. The message is clear we must face our fears! It would also be a great addition to an emotion regulation or stress and anxiety small group.

Books to Help Children with Anxiety

I recently found these 3 great resources to help my students who struggle with high levels of anxiety. A Small Thing ... but Big explains systematic desensitization in a kid friendly way - the girl overcomes her fear of dogs. Upper elementary students can learn about the same process by reading School of Fear. I always tell parents and children that trying to manage anxiety if like the Wack-a-Mole game at the arcade because you might get separation anxiety under control and then it pops up as social anxiety or a specific fear.  Therefore I think this new release has the perfect cover. I have it on pre-order from Amazon but I am hoping they will have a copy at our state SCA conference this week. Reading about the struggle of others with anxiety helps normalize the experience and teach strategies. I read A Small Thing... but Big to my emotion management group.

Back to School: Part 4 - Effective Strategies for Helping Students Reduce Anxiety

Helping students with anxiety is a topic I have researched, lived, and presented on extensively. I share most of my presentations in LiveBinders so if you want to see the PowerPoint from the ASCA webinar, my state conference presentation, or from the ASCA National conference on anxiety check them out on the Anxiety, Stress, and Worry tab livebinders.com/ The binder also has links to some good articles and resources about helping children reduce anxiety.

There are new resources being developed all time to help children manage anxiety. For individuals, I begin by assessing how big a concern anxiety is for them. I do this a variety of ways but one all the students seem to favor is selecting the stone that represents the amount of discomfort their worries are currently causing them daily. I have a small pebble, a 1-2 inch rock, and a 4-5 inch rock that I keep on my window sill and bring out. I say, "you could have a little anxiety and it fits in your pocket and you only notice it occasionally, a medium size rock in your pocket that you would notice every time you moved, and a heavy rock that would weigh down your backpack." Once I know how big a problem the child perceives their anxiety issues to be I start assessing their coping tools. What have they tried so far that works to reduce their anxiety when they are stressed? What did not work? If I do see a student for ongoing short term counseling we set a goal to reduce anxiety and quantify it (for K-1 to make it a pebble and for grades 2-5 to reduce it from a __ to below 5 on a 10 point scale). I have found that students who are highly perfectionist or compulsive do not like groups and will only agree to individual support.

If possible I try to have most students with anxiety issues participate in small group counseling. It has many advantages and students  help one another as much as I help them. For groups, especially in grade 2 my students love worrywoos The books in this series are great and the website offers some good materials to create activities.I have done a whole group based on the worrywoos.  For more resources check out my pinterest/worry--anxiety-stress board. Some of my favorite picture books on anxiety are: Hey Warrior, Caterpillar's Wings, The Huge Bag of Worries, and The Worry Glasses. I generally teach a strategy each session and provide members opportunities to practice (calming exercises, deep breathing, mindfulness, etc.)

Stress is so pervasive in my school I teach a class lesson on techniques to reduce stress in grades 3-5. I think this further helps normalize anxiety issues and gives all students a few tools to self-regulate when experiencing normal stress. Since we use Second Step I use their lessons in the classroom.

Back to School: Part 3 - Counselors Supporting Students with Anxiety

Last year I wrote an article for ASCA "Address Student Anxiety" it provides lots of details about how to help  https://www.schoolcounselor.org/address-student-anxiety It discusses how to work with parents, staff, and students in the school environment.

One of the most useful books for counselors on this topic is Working with Parents of Anxious Children: Therapeutic Strategies for Encouraging Communication, Coping, & Change. The author, Christopher McCurry, outlines the behaviors and symptoms to look for in children with anxiety disorders, and offers a guide for clinicians who work with their families.

When working with children who are reluctant to come to school I try to make a deal with the families, you get them in the building and I will keep them here. Many parents have told me how much they appreciated knowing that if they hung tough and got their child in the door I would work out a plan to make them feel safe inside.

If you have been a counselor very long you have probably had a child brought to you after the bell crying and clinging to a parent. Once you can get the parent to leave the building then you need to start your work with the child with the goal to get them in their classroom ASAP. I generally start by saying, "I am here with you and you are safe." Often I begin by acknowledging that right now their body does not feel OK. This begins the psycho-education of teaching them common body responses to anxiety and normalizing what they are feeling but correcting the misconception that they are "sick". Next I address their emotions and generally have them scale their unpleasant feelings. I have many scales readily available in my office from simple color coded and 1-5 scales for the young ones to 1-10 with a range of emotion vocabulary for older students. Finally their distorted thinking needs to be addressed. I acknowledge that they are telling themselves they are not safe in school (away from parent) but in reality they know they are - it is just their "worry brain" sending a false alarm. Once the student begins to calm down I try to get them to walk with me to class. 

I find small groups to be the most effective place to teach skills to students who need help with emotion regulation. I cannot possibly provide individual counseling to all my students with anxiety issues.  I offer groups for students who need to develop coping tools to students in grade 1-5 using both CBT and Mindfulness.  I typically start my first round of groups in late September or early October which means the first few weeks of school I am probably doing more individual counseling than any other month. Students with anxiety issues are my number one referral reason and this is typical for most school counselors from both elementary and secondary levels according to surveys conducted by ASCA.

Back to School: Part 2 - Help Teachers Handle Students with Anxiety

Many teachers do not understand anxiety and need some basic information before they understand saying "Just relax" or "Calm Down" will not help. If students had the skills to do this they would. Anxiety is often confused with other issues like ADHD, willful behavior, and school avoidance. Teachers often blame the caregivers, and although they may play a role in making the anxious behavior worse, they are not the cause. Teachers can provide parents with strategies for preparing the child for school and the classroom. At our school we invite students we know are very anxious to visit the classroom before the regular Open House so they can have a few minutes to meet the teacher and get a feel for their new class privately. This has helped many students feel more confident on the first day of class.

Particularly at the beginning of the school year, or after a long break from school, students with anxiety are going to frequently show signs of increased stress. What helps anxious students can frequently benefit all students: provide a warm and inviting classroom environment, establish clear routines at arrival, give students movement breaks, go outside whenever possible, play relaxing music, dim the lights for a quiet time after lunch/recess, practice mindful breathing. Students with anxiety need an organized and predictable routine and warnings when there will be changes.

Teachers can use help identifying common triggers of anxiety like morning meeting when students are expected to give eye contact and greet peers, assessments, large assemblies, the cafeteria,  presenting in front of class, and substitutes. The teacher should also know what helps a particular student gain a sense of control and calm (such as a pass to go get a drink). Many students with anxiety benefit from having a list of 3 "safe persons" that they can go to for a break or help, especially when the regular classroom teacher is not available.

Resources: 
Books

Reaching and Teaching Stressed and Anxious Learners in Grades 4-8: Strategies for Relieving Distress and Trauma in Schools and Classrooms (2015) by Barbara E. Oehlberg

Your Anxious Child: How Parents and Teachers Can Relieve Anxiety in Children 2nd Edition (2016) by John Dacey, Martha D. Mack, Lisa B. Fiore 

On line

This site does a good job of explaining Anxiety in the Classroom childmind.org

Some students with an anxiety disorder will be eligible for a 504 Plan. Some of the common accomodationsor modifications requested are described on these sites  worrywisekids.org  healthcentral.com  healthcentral.com

Back to School: Part 1 - Resources for Parents to Help Children with Anxiety

August means the end of summer vacation and the time to start back to school. Children frequently experience a wide range of emotions about the start of a school year including excitement, worry, and sadness. The emotions about a new school year can start showing weeks before the first day of class. Many parents report an increase in meltdowns and anxious talk at bedtime even before the "Meet Your Teacher" Open House.

I always recommend to parents, that if possible, not to travel just before school opens, instead plan to be in town and attend the Open House and get children back on a school schedule (generally earlier bedtimes than were the norm during summer). Also to try to arrange a play date with a classmate once it is known who will be in each class. We can all appreciate that having a familiar face in class helps with Back-to-School jitters. I remind parents that for children the start of the school year can be highly stressful. It is important that parents express optimism about the new school year and not feed into the child's concern about a certain teacher or classmate. Parents can also role-play with their child to prepare them to greet the teacher at Open House, introduce themselves to students they do not know, etc.

Most children will adjust to a new school year within a month. If after the first month of school a child is reluctant to come in the building on their own or expressing regular concern, I encourage parents to talk to the teacher and myself to see if we can help with the adjustment or discuss if a child may be experiencing serious separation anxiety. The main differences between separation anxiety and separation anxiety disorder are the intensity of your child’s fears, and whether these fears keep him or her from normal activities. Children with separation anxiety disorder may become agitated at just the thought of being away from mom or dad, and may complain of sickness to avoid playing with friends or attending school. When symptoms are extreme enough, these anxieties can add up to a disorder that affects approximately 4%-5% of children in the U. S. ages 7 to 11 years. It is less common in teenagers, affecting about 1.3% of American teens. It affects boys and girls equally. If a parent collaborating with the teacher, counselor, and student can't improve a students anxiety a referral may be warranted.

It is very important that parents understand anxiety if they are going to be successful in helping an anxious child. Parents need to work to make an anxious child feel safer not let them avoid the source of anxiety. There are many good books to help parents learn more about anxiety and related concerns. The ones from the past 10 years I recommend are the following:

Helping Your Anxious Child: A Step-by-Step Guide for Parents by R. M. Rapee et al. (2008) provides parents a guide for assisting their children in overcoming a variety of worries, fears, and anxieties.

Growing Up Brave: Expert Strategies for Helping Your Child Overcome Fear, Stress, and Anxiety by Donna Pincus (2012) helps parents identify and understand anxiety in their children, outlines effective and convenient parenting techniques for reducing anxiety, and shows parents how to promote bravery for long-term confidence.

Helping Your Child Overcome Separation Anxiety or School Refusal: A Step-by-Step Guide for Parents by Andrew R. Eisen & Linda Engler (2006) helps parents/guardians: a) identify child’s unique safety needs; b) empower child with simple and effective coping skills; c) guide child to better sleep and regular school attendance; and d) monitor progress.

Overcoming School Anxiety: How to Help Your Child Deal with Separation, Tests, Homework, Bullies, Math Phobia, and Other Worries by Diane Peters Mayer (2008) shows parents how to deal with a wide variety of problems, from test and homework anxiety, to bullying, and fear of speaking up in class. Mayer also offers easy-to-learn techniques for children including breathing and relaxation exercises, focusing techniques, and tips on proper diet and exercise that help relieve stress.

Freeing Your Child from Anxiety, Revised and Updated Edition: Practical Strategies to Overcome Fears, Worries, and Phobias and Be Prepared for Life--from Toddlers to Teens (2014) explains some of the ways they "help" actually makes children more anxious. The book explains how parents and children can work TOGETHER against the anxiety.

Anxious Kids, Anxious Parents by Reid Wilson and Lynn Lyons (2013) offers an effective approach to help children and teens push through their fears, worries, and phobias to ultimately become more resilient, independent, and happy.

Why Smart Kids Worry: And What Parents Can Do to Help by Allison Edwards (2013) guides parents through the mental and emotional process of where a child's fears come from and why they are so hard to move past. Edwards focuses on how to parent a child who is both smart and anxious.

Your Anxious Child: How Parents and Teachers Can Relieve Anxiety in Children 2nd Edition (2016) by John Dacey, Martha D. Mack, Lisa B. Fiore (Author) designed to help parents, teachers, and counselors support young people suffering from anxiety. Offers an array of innovative strategies organized into the authors’ four-step “COPE” program. Each strategy is accompanied by a set of activities contextualized with full details of the appropriate age level, materials needed, suggested setting, and a template script.

There are several good web sites that offer advice to parents regarding anxiety. These have good free resources for parents childanxiety.net and anxietybc.com and worrywisekids.org

Future posts will focus on resources for counselors, teachers, and children to develop a helpful approach to anxiety.

Help Your Anxious Child: Tips from a Child Therapist

This child therapist specializes in helping parents whose children have excessive anxiety and/or OCD. I recommend her website anxioustoddlers.com to parents frequently. She makes it clear that parents should not over accommodate  anxiety behaviors and let children avoid challenges like sleeping in own room or going to school. She cautions parents that getting frustrated and asking them to something they clearly are not ready to handle like a sleepover party are the two extreme parenting styles. She has some simple practical suggestions for a balanced approach for parents to use in coaching children to "crush" anxiety. She starts by telling parents to discuss anxiety with the child and give it a name to externalize it and keep it from eroding the child's self-esteem. That is where I usually begin when doing individual counseling with students who have too much anxiety. She has some great articles and has published two books, This video addresses a question I get every week as a school counselor,"How can I help my anxious child?"

Small Group Counseling An Opportunity for Students to Reach Outside Their Comfort Zone

Molinsky studied a variety of people to find out how some people are able to take the leap and step outside their comfort zone, rise to the challenge, and build confidence. I read his book with lots of interest and also watched his TED Talk youtube.com/TEDtalk While I was reading it I kept thinking about the students in my small groups, especially those in my emotion regulation groups. People with anxiety are masters at avoidance and frequently lack confidence which Molinsky discussed at length. When I lead small groups I am trying to help students develop attitudes that allow them to be courageous and develop new skills. The author talked about how to customize interventions so a person can act on their convictions to try new behaviors. He discusses clarity which is the process of self-talk needed to step out of your comfort zone. He talks about how important practice is to practice new routines. That is exactly why we do role plays and other activities in small groups. As school counselors we are coaching students to adopt what Carol Dweck calls a "learning orientation" where they view practice and making mistakes while learning a new skill a growth opportunity - not further evidence they will never succeed at whatever is challenging them Not Yet!). This book also validated the practice I use when leading small groups of having every member set a personal learning goal related to the topic of the group. For example, I will try a new sport and attend all practices and games without complaining for a 3 month period. That is a great goal but in order for someone who gets anxious trying new things there is a lot of work and practice that must happen to meet the goal. For example, the student would need to develop physical, emotional, and cognitive strategies to be able to be successful. I can tailor the skills I teach based on the goals students are trying to accomplish. A small counseling group is often the best place to help students develop the knowledge, attitude, and skills to step outside their comfort zone and overcome challenges. I devote a large percentage of my time to small group work because I think this venue can help lots of students tackle a lot of challenges with the needed support and opportunity for practice.

iPad Apps for Stress and Anxiety

I have 2 iPads which I use multiple times a day. The one at the top is a iPad Mini which I actually let kids use in my office and show Apps to parents during consulting sessions. The second is a standard iPad that I use to keep track of my program and also keep me centered. The Apps I recommend the most to families fall into 4 basic categories: a) Mindfulness; b) Breathing; c) Yoga; and d) Sleep. There are so many useful Apps to help people, including children, reduce stress and anxiety. Please comment if you have a favorite, mine is Smiling Mind!

Last Session for Groups

My favorite way to end groups is to do the post-group survey, a round or two sharing what they learned, and then play a review bingo. I do LOTS of groups for students with stress and anxiety and I have made my own bingo games but I really like the one I bought from mar*co for less than $20 marcoproducts.com This one, Stress-less, was written by an elementary counselor, Lisa Miller, who has published a few resources through mar*co. Included with the bingo game are several handouts that could be used during the group. I always laminate the student cards because my groups in grades 3-5 are always at lunch and then they can be wiped down.  I never give prizes for "winning" but I frequently tell the members is they play fairly and don't make a big deal out of winning or loosing they will all get something. I usually give them something to remind them of the group like bubbles to practice slow breathing or a stress ball to squeeze when studying for a test.

Anxiety and Depression: Consulting with Teachers

Our district is requiring all staff to go to mental health first aid training to help prepare them to deal with mental illness. Since the most common mental illnesses in elementary school are anxiety and depression, this is a resource I have available for my teachers. In Anxiety and Depression in the Classroom: A Teacher’s Guide to Fostering Self-Regulation in Young Students, Nadja Reilly explains the impact of anxiety and depression and other mental health issues in children. She provides suggestions to build resilience and teach self-regulation in order to help kids to succeed in school and beyond.

Self-regulation, fun, and play activities are natural ways to relieve stress and worry and recharge energy. Reilly discusses how to teach students deep-breathing exercises and various ways to understand their bodies. The book provides detailed instructions for educators who teach children in grades K-5. Reilly lists materials needed, gives step-by-step instructions, and offers variations to accommodate specific needs.

As Reilly explains, the teacher can encourage students to come up with funny or silly names for these sensations to make them less threatening. The class comes together to come up with ideas for decreasing these body sensations, such as deep breathing. The book also provides a chapter on communicating with parents to promote teacher-parent collaboration and assist families with kids who are struggling. For use both in the classroom and with parents of school-aged children, this is a book school counselors may want to purchase and loan out to teachers.

Self-Regulation Books

One of my favorite books on self-regulation is Listening to My Body by Gabi Garcia a school counselor. It is available in English and Spanish and learn more about the author at listeningtomybody.com/  This engaging picture book introduces children to the practice of listening to their bodies which is the first step to developing self-regulation. My students love the "horse lips" strategy where you take a deep breath in through your nose and blow out through your lips like a horse. It can change someones brain from being mad to silly in a few seconds. It is loaded with ideas so I frequently use it in 2 sessions in both individual and small group sessions. It will be one you use frequently!