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Including everyone: anxiety in your students

| September 14, 2018 | 0 Comments


The American National Institute of Mental Health (NIH) states that “occasional anxiety is a normal part of life”.1

But anxiety disorders involve more than temporary worry or fear, says the NIH: “For a person with an anxiety disorder, the anxiety does not go away and can get worse over time. The feelings can interfere with daily activities such as job performance, school work, and relationships.”2 Anxiety is “a feeling of apprehension and fear characterized by physical symptoms such as palpitations, sweating, irritability, feelings of stress… anxiety disorders are serious medical illnesses…”3 Anxiety disorders as a group are the most common mental illness and can affect adults, children and adolescents. Teachers are often the first adults outside the family unit to identify mental health concerns in children, and parents often rely on them for guidance and support in these matters, however they are not expected to diagnose children. “They can choose to manage the issues internally (i.e. within the classroom) if they believe they have the appropriate skills to address the concerns, refer to the school guidance counsellor for assessment and management, or access alternative school supports if deemed necessary, say authors Headley & Campbell.4 However, in our classrooms, anxiety disorders in children are “woefully underdiagnosed” writes author Kirsten Weir.5 One of the reasons might be that anxiety symptoms are so variable. Children and young people with anxiety disorders may not present or complain of having anxiety, they may have difficulty articulating their experiences or be confused or embarrassed by them. Often parents, caregivers and teachers don’t realise the severity of a child’s anxiety, nor do they recognise that it needs to be treated. There is also the notion that the child will outgrow the anxiety. Nevertheless, making an early diagnosis is important, as many anxiety disorders remain untreated in the community, causing distress and impeding academic and social functioning.

“In South Africa, it is now widely accepted that as many as 8-11% of children and adolescents suffer from an anxiety that affects their ability to get on with their lives.”

Has anxiety become an epidemic?

The American National Alliance on Mental Illness (NAMI) estimates that “eight per cent of children and teenagers experience an anxiety disorder and most people develop symptoms before age 21”.6 The World Health Organization states that “the proportion of the global population with anxiety disorders in 2015 is estimated to be 3.6%… and anxiety disorders are more common among females than males”.7 The total estimated number of people living with anxiety disorders in the world is 264 million.8 Most studies report an increase in internalising problems in adolescent girls.9 The findings for internalising problems in boys are mixed. While internalising behaviours are associated with problematic internal feelings, such as anxiety, sadness, reticence, fearfulness and oversensitivity, externalising behaviours are where a person has “problems controlling emotions and impulses and expresses them with antisocial behavior that often violates the rights of others”.10 The South African Depression and Anxiety Group (SADAG) estimates that “anxiety disorders are the most common mental illness in South Africa and about one in five South Africans are affected by these debilitating illnesses each year”.11 Another article on the SADAG website states that in South Africa, “it is now widely accepted that as many as 8-11% of children and adolescents suffer from an anxiety that affects their ability to get on with their lives”.12

Types of anxiety disorders

Anxiety disorders comprise the following conditions: panic disorder, agoraphobia, social anxiety disorder (social phobia), specific phobia, generalised anxiety disorder (GAD), separation anxiety disorder, and selective mutism. The most common anxiety disorders are specific phobias, which include an excessive fear of a specific object or situation, such as spiders, heights, flying or closed spaces. Separation anxiety is normal in young children. However, when the fear of being away from their parent persists or interferes with normal development, separation anxiety disorder is diagnosed. Selective mutism refers to an inability to speak in social situations where there is an expectation to speak (such as school), but individuals are still able to speak in other settings. When this pattern persists and causes problems with school, work or other performance, selective mutism is diagnosed, which is “school refusal behavior [that] refers to the avoidance of a child attending school and/or persistent difficulty remaining in the classroom throughout the school day”.13 School refusal behaviour may be linked to diverse mental health disorders, such as separation anxiety disorder, generalised anxiety disorder, oppositional defiance disorder, social anxiety disorder and depression. By asking the following questions, one might be able to identify the cause of the school refusal behaviour: • Why does the child not want to go to school? • Does the child experience negative feelings about going to school? • Does the child struggle with all the social interactions and expectations at school? • Would the child prefer it if his parents taught him at home or went to school with him? • Would the child prefer to do things out of school that are more fun? The first two questions might identify school anxiety or phobia and the last two questions might indicate absenteeism or truancy.

Causes of anxiety disorder

New technologies are enabling scientists to learn more about the biological, psychological and social factors that may cause anxiety disorders.14With a better understanding of underlying causes, even better treatment and prevention of anxiety disorders will be closer at hand. For now, heredity, brain chemistry, personality and life experiences are all believed to play roles in the occurrence of anxiety disorders. Biological factors include our genes, as there is clear evidence that many anxiety disorders run in families. Because symptoms of anxiety disorders are often relieved by medications that alter levels of chemicals in the brain, scientists believe that brain chemistry appears to play a role in the onset of anxiety disorders. Temperamental factors relate to a child’s temperament, for instance if they are naturally anxious or sensitive. Social or environmental factors include experiences such as bullying, illness, problems at school, arguments with friends and major changes in the family such as moving to a new house or the divorce of parents. Anxiety does not result from any single risk factor of those listed above. Instead, it occurs when several factors occur together.

Anxiety at school

An anxious child is generally not a happy, carefree child. Internalising disorders such as depression, anxiety and suicide ideation are subtler and more difficult for school personnel to identify. Behavior problems, academic difficulties and inconsistent school attendance are early or actual signs of mental health problems in students and are externalising disorders. These are far easier to identify, as the behaviours are largely disruptive and noticeable. Children’s mental health problems can present in a variety of ways. It is not unusual for children who are high achieving and well attending to mask their depression/mental health concerns. It is also easy for educators to miss red flag warning signs in children with high academic achievement. Anxiety at school could also be consistent throughout the year or worsened at certain times of the year, for example during examination time or at the beginning of a new year or term. The teacher would need to be in contact with the parent, to manage the anxiety during these times. Teachers are in a key position to screen for mental health issues in the school setting. Children often present with somatic complaints such as a stomach ache or headache. School behaviour problems, academic difficulties, and inconsistent school attendance can also be early or actual signs of mental health problems in students.

Department of Education policy and protocol

In 2014, the South African Department of Education released the Policy on Screening, Identification, Assessment and Support (SIAS)15 “to provide a policy framework for the standardisation of the procedures to identify, assess and provide programmes for all learners who require additional support to enhance their participation and inclusion in school”.16 The policy is also aimed at improving access to quality education for vulnerable learners and those who experience barriers to learning. The policy refers to “challenges in the learning process that are a result of a broad range of experiences in the classroom, at school, at home, in the community, and/or as a result of health conditions or disability”.17 These challenges are referred to as ‘barriers to learning and development’ and may include: 1. socio-economic aspects i.e. lack of access to basic services, poverty and underdevelopment 2. factors that place learners at risk, i.e. physical, emotional and sexual abuse, political violence, HIV and Aids and other chronic health conditions 3. attitudes 4. inflexible curriculum implementation at schools 5. language and communication struggles 6. inaccessible and unsafe structural environments 7. inappropriate and inadequate provision of support services 8. lack of parental recognition and involvement 9. disability 10. lack of human resource development strategies 12. unavailability of accessible learning and teaching support materials and assistive technology. The list makes no actual mention of mental health challenges such as anxiety or depression, however these could possibly be included under “chronic health condition” or “disability”. The policy includes a protocol as well as a set of official forms to be used by teachers, school-based support teams and district-based support teams in the process of screening, identifying and assessing barriers experienced by learners with a view to planning the support provision.


When a child starts doubting her abilities in a subject, anxiety can become a factor that gets in the way of her learning or showing what she knows. Sometimes this can be mistaken for a learning disorder when it’s just anxiety in children. However anxiety can also go hand in hand with learning disorders. When kids start noticing that something is harder for them than the other kids, and that they are falling behind, they can understandably get anxious. The period before a learning disorder is diagnosed can be particularly stressful for kids. When a student does not do her homework, it could be because she is worried that it isn’t good enough. Likewise, anxiety can lead to second-guessing – an anxious child might erase his work over and over until there’s a hole in the paper – and spending so much time on something that it never gets finished. We tend to think of perfectionism as a good thing, but when children are overly self-critical it can sabotage even the things they are trying their hardest at, like schoolwork. You might also notice that some students with anxiety will start worrying about tests much earlier than their classmates and may begin dreading certain assignments, subjects or even school itself. Some kids will avoid or even refuse to participate in the things that make them anxious. This includes obvious anxiety triggers like giving presentations, but also things like physical education lessons, eating in front of others and doing group work. They will also tend to be absent on gala days or sport days. When kids start skipping things, it might seem to their teachers and peers as though they are uninterested or underachieving, but the opposite might be true. Sometimes kids avoid things because they are afraid of making a mistake or being judged.

Treatment of anxiety disorders

Teachers need to be incredibly perceptive in identifying a potential anxiety disorder. The first step would be to have a discussion with the parents to share experiences and behaviours that have been noticed and that are impacting on the child’s performance in the classroom. The parents should then take the child to see a general practitioner or a psychologist who would begin with interviewing the parents and making use of a questionnaire or checklist. Occasionally, the teacher will be asked to complete a checklist as well. Treatment is usually a combination of play therapy or counselling and medication prescribed by the doctor or psychiatrist.

Philippa Fabbri is director: communications, fund raising and school design at Elsen Academy in Port Elizabeth in the Eastern Cape.

1. See:
2. Ibid.
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12. Ibid.
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15. Ibid.
16. Ibid.
17. See:

Category: Spring 2018

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