Five Questions With Kathleen Treloar

At the start of the school year the pediatric behavioral health team at Rhode Island Primary Care Physicians Corporation notices an increase in referrals because of social and school anxiety. Kathleen Treloar, director of behavioral health for RIPCPC, answered PBN’s questions about school-related anxiety.

PBN: How many more referrals does RIPCPC receive because of social and school anxiety around the start of the school year?

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TRELOAR: In August, about 44% of referrals for our behavioral health team at Rhode Island Primary Care Physicians Corporation  were related to school-related anxiety and we expect a similar trend as the school year ramps up. Not surprisingly, summer referrals to RIPCPC’s behavioral health team related to school anxiety slowed, with referrals in July down to 25%.

PBN: Who is most at risk for developing social and school anxiety?

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TRELOAR: Children most at risk at developing anxiety related school disorders are children who experience socioeconomic stressors, such as homelessness and children who witness or are traumatized by interpersonal violence. The day-to-day vulnerabilities for a child at home creates increasing levels of anxiety or fear. One of the long-term effects of these adverse childhood experiences is that they prevent the children from developing age-appropriate relationships and trusting their teachers and school administrators during the school day.  Consequently, decreased socialization results in decreased attendance in school or increased anxiety related behaviors during the school day.

One study from the American Academy of Family Physicians estimates that the prevalence of anxiety disorders is approximately 1in 4 adolescents. These anxiety disorders are specifically Social Phobia or panic disorders resulting in significant impairment in daily functioning.

PBN: What are some signs parents should look for if they’re concerned about their kid’s school-related anxiety?

TRELOAR: Anxiety in children looks different than adults. When we think of childhood anxiety, the symptoms children experience can be more somatic or a reactive behavior in nature. A child who is worried about a friendship or upcoming test may resist going to bed and have more frequent crying episodes or anger. Children who are experiencing sadness because they miss being at home at the start of school may begin to develop stomach aches, headaches and go to the nurse for comfort. In the classroom, children who are experiencing anxiety may be more distracted and this anxiety may manifest itself in many ways ranging from more frequent trips to the bathroom to refusal to attend school entirely. This is the time to understand what is at the center of the refusal. Opening lines of communication with the school social worker and the classroom teacher will allow for a review of the classroom environment and potential peer issues with which the student is struggling.

PBN: What are some ways parents can help their kids manage stress and anxiety at the start of the school year?

TRELOAR: One of the most important ways to support your children’s stress and anxiety at the start of the school year is to actively listen to all the stories they want to share. Asking your child ‘how was your day?’ may illicit a one word “good’ or “ok.” Parents should apply a more active listening approach by asking open-ended questions like “Who sat with you at lunch today?” or “What was one interesting thing your teacher talked about in class?” This open-ended approach fosters an environment where children are more willing to share about challenges like a bully in their class or their fear of loneliness at lunch.

It’s important to observe what your child is notsaying and how they are talking about their day. Be sure to recognize the small wins and stay calm when they express an anxious moment of their day. Validation of their feelings helps a child to understand that all emotions, especially anxiety, can be very normal as they adjust to changes at school.

Routine within the household can also have a significant impact on a child’s success and management of anxiety. When a household follows a routine, it helps both parents/guardians and children have an expectation of each person’s role and responsibility during the school year. The days of sleeping late and watching a little extra tv are replaced by taking the bus at an early hour and afterschool homework or school related activities. The transition time to reacclimate to a school schedule is recommended to be a few days to a week. The stress of this transition can be diminished when the entire household embraces the change. Suggestions like ‘How about if we start with going back to bed 30 minutes earlier and get up at 8 a.m. this week?’ can go a long way. The collaboration of the schedule change can help a child to become more invested in the change and allows them to work out their anxieties a week before school starts rather than  the night before school starts.

PBN: What resources are available for parents and children?

TRELOAR: Parents can reach out to their school adjustment counselors or teachers about their children’s fears or anxieties about being back in the classroom. Some schools can help with orientation and tours ahead of time to ease back or develop plans to help your child feel less anxious about coming into school.

Organizations such as Rhode Island Parent Information Network, can be a great resource for parents with kids with anxiety. They can also offer guidance on how to advocate for in the classroom support. Always remember, your child’s primary care physician (e.g. pediatrician, family medicine physician) can work with you to get referrals to behavioral health clinicians to address the new onset of behaviors or stressors that are contributing to school avoidance.

Katie Castellani is a PBN staff writer. You may contact her at Castellani@PBN.com.