Kids and Anxiety: How schools are trying to help kids cope with anxiety

By KARA YORIO STAFF WRITER | The Record

Hysterically begging not to go to school each morning, then, once there, tears, trips to the nurse’s office, focus lost to a cycle of worries and a never-ending series of questions for teachers about the schedule and assignments. For kids with anxiety, school can be a nightmare of fear-inducing, day-disrupting land mines, set off by triggers including separation from parents, academic pressures, social situations and germ phobias.

“In general, we’re definitely seeing it more and more,” Montvale superintendent Darren Petersen said of anxiety disorders and issues such as kids being unable to get to school. “In talking to other superintendents around the county, definitely something that’s a concern is mental health issues.”

Anxiety is the most prevalent psychiatric illness among children and teens. As many as one in four children and adolescents are affected by an anxiety disorder at one or more times over a lifetime, according to mental health experts. As school staff report seeing an increasing number of anxiety issues in their schools, administrators and teachers are seeking ways to help these children succeed and assist the general population of students with handling day-to-day stress and anxiety.

“As a general rule, I think schools do a good job,” said Philip Kendall, director of the Child and Adolescent Anxiety Disorders Clinic at Temple University. “We can find examples of some hellacious mistakes and some stellar performance. I think most of them get the C+. They do a good job. Where they make the mistake, [is] in context of they’re trying, but not educated and they’ll do things that don’t help.”

Schools often make accommodations that accentuate the anxiety, such as allowing the child who is afraid to eat lunch in the cafeteria to eat lunch in the nurse’s office, according to Kendall. Or putting a spotlight on the child, drawing attention to them in ways that make the anxiety worse, he said.

It requires staff to be educated on how to deal with anxiety, and that’s what Kendall and his team are trying to do with a research project meant to bring information and evidence-based treatment to school systems. In the meantime, New Jersey districts try to do their best.

“If a child has a diagnosis or not, if they’re experiencing anxiety, whether it’s test avoidance, social avoidance, withdrawal in the class, not wanting to change for gym, we deal with it,” said Debra Keeney, president of the New Jersey School Psychologists Association.

For some children, the anxiety goes beyond simply being stressed by overscheduling or an upcoming test. These children are overwhelmed by a cycle of worried thoughts that affect their lives.

When issues are mild or just beginning, counselors, psychologists, teachers and support staff can be a resource team for the child, helping her navigate through the worries.

When the child’s anxiety is more severe and significantly affecting their school experience or schoolwork, a family can create official plans such as a 504 or Individualized Education Program. These are legally binding agreements for kids classified with a disability or physical or mental health condition after school-administered evaluation. The school’s child study team and the family set up child-specific plans to help the student — whether it’s the ability to leave the classroom when overwhelmed or a change in the way they are taught the lessons. Individual aides may also be provided to help a student.

For one North Jersey family, a 504 plan was the only way to get an administration to support their daughter. After struggling through a traumatic kindergarten experience and leaving school before the end of the year, a 504 was implemented for first grade. It allowed her to leave the classroom when she was feeling overwhelmed.

“We could refer to it,” said the father of the girl, who is now in fifth grade. “It didn’t matter what the teachers said. It didn’t matter what the principal said. We’re going to the superintendent if this is the reaction you’re going to have and obviously nobody wanted us to go to the superintendent or the Board of Ed, so it was helpful that way. It’s not the way you want it to be helpful.”

That year, the girl also had an aide, who would help her calm down when needed by taking her out of class and talking to her. She no longer has an aide, but continues with the 504, which has adapted over time. It still allows her to leave the classroom when she needs to — to go to the bathroom, nurse, principal or social worker. It also says she can carry a cellphone in her pocket.

Some schools try to remove the children from the general class, hoping that a smaller class size will lower the anxiety, but typically those smaller classes are for kids with other issues such as learning disabilities or behavioral disorders.

In kindergarten, the girl was moved to a remedial class despite the fact that the academics were not an issue for her, as is the case with most kids with anxiety and no accompanying learning disorder. It is a misguided maneuver by many schools, according to many families. “There’s no classes for these kids with anxiety,” said a Passaic County mother who threatened to sue the school if they put her daughter with severe anxiety in a class of kids with behavioral issues. “It should be state-mandated that they have classes for anxiety-ridden kids, kids that can’t cope with every day school.”

For a child in private therapy, the schools often work with the outside therapist to help with progress. It is important, the therapists say, because anxiety must be faced where it is felt.

“If I’m seeing a kid who has selective mutism in school, then the work has to be done in the school,” said child psychologist Sarah Trosper Olivo of the disorder characterized by a child’s or adolescent’s inability to speak in one or more social settings — at school, in public, with adults — despite speaking comfortably in other settings such as at home. “There’s nothing I can teach her one hour a week in my office that is going to necessarily leap over to the school system and generalize to that.”

She tries to work with teachers, educating them on the issue and providing a behavioral plan.

When the situation is beyond a school’s ability to provide appropriate resources, parents can choose to find a private out-of-district situation such as Sage Day School, which offers education and therapeutic services for kids with anxiety and depression.

Districts pay tuition for more than 90 percent of the kids at Sage, according to the private school’s executive director John Reilly.

Sometimes, though, he admits, it has to get litigious — at an additional cost to the families.

A mother in Essex County, whose son attends Sage Day, had to sue to get her son evaluated by her home district. Because his grades had been fine, the school refused to perform the evaluation despite the many signs that something was wrong — including him hiding in the back of the room and crying during class in the fifth grade. When the evaluation came back, the district admitted they were not equipped to deal with his anxiety issues and now pay for out-of-district placement. At Sage, he has found his place, not only thanks to the therapy and classes, but the culture, according to his mother.

“He knows all the adults have his back,” said his mother. “That’s huge. He feels secure. He feels cared about. He feels understood.”

In the case of Rob and Joyce Mortorano, whose preschool-aged daughter had been diagnosed with selective mutism, their school district claimed they could provide the necessary resources. The family disagreed.

“Hackensack wanted us to put her in a preschool disabled class with a one-on-one [ratio between teacher and student],” said Mortorano. “We visited the class. It was not appropriate for her. We provided a letter from [her doctor] stating that it would be a determent to her to pull her from her current placement since she was finally making progress. They continued to tell us that they could meet her needs. They didn’t understand selective mutism and what type of needs she required.”

The Mortoranos kept her in the original private preschool and hired an attorney to force the Hackensack school district to pay. The superintendent’s office did not respond to repeated requests for comment.

Because of their experience with the school district, when rising medical bills forced the family to sell their home, they looked elsewhere, despite having deep ties to Hackensack, where both had gone to school and Rob had taught.

“We never thought about going somewhere else,” he said.

They found what they were looking for in a supportive school district and administration in Wyckoff.

“From case manager to guidance counselor to elementary school principal — anything to help with transition in any way,” he said. “They actually listened and brought a lot to the table. As a result of all of this, she is doing so well.”

Kendall and his research team are trying to create a way for all schools to have that kind of success with students with anxiety disorders. He and his team are in the fourth year of a five-year research project called Child Anxiety Treatment in Schools and Disseminating of Good Strategies (CATS and DOGS) that is taking an anxiety treatment program into chosen schools to help students with anxiety. They have trained personnel and donate the software and materials to schools in South Jersey, suburban Philadelphia and the Toronto area. After the year of the computer-based program, the researchers check with the schools to see if the program is sticking and follow-up protocols are school personnel.

The goal is to educate school staff and train them on “empirically supported treatment” to help schools deal with the growing problem.

“Anxiety in kids is on the rise,” Kendall said. “It’s a phenomenon that we don’t really understand on science and data; we have some speculations, but it’s definitely on the increase.”

While he doesn’t have official data from CATS and DOGS yet, because it is ongoing, Kendall and his staff have some preliminary results. What they’ve found suggests that while the year with the computer program and training went well, the percentage of follow-up care that required school personnel to implement skills and help kids through their fears was 50-50.

“Half the school service providers will say they’ve done it and it’s been very helpful,” he said. “Half will say, ‘I just can’t find the time,’ ‘I can’t come up with something to do’ or ‘I don’t think this kid can handle it.’ Excuses, let’s say.”

He is not necessarily blaming the staff.

“Here’s where the problem came in — they’re overworked,” Kendall said. “Teachers and other staff are told ‘Do this, do that, do the bullying program, teach math, watch out for peanuts. They’re just overwhelmed with some necessary and some unnecessary, some empirically supported and some not, things they are supposed to do. …

“I think the schools are right, you can’t do everything,” he said. “We’re asking too much of them. We’ve got to give them more staff. From my area of expertise, I would say [they need more] mental health support staff and school support staff.”

He and his researchers have also found a key component in schools helping their students with anxiety.

“Things don’t go as well if the schools and people at the schools are not receptive,” he said. “If you have a receptive school and a champion at the school, things go really, really well.”