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School Based Anxiety: Signs, Causes & Strategies to Support

School Anxiety, Signs, Causes, Support and Resources.

The subject of school anxiety is often a source of frustration and conflict between schools and parents. This is unnecessary and unhelpful and does nothing to provide support to the child. Children are often labelled as being school refusers. Pressure from local authorities may be put on parents to force attendance. The result of this is increasing stress all around. Looking at anxiety at school in isolation can be misleading, the question should be, what can make a child anxious? This should lead us to consider historic trauma, situational conflicts, pressures and stress at home, conflict within the school environment, low self esteem, bullying etc.

Fault finding and a blame culture is not a solution. Over 20 parents, carers, teachers, senior leaders, therapists and others have contributed to the following article. Below is a summary of the discussion held by #SENexchange. You can download the free PDF transcript below. 

What are the signs of school anxiety in children?

Anxiety around attending school can show as a range of different behaviours including a child internalising and becoming withdrawn. The first sign of anxiety may not be visible but is when their parents/carers approach you to tell you of anxiety you can’t yet see. Visible high-impact behaviours often gain our attention but with anxiety we have to be mindful of the quiet internalisation of these anxieties. There is the risk these will manifest as self harm, overeating, skin picking etc.

Common Indicators of Anxiety in School

  • Meltdowns at home
  • Getting distressed with morning routine
  • Refusals to go to school or take part in activities at school
  • Being easily distracted during lessons “Zoning out”
  • Withdrawing
  • Freezing at the door and during transitions within school.
  • Quiet or situational mutism
  • Tearful episodes

These symptoms are easily labelled as “challenging behaviour”. Many of these actions are actually more challenging to the child than anyone else. One contributor stated that “With me, it was always a reluctance to talk about things due to autism, when I was younger I always used to keep things in, still do now sometimes. When I was younger I would never do things I was worried about like school residentials.”.

Many children who cannot access elements of school due to anxiety are labelled as non-compliant. Interpreting a behaviour as challenging is the first step to labelling the child as a school refuser.

A letter from an anxious school child. Sarah Dove
A letter from an anxious child

If we look at behaviour as a form of communication we should look at lateness, non attendance, withdrawal and disruptive behaviour as indicators of anxiety. Often the anxiety or other needs mean these feelings can’t be verbalised or explained by the child. For some children, there might be no signs at all while they are at school, as they are hoping to go under the radar so work extra hard to keep their emotions and anxiety hidden. This masking can be exhausting for a child leading to behaviours coming out at home after school. In recognising anxiety in young people we must start with the belief that children aren’t ‘bad’ or ‘naughty’.  They use disruptive or “challenging behaviour” as a way of communicating, often complex, needs or difficulties

Physical Manifestations of Anxiety 

Mental illness such as anxiety potentially has a significant impact on the immune system, you can see from the list below how anxiety will impact on physical health. 

  • Vomiting
  • Temperatures
  • Repeated infection
  • Constant tummy aches
  • Poor appetite
  • Disrupted sleep/Insomnia
  • Physical Shaking
  • Self-injurious behaviour

These all to a sense of anxiety or stress in that child’s life creating a vicious circle. I have worked with children that would become distressed and vomit due to anxiety. Working in a residential school there was homesickness.

Thanks everyone who replied to Q1. Has confirmed/reaffirmed what I felt my daughter’s displayed behaviours have been about. School has been slipping since pneumonia in November, it’s taken me 3 hrs to get her to school at times. Many tears. But we’re finding a way. 

Dr Lucy Dix

Despite the above lists every child is different but in autistic children, blank/neutral facial expressions is often a red flag as the child may be masking their anxiety along with meltdowns at home after school. Complaints of tummy aches, refusal to get dressed for school, hiding, refusal to leave house, challenging behaviour in house before and after school & onway to/from school, violence to staff, ripping school clothes, masking to a degree & exploding at home

In the case of the daughter of one contributor the anxiety starts the night before. Angry, shouting, grumpy. Not being able to explain how she feels. Tummy ache, headache. Complaints of tummy aches are common, refusal to get dressed for school, hiding, refusal to leave house, ripping school clothes, masking to a degree.

What can cause anxiety around school attendance? 

The school environment is a complex organism, with multiple interactions, and social and behavioural rules. Lots of unpredictable variables that can contribute to school anxiety. Most often, the classroom environment, approach or peers at school are not right for the child. It could also be driven by an inability to understand what is being worked on during the school day, or a fear of failure. Often this fear of failure is real with children being moved sets, being made aware their reading book is lower or their name is on the cloud of shame. I have worked with children whose greatest fear is making mistakes. Often a teacher’s response to this can make or break a child’s self-esteem.

children whose greatest fear is making mistakes self esteem and mental health quote SEND

Common Causes of School Anxiety

  • Sensory issues,
  • Fear of mistakes/getting things wrong, 
  • Unplanned/Unprepared changes
  • Demands around social interactions
  • Unpredictable peers.
  • Isolation
  • Cognitive demands
  • Environment
  • Poor relationships with staff
  • No trusted adult/peers
  • Bullying
  • Unpredictable schedule
  • Unsure of when they will return home

It isn’t always obvious. Professional curiosity is vital. I also talk about belief in experiences. We may not see it as teachers because it spills out at home. An especially misunderstood group are autistic girls. Many children are affected by changes to routines that haven’t been discussed prior to them happening. For children who have been bullied, there is additional specific anxiety about seeing those people. Change is a HUGE issue for many classes as well as individuals. Anything that is changed from the timetable can cause crippling anxiety. For the boys of one contributor it was the unpredictability of secondary school, teachers not being there, no advance warning to change in expected lessons. Topics changing daily not really finishing a full topic.

Through The Doors 

Doors were an issue for one child, he would either not walk through or walk through then leave, plus unlike most recommendations, he was actually worse if met by a TA, issues with roundabouts/key locations marking proximity to school, issues in the school car park! For some it’s not even making it out of bed…then doors, doors, so many doors to negotiate (real and metaphorical) before they’re in the classroom.

Looking for a WHY also makes us think there are conditions attached to the answer – if school anxiety is because of X then that’s ok but if its Y then it isn’t. If it’s because of A then you are on your own but B, i’ll help you. A child may freeze because they don’t know the right answer. One contributor’s daughter could never answer the question ‘why?’ which is all anyone ever asked. It just made her feel stupid, and scared or more.

A child doesn’t want to give the wrong answer and be abandoned when they are at their most vulnerable. It doesn’t have to be rational – it just to be realised, be heard and be supported. We should never ever question a child’s feelings. We don’t need to understand why. It doesn’t need to make sense to us. It doesn’t need to be something you’ve experienced. 

In a previous chat, we discussed school as a healing environment. In the case of school anxiety not feeling safe; Not being able to have your needs met and not being able to say how you feel means that no healing can take place. As school staff we need to be trusted as not trusting the adult or worse, being triggered by the actions of adults will lead to high levels of anxiety and no engagement in learning. 

The key is about knowing the child and how to meet their individual need to feel safe SEND quote anxiety

Many children rely on a predictable routine to process and make sense of their day. If a classroom does not provide this i.e not knowing you will go home, not being supported by a familiar adult then a child will be constantly focusing on the unknown. Additional complications such as language difficulties & not understanding work/other children will be another cause. One child taught by a contributor liked to be in class first, another last. One wanted to enter wrapped/under a ‘security’ blanket and go straight to the reading corner before easing his way back into class. The key is about knowing the child and how to meet their individual need to feel safe.

“In my experience overly noisy environments are often a trigger for anxiety, Yes!!! Like waiting in line for classes to start , I was always the kid with his fingers in his ears.”

Harry E

What can we do to support a child with school anxiety?

Although ultimately there is a long list of things we could do, the most important thing is to make the child feel safe, to trust in our support and allow them to lead the process. Parents are the biggest source of support in the child’s life. I think it’s important to remember this. They’re probably already very stressed. Schools should not add to this by threatening nonattendance penalties, visiting their home without warning, sending intimidating letters. Give parents the info they tell you they need to support their children. Then do absolutely what you promised the parents as they are likely to have coached and reassured on those terms.

We need to appreciate that both parties want what is best for the child. If you don’t kid loses faith in parents and disempowers them from supporting. One of the suggested approaches that I thought would be particularly helpful was to tell the parent of issues before they collect the child at the end of day. That reduces the likelihood that the child will overhear and suffer another blow to their self esteem. It also means the parent can be emotionally available to the child. Make sure everything from the school day can be straightened out before the end of the school day. We don’t want a scared child at bedtime when it’s too late to know facts or help them feel calm

Supporting Children with Anxiety in the Classroom: Strategies for Teachers

Anxiety affects many children, and as educators, we play a crucial role in creating a supportive environment. Let’s explore strategies to help children with anxiety thrive in the classroom:

Understanding Anxiety

  1. Normalising Anxiety:
    • Definition: Anxiety is a normal human response to stress.
    • Fight or Flight: It triggers our brain’s alarm system, preparing us to deal with threats.
    • Short-Term vs. Chronic: While short-lived anxiety is common (e.g., during exams), chronic anxiety can impact mental health.
  2. Risk Factors:
    • Gender: Anxiety disorders are more common in females.
    • Coexisting Conditions: Anxiety often coexists with conditions like autism or ADHD.
    • Home Environment: Poverty, homelessness, or parental mental health issues can contribute.

Creating a Supportive Classroom

  1. Open Communication:
    • Talk to the Child: Understand their feelings and triggers.
    • Involve Parents: Collaborate with parents or caregivers.
  2. Calming Techniques:
    • Self-Calming Objects: Allow a special object, wait box or family pictures.
    • Movement: Encourage physical activity to reduce anxiety.
    • Creative Outlets: Drawing, coloring, or listening to music can help.
  3. Emotion Vocabulary:
    • Teach Emotion Words: Help children express their feelings.
    • Coping Strategies: Teach deep breathing, mindfulness, or progressive muscle relaxation.

Classroom Accommodations for School-Based Anxiety or Emotional-based School Avoidance

  1. Predictability and Structure:
    • Consistent Routine: Establish a predictable daily schedule.
    • Visual Aids: Use schedules or calendars to help children anticipate changes.
  2. Safe Spaces:
    • Designated Areas: Create a quiet corner for self-regulation.
    • “Call Home” Breaks: For students with separation anxiety.
  3. Inclusive Practices:
    • Neurodiversity: Embrace diverse minds and learning styles.
    • Accommodations: Provide extra time, breaks, or alternative assignments.

Model Coping Strategies

  1. Lead by Example:
    • Self-Regulation: Show how you handle challenging emotions.
    • Problem-Solving: Model effective problem-solving techniques.
  2. Promote Social Connections:
    • Peer Support: Encourage positive interactions.
    • Buddy System: Pair anxious students with supportive peers.

Engaging Parents

If schools can engage parents so they are part of the plan then the plan is stronger. Listening really carefully to parents and carers is key to understanding the bigger picture. We dismiss their instincts/comments/input at our peril. This is a great way of extending our understanding beyond the school gates and identifying triggers that cross-pollinate home and school environments. Parent relationships are so important when it comes to working with vulnerable children.

Teachers need to know they can be vulnerable with parents, ask for their expertise & guidance and work collaboratively rather than taking an expert/authority position. Initiate and keep conversations going, between parents and school. Reading about anxiety and home experiences in regards to pupils with SEND. We talk about the good times and the struggles but most of all we communicate to get the best for the children. When a parent comes to me with concerns, we do a joint assessment comparing home and school – part of our job is ensuring we support home. We believe all as a starting point. 

One parent with an in-depth knowledge of both her child and SEND in general had to very forcibly insist there was no play therapist provision for her son before the hospital operation, & no numbing cream before his injection. Treated suspiciously, but her autistic son trusted her and she knew how to time explanations and host sensory preferences.

One contributor shared her experience. At her last school apparently, she was ‘not at all anxious’. We knew she was dying on the inside but masking. The school had a ‘jolly hockey sticks’ approach. If we acknowledge anxiety we can reduce the need for masking hopefully leading to reduced anxiety.

Anxiety Caused by Staff Interactions

Harry was always provided with a worry diary which could be used between home and school. Model student yet at home shouting swearing and violence. It’s awful school doesn’t see it so it doesn’t happen. When we acknowledge this need for co-regulation and support then our support is more effective and less likely to trigger more anxiety. Recognise that these children are often not able to self-regulate so don’t expect them to and instead support them to regulate themselves.

Staff demands/interactions can be a real source of stress for a child, if those staff are trained to co-regulate they become supporters rather than stressors. Co-regulation. Recognise that these children are often not able to self-regulate so don’t expect them to and instead support them to regulate themselves. Providing a space for children to self-regulate and teaching skills for good self-regulation alongside this is essential. Having tools etc close by to communicate what they need is a must. If a child is an AAC user their PECS/PODD book must be close by.

We are biologically predisposed for relationships  SEND behaviour quote

Encourage a key person to connect with. One relationship to start. And accept it may take a few goes to see who is a match. Start from there, together. Minute by minute, build the walk back to trust. In secondary, make every effort for any plan to be conveyed to all teachers (and supply teachers). Good work can be undone in a second.

Communication means Listening

If you are asking the child to communicate when they find it difficult everyone must listen to what they say. Learn to read their body language and subtle signs, regular check-ins on how they are feeling, comments on how you think they are feeling especially for those that lack emotional language, give them jobs to do, and don’t stress about uniform. Include issues such as sensory experiences of school, and relationships. Some children may not really understand other children. Does the child need a Key Adult? A familiar and empathetic adult, who can check in with feelings, support transitions and model regulation skills. We are biologically predisposed for relationships – attuned & sensitive interactions are comforting & healing.

This book was recommended at a SENCO forum and Kirsty found it very helpful, as a sendco and a parent. Also, strategies like the stairway to bravery from Timid to Tiger. Understand their use of language. I have worked with a child who said they ‘hate’ some staff. Knowing it wasn’t true meant listening and being curious as to what they meant. It meant they felt unsafe and that person would cause them high anxiety.

Key strategies to support a child with school anxiety

  • Ask
  • Listen
  • Believe (even when it’s not what you would have thought)
  • Adapt when required
  • Ask again
  • Knowing trigger points 
  • Giving warning before known triggers occur.
  • Initiate and keep conversations going
  • Avoid conflict and look for holistic solutions
  • Acknowledge the existence of anxiety
  • Being aware, 
  • Proactive in strategies to support
  • Provide self-coping opportunities when appropriate
  • Visuals, timers, social stories
  • Breaks and space
  • Co-Regulation
  • Familiar adult
  • Work with parents
  • Visual schedules (written/pics), 
  • Prepare for change
  • Escape routes
  • Favourite activities to look forward to, 
  • Calming/relaxing activities
  • Reducing demands
  • Sensory support
  • Social support 
  • The most important thing anyone can do is believe them
  • Share the plan with all staff
  • Conduct a joint assessment such as the NCBRF
  • Boundaries, routine
  • School culture
  • Foster feelings of belonging
  • Exploit technology
  • Provide opportunities for children to “say” how they feel
  • without words (scaling, traffic light bands)

Sometimes for those with PDA though, a routine can be an extra demand. For these children, novelty and switching things up often can be the winning key

What adaptations can schools make to reduce anxiety around school? 

One of the biggest barriers a school can put up is being inflexible. I would urge all schools supporting a child with anxiety to keep in mind the main aim: To ensure the child is willing in school and engaged in learning. That is your target, if your starting point is full attendance with no additional support, in class by 9:00 full uniform and no opportunities to check in with someone then you will fail and you will fail the child.

Time to process the transition is key. If you start at 10 but it works the child starts at 10. Some contributors acknowledged it’s hard to make adaptations, ultimately we need to encourage all schools to embed a proactive approach to managing mental health. The challenge is to get to that place without neglecting any of the pupils we serve. If the child’s stress-response system is compromised by exposure to adverse experiences, their prefrontal cortex can’t keep a lid on their amygdala. When faced with academic, social and sensory demands, many children resort to survival habits – fight, flight, freeze or flock.

Possible Adaptations to Reduce Anxiety on Transition into School

  • Scooting to school
  • Separate entrance 
  • Reading before school, 
  • Listening to music on transition
  • No challenge agreement
  • Chewy sweet before leaving
  • Leaving school 10mins early.
  • Agreement not to ask about home at school
  • Agreement not to ask about school at home
  • Phased transition
  • Doing odd mornings in the new school
  • At least one staff member they trust
  • Stop 100% attendance awards
  • Work with parents
  • Create solutions eg school tells us when fire alarm test is (also social stories for this or graduated alarms)

One suggestion was to allow parents to stay. I would be interested to hear what people thought about that (add to comments) Seriously my son said if parents could stay at school that would help him! So slow exposure with a safe adult. Emotional regulation support plans, with a focus on preventive or proactive strategies (visual scheduling & structure; consistent & predictable table routines; choices; sensory breaks) and a low arousal approach (reducing demands; simplifying language; access to a safe space).

Build a School Culture That Acknowledges Anxiety

Before implementing strategies such as the 5 point scale, check that the child is actually able to identify how they feel inside their body. I see so many kids that are not able to recognise they feel anxious, just that they don’t feel good. Flexible start times, allow each child to enter how and when they need to. For one contributor’s daughter, a lot of anxiety stemmed from being looked at or ‘judged’ – and she needed to be the first one in the classroom rather than walk into an already busy classroom. That way the child could process each individual on their entry not have to process a whole group/mass of information at once.

To begin with inhabit a schoolwide culture that believes anxiety exists and that it is a barrier to learning. Sometimes that’s the first step needed to get a community on board. Avoiding unnecessary or lengthy transitions can be really helpful. Targeted interventions both at home and safe spaces in school; multi-agency working; pupil voice; restorative conversations. Adaptations can, and should be very pupil/family specific.

Transition between home and school can be a cause of anxiety, what can we do to overcome this?

The physical journey between school and home can itself cause anxiety or the shift it represents – going from safety, for example, or being comfortable or confident or in control or even with your favourite blanket or toys. As with any aspect of school life get to know the child as best as you possibly can, what might help their journey be as painless as possible? A favourite toy to hold, singing songs, telling a story stepping out of the door can be stepping out of our comfort zone so we might like to think about how we can make school more like the comforts of home to reduce the contrasting environments. – can they have a cuppa? do they have a comfy chair etc? Are they able to choose the radio station or are you going to make them listen to what you want?

Focus on the aim of the transition

All of these have an impact. Sometimes, it is just the transition itself that causes anxiety. Try and make transitions more meaningful and purposeful for the child. Give them something to do during the transition. The aim is to get the child to school in a positive state ready to learn. Everything else is a distraction, source of conflict or potential barrier. Remove and reduce these were possible.

The aim is to get the child to school in a positive state ready to learn School anxiety quote

As with other causes of anxiety, common strategies can be effective. Being aware, and proactive in strategies to support and provide self-coping opportunities when appropriate. E.g. visuals, timers, social stories, breaks and space. One resource I have used is an eye spy that the child uses on the way to school. A distraction. Another is a follow-the-route map. The driver can add diversions if needed. For more information on supporting transitions in general take a look at our Guide to transition.

Support of Home-School Transport Providers

Elly Chapple reflected on the importance of relationships If you have taxi collection “Having a strong relationship with the people on the journey is key. Stan and Susan made all our lives better – Ella’s in particular. They were #human and stayed with her for years. Taxi escorts are such key people in the day of our students…all too often these colleagues get the least input and very little credit for the brilliant work they do. An oft-overlooked yet crucial part of the team. Often the first to see and pick up on how the child feels that day.”

Supporting the home-to-school transition.

  • Visual supports, transitional objects, 
  • Relaxing/favourite activities when entering,
  • Roles when entering, quieter/less crowded entrance.
  • Travel schedule showing landmarks on the route to school
  • Communication, communication, communication.
  • Keeping consistency at home and school is paramount to our children. 
  • Make visuals for home to help children who are struggling
  • Visual communication can add structure & predictability
  • A Social Story about coming to school

A checklist to break down the routines of getting up, having breakfast, brushing teeth, changing clothes 

What sources of support/resources are you aware of that can support children and parents?

There are an increasing amount of digital tools to help children and young people with anxiety in school and in general. I fear that a very human process can not be replaced by technology and we run a real risk by trying to do so. 

The basic building blocks of support are giving both teachers and parents confidence, helping them understand and signposting resources in the wider community, Training in the management and delivery of ehcp, knowing the roles and responsibilities of LAs etc. 





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SEND School based anxiety guide

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  1. Thank you to all contributors. This is a very useful piece of feedback research. I particularly like the bullet points, which give lots of alternative strategies and suggestions to consider for busy teachers and parents when they listen to and reflect on the children’s possible points of view.

  2. Interesting, parents staying in school, when my son started a new school, I signed up as chair of their parent association charity I was at the school a lot, knew all the teachers, it was the only time he was not anxious at school, then senior school began and the anxiety returned.

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