Anxiety is an important subject in educational psychology because it is known to interfere with children's ability to learn, the level of their classroom performance, and their relationships with classmates. Anxiety can be understood as a multisystem response to an object or event that arouses apprehension. It involves biochemical and neuro-muscular changes in the body, memories of past events (including personal history), anticipation of future outcomes, and appraisal of the present situation. While animals clearly experience fear, as far as is known only humans experience anxiety. Children who feel anxious in school interpret some aspect of the classroom situation through the lens of their past experiences and anticipate negative outcomes. According to Lagattuta, children begin to worry about the future because of a negative past event at some point between the ages of three and five. The specific trigger of classroom anxiety is commonly a test or task of some kind, but it may also be a feature of the social environment, such as a recent move to a new school, general feelings of isolation or rejection, verbal criticism from the teacher, or bullying by schoolmates. In general, schoolchildren are most likely to experience anxiety when they are worried about something bad happening in the future but feel powerless to avoid it, prevent it, or otherwise influence the outcome.
In 1972 Spielberger introduced the distinction between state and trait anxiety that is commonly used by school psychologists in the early 21st century. State anxiety refers to the unpleasant sensation of fear experienced in the face of a threat, whether physical or psychological. State anxiety presupposes a cognitive perception or appraisal of a threat; that is, individuals must know or believe on some level that a specific situation is in fact dangerous or threatening. Test anxiety is a commonly encountered form of state anxiety, as is anxiety related to a public athletic competition or musical performance. Typically, children or adolescents feel less anxious after the stressful event is over. Trait anxiety, by contrast, is an aspect of personality—namely, a tendency to experience state anxiety when confronted with a threat—that remains stable in a specific individual over time but varies from one individual to another. High levels of trait anxiety are closely linked to neuroticism as defined by Eysenck and Eysenck (1991).
In 1980 Spielberger distinguished between two features of both state and trait anxiety, namely worry and emotionality. Worry is related to the cognitive dimension of anxiety; that is, how individuals assess the danger and their competence or incompetence for handling it. Emotionality refers to the feelings and physical sensations associated with anxiety, such as sweating, breathing heavily, feeling nauseated, or having a dry mouth. Worry and emotionality are usually present at the same time; however, they are not necessarily closely related to each other. Thus it is possible for children to be intensely worried but to experience only a moderate level of physical arousal or vice versa.
The physical symptoms that children may experience when they are feeling anxious are related to the so-called fight-or-flight reaction to stress. Some essential body functions, such as breathing, heart rate, and sweating, speed up or intensify, while other functions such as digestion, secretion of saliva, and blood flow within the skin slow down. Children may experience a wide range of bodily sensations, including dry mouth, nausea, vomiting, diarrhea, or abdominal cramps; dizziness, choking sensations, or shortness of breath; rapid pulse or heartbeat, irregular heart rhythms, headache, or heavy sweating; muscle tension or cramps, chest pain, shakiness and impaired physical coordination, general fatigue, or stiff or sore joints. Parents or teachers may notice other signs such as insomnia, general restlessness, or pacing the floor.
Behavioral changes associated with anxiety in children include general irritability and moodiness; regression to earlier stages of development, often around eating habits or toilet training issues; crying, angry outbursts, or temper tantrums; clinging to parents or caregivers; or avoidance behaviors, which may include school refusal, avoidance of after-school activities, or selective mutism (being unable to speak during anxious periods but able to do so normally at other times).
Evaluation and assessment of school-related anxiety in children is a difficult and complex process. First, anxiety is a universal human experience that most children are able to manage. According to Huberty (2004), most schoolchildren cope satisfactorily with anxiety or can be taught to cope more effectively without the need for formal therapy. Between 15 and 20 percent of children in the United States, however, may eventually require treatment for a childhood anxiety disorder.
Second, some childhood fears are age-related; for example, separation anxiety is normal in children between the ages of 18 months and 3 years but usually resolves by the time the child is 4 years or older. At some point around age 8, children's anxieties become less specific; they are replaced by more abstract worries. In other words, children worry less about a mean dog next door or a monster under the bed and more about fitting in with new classmates or making friends at school. Older children and adolescents commonly experience anxiety related to schoolwork, social popularity, and other areas of competition, as they become aware that academic and social competencies are important for success in the workplace as well as in marriage and in procreation. But because children vary in their developmental timetables, it can be difficult to assess whether an anxious child is simply going through a phase or requires closer evaluation.
Third, recent changes in a child's life, such as geographical relocation, starting a new grade, changes in the family structure (such as divorce, death, or remarriage), chronic illness, or parental job loss can affect the child's normal reactions to tests and other anxiety-provoking experiences in school. It may take time to discern whether the child is adjusting to a new situation or whether the child needs additional help. Huberty recommends looking at the child's daily functioning to determine whether professional help is needed. If children are having difficulty with everyday classroom activities, then the anxiety must be addressed regardless of its cause. Evaluating the degree to which the anxiety is interfering with daily life will guide answers to such questions as whether the anxiety is typical for the child's age, whether it is limited to specific learning situations (such as mathematics or foreign-language classes), or whether it appears across a range of activities in the child's life.
Fourth, the physical symptoms associated with anxiety may be caused by a range of other diseases and disorders; thus it is important to rule out such disorders before giving the child a psychological evaluation. In addition, side effects to some medicine should be considered. For example, some cold or asthma medications may cause anxiety symptoms in some children.
If the physical examination gives normal results, and if children still have difficulty with homework or other school-related activities, they may need further evaluation by one or more professionals qualified to diagnose and treat anxiety-related problems in children or adolescents. They may give children one or more brief self-report instruments to screen for excessive anxiety as well as clinician-administered tests.
The State-Trait Anxiety Inventory for Children (STAIC), first used in 1973, is a widely used clinician-administered instrument for measuring state and trait anxiety in children. As of 2008, it was considered the standard in the field and had been translated into more foreign languages than any other measure of anxiety in children. The STAIC is designed for use in children from 9 to 12 years of age and requires about 10 to 20 minutes to complete. It has two 20-item scales: an S-anxiety scale that measures how the child feels at the specific point in time when completing the inventory, and a T-anxiety scale that elicits the child's general feelings of anxiety over time. The STAIC has been used to measure differences in trait anxiety between boys and girls as well as differences between children from different social classes. It has also been used to evaluate the effect of state anxiety on children's ability to recall information accurately.
Another clinician-administered instrument, the Beck Anxiety Inventory (BAI), is used to distinguish between anxiety and depression in children over the age of 7. The STAIC and the BAI are used in psychological research as well as in clinical diagnosis.
Common screening measures include the Screen for Child Anxiety Related Disorders (SCARED), which consists of 41 items; or the Multi-dimensional Anxiety Scale for Children (MASC), which consists of 39 items. These two instruments are designed for children between the ages of 8 and 19 and can be completed in five to 15 minutes. The Spence Children's Anxiety Scale (SCAS), intended for children between 8 and 12 years of age, consists of 45 items and can be completed in five to 10 minutes. A 34-item version of the SCAS for children from 2.5 to 6.5 years of age is designed to be completed by parents. Muris and colleagues (2002) reported that these screeners are reliable and internally consistent instruments that yield results strongly correlated with scores on the STAIC.
One question that has surfaced repeatedly is whether children in the early 2000s are more anxious than their counterparts in previous generations. This question has been asked in connection with state as well as trait anxiety. Twenge reviewed three major explanations for the reported increase in trait anxiety in children between the 1950s and 1990s, namely an increase in overall threats to life and health; increased economic hardship; and loss of social connectedness. After analyzing a number of studies, she came to the conclusion that self-reported levels of anxiety have risen “about a standard deviation between the 1950s and 1990s, a result consistent across samples of college students and children and across different measures” (Twenge, 2000, p. 1018). She attributes the rise in children's anxiety to a combination of worry about personal safety and loss of social connectedness, with economic conditions having a smaller impact.
On the individual level, some children appear to be genetically predisposed to high levels of trait anxiety, as Eley and others have reported in twin studies. Children with a temperament marked by behavioral inhibition (avoidance of new stimuli) are also more likely to develop high levels of trait anxiety. By contrast, Degnon and Fox reported in 2007 that behavioral inhibition is itself a trait that changes over time in many children, with some who were extremely inhibited as toddlers becoming more resilient in later childhood. The researchers attribute these changes in temperament to the development of adaptive attention skills, the influence of parenting, and the child's gender. With regard to gender in particular, Huberty cites findings that girls have higher levels of general anxiety than boys, as well as higher levels of anxiety related specifically to social acceptance. He attributes these findings to the social roles that girls are expected to maintain in contemporary society.
An external factor that increases children's risk of high levels of trait anxiety is low socioeconomic status (SES). According to Papay and Hedl, there is a clear correlation between higher levels of trait anxiety in schoolchildren and lower socioeconomic status.
Some parenting styles have been associated with an increased risk of high levels of trait and state anxiety in children. Parental verbal abuse has been associated with anxiety in children, as have overly controlling parental behavior and negative or rejecting attitudes toward the child. The combination of excessive control and emotional rejection by parents has been shown to have a particularly strong correlation with high levels of anxiety in school-age children.
Anxiety in children is a major concern to educators because of its long-term toll on future academic success and social adjustment. High levels of anxiety increase the likelihood that a child will make mistakes in schoolwork, thus drawing criticisms from teachers and parents that typically reinforce the anxiety. Test taking, bullying, and other anxiety-provoking situations in school may lead to school refusal, which in turn has both short-term and long-term consequences. The short-term consequences include falling behind academically, weakened relationships with peers, and increased stress and conflict within the family. Over the long term, a child with a high level of school-related anxiety is at risk for lifelong academic underachievement, substance abuse, mental disorders in late adolescence or adulthood, recurrent difficulties in social relationships, and employment problems. Other possible outcomes include low self-esteem, underestimation of competencies, and poor problem-solving skills.
Anxiety related to specific intellectual tasks—mathematical problem solving and recitation in foreign-language classes are the two most frequently mentioned—is known to affect eventual career planning. Some students decide against careers that require skill in these fields because they are made anxious by past experiences of difficulty or failure with math or foreign languages.
Bullying in the school environment is another factor in anxiety shown to affect classroom outcomes. According to Grills and Ollendick (2007), girls are more severely affected in their academic performance by anxiety related to bullying than are boys, even though boys are bullied more frequently.
A multimodal approach is the most common recommendation for the treatment of anxiety in school-age children, in that anxious children vary widely in the nature and severity of their symptoms as well as the causes of their anxiety and the degree of their functional impairment. Teachers and other school personnel are usually consulted when a child's treatment is being planned.
Huberty recommends beginning the treatment of anxiety in children with psychotherapy rather than medications. Although the use of medications in treating anxiety in children is no longer controversial, these drugs should not be used as the only form of treatment. They are usually prescribed for children whose anxiety symptoms need to be reduced as quickly as possible, who suffer from concurrent diseases or disorders, or who have not responded to psychotherapy within a reasonable amount of time.
Several forms of psychotherapy have been shown to be effective in managing anxiety in children. Cognitive-behavioral therapy (CBT) is the approach most frequently recommended for children over the age of 6 or 7; between 70 and 80 percent of children respond favorably to it, with 50 percent maintaining their improvement over seven years. CBT helps children improve their sense of mastery and self-esteem as it reduces anxiety symptoms. It is also useful in correcting the cognitive distortions that contribute to anxiety in children; many studies indicate that anxious children tend to focus their attention selectively on threatening rather than positive or neutral features of their classroom. A CBT therapist teaches the child to identify anxious self-talk, to challenge it (with such statements as “That's just my fear talking”), and to substitute positive statements (“I can get through this!”). Key factors in the success of CBT include the child's willingness to practice the new behaviors when the child is not anxious and the parents' willingness to practice the new skills with the child.
A version of CBT introduced by Kendall in the 1990s is the Coping Cat program. The program teaches children to (1) recognize worry and physical reactions to anxiety; (2) clarify their feelings in anxiety-provoking situations; (3) develop a plan to cope effectively with a specific situation; and (4) evaluate their performance and administer self-reinforcement afterward.
Christophersen and Mortweet discuss the ways in which CBT can be used effectively in treating groups of anxious children as well as individuals. According to these authors, forms of psychotherapy that have been shown to be effective in anxious children include child psychoanalysis and psychodynamic psychotherapy. Parent-child interventions include family therapy for parents with problematic parenting styles and inclusion of the parents in the child's CBT therapy.
The American Academy of Child and Adolescent Psychiatry recommended in 2007 that teachers should be involved in the treatment of anxious children when the child's anxiety is interfering with classroom work. Specific suggestions include tailoring the length of homework assignments to the student's capacity to complete them without increased anxiety; identifying an adult outside the classroom who can assist the child with problem-solving and coping strategies; administering tests in quiet or private environments; and writing such accommodations into the child's Individualized Education Plan.
See also:Evaluation (Test) Anxiety
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