Back to School Anxiety Post COVID-19

By Ashaad Hipps, MSW, LMSW, CYMHS

Returning to school after summer break can be a stressful time for everyone. A new school year comes with many new adventures and challenges, which can be scary for children and teens. During the COVID-19 pandemic, students transitioned to remote learning, and post COVID-19, they returned to the classroom. Imagine trying to adjust to in-person learning, instead of learning virtually, and a post COVID-19 world of uncertainty. The reacclimation to in-person social interactions, removal of social distancing requirements, and receipt of in-person instruction could lead to anxiety in young children and teens.

The Impact of COVID-19 and Anxiety
The COVID-19 pandemic had a tremendous impact on children and families due to the widespread uncertainty caused by the virus. Children suddenly lost the ability to engage in their day-to-day activities, such as going to school, hanging out with friends, and playing sports. This unexpected disruption combined with the unknown could have exacerbated anxiety in children. In addition, the pandemic and lockdowns also affected school-aged children and teens developmentally due to the disruption of their social and learning environments. The transition from elementary to middle and middle to high school are important factors in the lives of children.1 During COVID-19 lockdowns, many students were promoted and had their transition to elementary, middle, or high school virtually. An online transition removed many opportunities for students to appropriately acclimate to their new environments or form positive relationships with peers or teachers, which influences social development and may increase anxiety levels.

School-aged children and teens commonly experience fears and worries related to their everyday life. It is when these symptoms begin to cause a significant disruption in a youth’s daily functioning that a diagnosis of anxiety may be necessary.2 Anxiety disorders are classified as one of the leading causes for disability in the world.3 Anxiety symptoms for children have been found to have elevated significantly following the lockdown when compared with symptom prevalence rates prior to COVID-19.4

There are several different types of anxiety disorders that may affect the lives of children and teens. Generalized anxiety disorder, the most common, can be identified by excessive and uncontrollable worry related to school performance or other day to day events. Children struggling with anxiety may also express anxiety through physical symptoms, such as headaches, stomachaches, and tiredness. Roughly 20% of adolescents and 10% of school aged children meet criteria for a diagnosis of anxiety.5 Those diagnosed with anxiety disorders typically perform poorly academically, struggle with social relationships, and have an elevated risk for depression.5

Treatment Techniques
As mentioned, anxiety disorders have many negative consequences for children and teens who are unable to cope with daily life. Students struggling with untreated anxiety tend to have attendance issues, trouble with verbal and nonverbal problem solving, heightened aggressive behaviors, and more attention seeking from teachers and other adults.6 The placement of school social workers, school psychologists, school counselors, and other school-based mental health professionals puts them in a prime position to provide support to school-aged children and teens who have difficulties coping with anxiety.

One way for school-based practitioners to help children and adolescents experiencing anxiety is to be proactive by implementing prevention measures within schools. An example of a proactive prevention measure involves a three-tier approach. The first tier would be school-wide education on signs and symptoms of anxiety.6 By implementing a school-wide approach as the first intervention tier, the topic becomes less stigmatized, and has the potential to address the needs of each student. Tier two provides more focused support for students who may be at higher risk for developing a mental health disorder, such as children from marginalized backgrounds, who may have experienced a significant loss, or experienced trauma. This level allows students who may not respond to the schoolwide intervention to receive support.6 Tier three involves the selection of certain students from the larger population; this group is known as the target or focus group. Students in the target group are those who are exhibiting early warning signs or symptoms of anxiety but have not yet met the criteria for a diagnosis.6 During all levels of the tiered prevention approach, school-based practitioners provide psychoeducation to parents and students about the signs, symptoms, and potential impact of anxiety on their lives.

Maybe a school is not at the point where it is ready to implement a tiered approach to addressing and helping to reduce anxiety symptoms among the student body. For such schools, teaching students coping skills is another great way for school-based professionals to assist children and adolescents who are experiencing anxiety.

Following are examples of coping techniques for students:

• Grounding techniques, such as the five senses technique, are great to help reduce anxiety. In this activity, the student identifies five things they can see, four they can hear, three they can feel, two they smell, and one they can taste.

• Emotional awareness techniques include the creation of positive affirmations or coping thoughts. This can include, “I can make it through this,” or “Everything is going to be okay.” These are ideal for helping students work through anxious situations and helping them realize they can overcome the anxious situation.

• Calming strategies, such as slow breathing, deep belly breathing, or imagery breathing are all approaches that teach students relaxation to reduce anxious symptoms.

Conclusion
The education of teachers, students, and their families about the signs, symptoms, impacts, and proactive interventions are all crucial in helping reduce the increased anxiety symptoms caused by COVID-19.

— Ashaad Hipps, MSW, LMSW, CYMHS, is a therapist in an acute behavioral health hospital and a Doctor of Social Work candidate at the University of Kentucky. He also works part-time as an instructor in the Master of Social Work program at the University of Kentucky and as a psychotherapist working with children and adolescents with anxiety, depression, anger management issues, and low self-esteem.

References
1. Lane J, Therriault D, Dupuis A, et al. Impact of COVID-19 pandemic on the anxiety of adolescents in Québec. Child Youth Care Forum. 2022;51:811-833.

2. Bobbit S, Kawamura A, Saunders N, Monga S, Penner M, Andrew D. Anxiety in children and youth: part 2 the management of anxiety disorders. Paediatr Child Health. 2023;28(1):60-66.

3. Monk NJ, McLeod GFH, Mulder RT, Spittlehouse JK, Boden JM. Childhood anxious/withdrawn behaviour and later anxiety disorder: a network outcome analysis of a population cohort. Psychol Med. 2023;53(4):1343-1354.

4. Panchal U, Pablo GSD, Franco M, et al. The impact of COVID-19 lockdown on child and adolescent mental health: systematic review. Eur J Child Adolesc Psychiatry. 2023;32(7):1151-1177.

5. Grist R, Croker A, Denne M, Stallard P. Technology delivered interventions for depression and anxiety in children and adolescents: a systematic review and meta-analysis. Clin Child Fam Psychol Rev. 2019;22(2):147-171.

6. Tomb M, Hunter L. Prevention of anxiety in children and adolescents in a school setting: the role of school-based practitioners. Children & Schools. 2004;26(2):87-101.