Common forms of anxiety
Students with separation anxiety will often hide their anxiety, making it more difficult to identify. They may say they don’t like school or refuse to go to school. School refusal may be heightened during transition points (such as starting at a new school) or after an extended absence or change in their family circumstances (such as illness or death of a family member).
Some students may want to know where a family member is at all times and worry about losing them through death or an accident, and become anxious when they are not with their parent.
Students with social anxiety usually fear and avoid places and situations where they may need to interact with others. They can be self-conscious, and find situations where they are the center of attention, such as speaking in front of the class or meeting someone new, challenging. They experience significant distress in social situations, and may cry, freeze/shrink, or fail to speak. They may appear shy/withdrawn, refuse to go to school, and have a limited number of friends.
Panic disorder involves repeated and unpredictable panic attacks. Panic attacks are short periods of fear or panic with significant physical symptoms, such as chest pain, difficulty breathing, dizziness, feeling sick and a sense of detachment from one’s self.
Students with a panic disorder may spend a lot of time worrying about having another panic attack and might avoid situations that could make them anxious. In some cases students may develop agoraphobia, which is a fear of being in specific places, such as a crowded place or away from home. Agoraphobia can be a contributing factor to school refusal in some students.
Students who have symptoms of obsessive-compulsive disorder tend to experience repeated thoughts or worries that make them feel anxious (obsessions). To manage these thoughts and worries, students feel they need to engage in specific repeated behaviours or rituals such as keeping items in a specific order, counting to a specific number, or checking and re-checking a door is locked.
These repeated thoughts or behaviours may make it more difficult for them to focus during class, or they may take longer to complete some tasks. Some students with obsessive-compulsive disorder may be late to school or class, or there may be unexplained absences or school refusal.
Students with selective mutism can become anxious about speaking in social situations. They may speak confidently and comfortably at home, yet not talk at all at school or in other specific situations. This behaviour lasts for at least a month, and beyond the first month of school.
Some students may not speak or communicate with others at all in a specific setting, some may speak to select people in a setting, and others may whisper or use gestures. They may also find eye contact difficult. Selective mutism is not the same as traumatic mutism, in which a student may cease speaking in any setting after a traumatic event.
Specific phobias or anxiety
A specific phobia is an intense and unreasonable fear of a situation or object. Some phobias that may be seen at school are fear of being away from home or in crowded places, exam or test anxiety, or maths or science phobia.
While many students experience some anxiety about tests or specific subjects, teenagers with a specific phobia may have so much anxiety that they don’t do well in the test or subject. They may have physical symptoms such as light-headedness and feeling sick, and some teenagers may have panic attacks.
Post-traumatic stress disorder
Some students who have experienced trauma may develop symptoms of Post-Traumatic Stress Disorder (PTSD). Students with PTSD may be irritable, have difficulty concentrating, or experience flashbacks or intrusive memories/dreams of the traumatic event. Students with PTSD may experience significant physical and psychological distress when exposed to reminders of the events (triggers), and may avoid situations in which they could be exposed to these triggers.
They may have persistent and exaggerated negative beliefs about themselves or others, experience ongoing disruptions to their mood or emotions, and feel detached or estranged from others. Disruptions to behaviour can also occur, such as reckless or self-destructive behaviour, outbursts, or aggression.
Students with generalised anxiety tend to have a wide range of unreasonable, excessive and uncontrollable worries, including worries about the past, the future, and their current popularity or performance. They tend to experience anxiety in a range of settings, which can disrupt their ability to relax or enjoy activities. They may be restless or irritable and have trouble paying attention when worrying. They may also lack confidence.