What to Look for In the Classroom

May get easily agitated when triggered.

Anxiety triggers a fight, flight, or freeze response. For some anxious students, their instinct to protect themselves kicks in when they feel overwhelmed or trapped by an anxiety-provoking situation and so they try to fight their way out. This may look like angry behavior: yelling, swearing, pushing items off a desk, or physically acting out.

For example, if a child feels their desk is contaminated because of OCD, they may not want to sit at it. The child may refuse to “take your seat” and feel increasingly trapped as the teacher continues to redirect the student to sit. As the situation escalates, the student may eventually yell at the teacher (“This is so stupid. I’m not doing this!”) and storm out of the classroom, slamming the door. 

This type of disruptive behavior results in strained relationships with the adults from whom the student needs help. It means a missed opportunity to learn to manage anxiety and can end up with the student in trouble.

May look like they have ADHD

When students are anxious, they may look a lot like students with ADHD. They may appear restless, have difficulty paying attention, and act impulsively.

For example, a high school student with OCD who fears that they may have touched chemicals in chemistry lab and then touched their eye, and therefore is about to go blind, may exhibit all three of these symptoms:

• Their knees may bounce up and down (a way to expend nervous energy),
• They may have difficulty paying attention in class and when the teacher calls on them they might not even notice, and
• As soon as the class ends, they are likely to bolt out the door to the bathroom to check their eyes.

It's very important to differentiate between anxiety and ADHD. The treatments for these two disorders are different. In fact, ADHD medicine can make anxiety worse.

May ask repetitive questions

Students with anxiety often have difficulty tolerating any measure of uncertainty. They may feel as if they can’t “move on” until they fully understand a topic or are completely ready.  This may result in students asking their teacher the same questions repeatedly, as they seek reassurance that they understand.

For example, a student may repeatedly ask for clarification on a homework assignment or directions for a project. If they sense growing frustration in the teacher from having to answer the same question many times, the student may then repeatedly ask if the teacher is angry, which may add to the teacher's frustration. All the while, the student is hoping that the teacher will answer the question in such a way that the student will feel certain that they fully understand the information.

Such questions, prompted by anxiety, often appear to be pressured, and/or urgent.

May not exhibit a consistent presentation of difficulty.

When a student has a classic learning disability (for example, dyslexia), the inability to read fluently is consistent across time. It doesn’t matter what day, time, or class it is, or which teacher is teaching. Such students' inability to match letters to the sounds those letters make is fixed. However, if a student has anxiety, they may perform differently from day to day, or even class to class.  In other words, for students with anxiety, the “can't do’s” are unpredictable. This is because anxiety is influenced by many different factors.

For example, if a child has emetophobia (an extreme fear/phobia of vomit), they might not experience any anxiety, and thus function well, until something triggers their fear, such as proximity to a sick classmate, overhearing someone talk about vomit, or feeling nauseous. Once anxious, the student may not be able to pay attention in class, participate in class discussions, or perform well on assessments. Unless the child discloses what is going on, the teacher will have no idea why the student’s performance has suffered. As a result, they may misinterpret the student's difficulty as a lack of motivation or effort.

May experience frequent headaches or stomach aches and make frequent trips to the nurse.

Anxiety puts a person on high alert for danger, and the body experiences physiological changes in the presence of anxiety as it prepares to face a threat. These can include feeling dizzy, short of breath, and/or nauseous, and can cause diarrhea.  Students experiencing anxiety in school thus may make frequent trips to the nurse. They may complain of feeling sick and may even ask to go home.

Because of this, nurses play a critical role in identifying students with anxiety. Some research even suggests that school nurses spend up to one-third of their time providing mental health services to students.

May have attendance problems.

Attendance problems are common for students with anxiety. They include excessive tardiness, missing classes, and school refusal. In many cases, students struggle with all three problems.

For example, a student who feels anxious during the school day on Monday may go into school late on Tuesday, leave early on Wednesday, and then miss Thursday and Friday completely. 

There are many reasons why anxious students have attendance problems, including somatic complaints that lead to sick days, fear of being separated from parents/caregivers, time-consuming rituals related to OCD, and an attempt to avoid the anxiety triggers that exist for an individual at school, such as germs, eating in front of peers, or tests. Attendance problems also may increase after vacations or when a student transitions into a new school building (e.g., going from elementary school to middle school).

May refuse to participate in certain activities/events at school.

Anxious students tend to avoid things that make them uncomfortable, as a way of coping. Some of the common school-related triggers that students avoid are:

• Gym or chemistry class.
• Eating lunch with peers.
• Using the bathroom.
• Going on field trips.
• Speaking up in class.

When students are avoiding because of anxiety, they tend to be inflexible and steadfast in their refusal to do something. They do not respond to logical arguments or information and are unwilling to re-consider their decision.

May be tired in school.

Students who appear to be sleep-deprived in class may be experiencing any of several different types of anxiety.

For example, some students struggle with perfectionism, which is a fear of making mistakes or not meeting their own exceedingly high expectations. These students may procrastinate starting their homework, work slowly to ensure their handwriting is excessively neat, and/or delay transitioning from task to task until they feel ready. 

Because perfectionistic students tend to work slowly, they often stay up late to finish their homework. By contrast, a student with “just right” or “contamination” symptoms may have to wake up very early, because they have several hours of rituals to complete before even starting the school day. Students with generalized anxiety may have persistent difficulty falling asleep or staying asleep.

For all these students, sleep deprivation will interfere with their ability to learn and perform at school.

May not complete homework.

There are many reasons why students don’t do their homework, and anxiety is one of them.

Students with perfectionism sometimes stop even attempting to do homework because of a concern that they can’t meet their own standards. Or they might begin but not complete it because they work so slowly. They also may think, “If I can’t hand in my best work, then I don’t want to hand in anything at all.” This is an example of a common style of thinking seen in anxiety/OCD called dichotomous thinking, or “all-or-nothing” thinking.

In addition, sometimes students with contamination OCD symptoms don’t hand in their homework because they feel that their school materials have become contaminated, and they don’t want to touch them.