By Dr. Mehri Moore

This article was originally published in PsychCentral’s Mental Health Library.

As summer winds down and returning to school becomes an unavoidable reality, many teenagers are experiencing a rush of varied emotions. Some teens enjoy school and are eager to trade their dull summer jobs for daily intellectual enrichment. Others find school intolerable and wish that the steamy summer months would carry on forever. A third set sees the first day of school as a landmark of dread and anxiety and spend most of August worrying about whether they’ll get along with their new teachers, whether they’ll be able to keep their grades up, and whether they’ll be able to continue navigating the at times treacherous waters of adolescent sociality.

When Butterflies Turn into Something More

A certain amount of school-related trepidation is normal — especially if a teenager has recently moved or is starting middle or high school — but where is the line between “a case of the butterflies” and serious clinical anxiety? The National Institute of Mental Health reports that 25% of 13- to 18-year-olds struggle with some sort of anxiety disorder at some point during their adolescence.

Not all of these cases are directly related to school, but educational environments play such a dominant role in young people’s intellectual, emotional, and social development that incidents at or related to school often underlie many adolescents’ mental health struggles. In the initial weeks of the school year, teens’ most imposing anxieties tend to be social. The average teenager’s self-image is substantially influenced by how she is perceived by her peers, and concerns about one’s place in social hierarchies tend to rise to the surface each fall. Once school gets underway in earnest, the pressure of this outward-looking self-definition is compounded by academic stressors, as teens must juggle the expectations not only of their peers but of their parents and teachers as well.

In extreme cases — occurring in roughly 2% to 5% of school-aged children — parents may encounter anxiety-based school refusal, wherein their child has an extraordinarily difficult time going to or remaining at school. School refusal is often characterized by psychosomatic symptoms including headaches, stomachaches, nausea, or diarrhea that dissipate once a student is allowed to skip school for the day or return home from school early. Though these issues can, on occasion, be fabricated, they are typically legitimate physical manifestations of severe psychological stress. In many cases, children who engage in school refusal will benefit from a small dosage of non-addictive anti-anxiety medication, something that their pediatrician should be able to prescribe.

The more proactive parents — and cooperative teens themselves — are about investigating and getting treatment for anxiety issues, the better, as school avoidance often becomes something of a self-fulfilling prophecy. When a teen feels panicked about school, her instinct is to avoid attending school, but while this may ease short-term anxieties, it also inculcates an ever-increasing fear of school by lending credence to the idea that school should be feared in the first place. Ultimately, the longer a teen is left to struggle with her anxiety alone, the harder it is to achieve a quick and durable recovery.

Even if a teenager’s issues don’t manifest as a full-on refusal to attend school, she may still be dealing with an anxiety disorder that would benefit from formal intervention. If a teen’s school-related anxiety becomes increasingly frequent and intense, if it doesn’t subside a month or so into the school year, or if it begins to interfere with her eating and sleeping, her parents should strongly consider soliciting professional help.

How to Help Your Teen Cope with Anxiety

There are a number of things that parents and teens can work on that help stabilize teens’ school-related anxieties. For one, taking care of daily “essentials” is absolutely critical. It’s difficult to cope — with anything, much less anxiety — when one is tired or hungry, so parents need to make sure that their children are getting enough sleep and eating regularly and healthily. Though most teens have probably outgrown a formal bedtime, it doesn’t hurt for parents to emphasize the importance of a consistent routine — both with respect to sleeping and eating — in maintaining one’s health, both physical and mental.

Further, parents should take steps to acclimate their anxiety-prone teen prior to the start of the school year. Pre-exposure to new environments and situations can go a long way toward helping teens establish a baseline amount of comfort with and control of their daily lives. This might entail walking the halls of a teen’s school before the academic year begins, arranging meetings with their teachers in order to get a head start on relationship-building, or anything else that amounts to a pre-orientation, of sorts. Though it may seem unusual — and is probably more appropriate among the younger set — this acclimatization can even extend to a parent riding the bus or accompanying a student to school during the first week in order to facilitate as smooth a transition as possible.

In short, parents with struggling teens should make every effort to make themselves available to their children in whatever capacity possible. As mentioned above, general nervousness at the start of the school year is normal, and parents should feel free to say as much to their children. Talking with a teen about their worries and fears is a great way to assess whether what they’re experiencing is just the normal ups-and-downs of adolescence or something more serious.

If monitoring your child closely or talking candidly with her leads you to believe that she is struggling with a serious anxiety disorder, it’s time to bring a professional into the picture. Fortunately, if you believe that your child is dealing with anxiety, you’re not alone. There are as many treatment options available as there are sources of school-related anxiety, and an initial consultation with a mental health professional will help you and your child figure out what’s best for your family.

Regardless of the treatment plan you choose, what’s most important is that you remain supportive of your teen, especially during challenging times like the start of the school year. Nobody expects parents to precisely diagnose what is wrong when their child suffers a lapse in mental health, only to notice that something is wrong. Doing so is not always easy, but with a bit of vigilance and a serious effort to maintain open and frank communication with your child, it’s certainly possible.