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Posted: June 26, 2009 12:00 a.m.

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Advice for students who won’t want to return to school

Reluctance to go to school is one of the most troubling symptoms of generalized anxiety, social anxiety or separation anxiety in children. They may plead to be excused from school, complain of illness or find reasons to be sent home if forced to go. The problem may be a fear of leaving home or a fear of school itself. They may find themselves compared with others and sometimes shamed by critical teachers or peers or frightened by bullies.

The problem may develop after a brief illness, an accident or the death of a pet or relative; sometimes a new school year with new teachers is the trigger.

School refusal is an urgent problem that must be confronted not only with treatment of the underlying anxiety, but also with more immediate action. Depending on where the problem seems to originate, a therapist may want to meet with parents or recommend that parents meet with school staff, or both.

Many infants and toddlers cry when parents leave for work or go out for the evening, but children with separation anxiety disorder fear their parents will be harmed and often have nightmares about separation. Stimulant medications used to treat attention deficit disorder can provoke these symptoms, as can some medications that are used to treat childhood migraine headaches.

Children with generalized anxiety disorder are self-conscious, self-doubting and excessively concerned about meeting other people's expectations. They need constant reassurance and approval. They worry about school grades and frequency and find reasons to avoid school or refuse to go to school. They often feel restless and tense and complain of headaches, stomachaches and other physical symptoms.

Children with social phobia are painfully shy and fear exposure to anything unfamiliar. They cling to their parents and may be afraid of other children as well as adult strangers at an age when such fear is no longer normal. They may be afraid of reading aloud, starting a conversation or attending a birthday party. They may refuse to talk in situations where talking is expected, a symptom known as "selective mutism." Examples include a classroom or doctor's office.

Diagnosing these disorders in children can be difficult because fear and anxiety are also symptoms of many other conditions, including depression, bipolar disorder and attention deficit disorder. Cognitive behavioral therapy is the best confirmed treatment for anxiety disorders in children and adolescents. With the exception of selective serotonin reuptake inhibitors, the FDA has not approved any drugs for childhood anxiety disorders. Parents and other family members can help by learning techniques for managing a child's anxiety, providing models of self-confidence and problem-solving and giving rewards for overcoming fears.

Peggy Nolen is a licensed professional counselor in Covington. Her areas of interest include anxiety, depression, recovery from traumatic experience and problems with drugs and alcohol. She can be reached at (770) 3134-5924.

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