Dealing with Back-to-School Anxiety and Behavioral Changes

“As we prepare for the new academic year, it’s crucial to remember that school readiness isn’t just about having the right supplies, it’s also about mental health,” Sunny Patel, M.D., M.P.H., writes in a 2023 article published by the Substance Abuse and Mental Health Services Administration, a part of the U.S. Department of Health and Human Services. “…Research tells us that there is a robust link between students’ mental health and their academic success,” says Dr. Patel, who is senior advisor for children, youth and families at SAMHSA.

Mental health in children and adolescents is at the forefront of concerns for parents, educators, pediatricians, family physicians and mental health professionals. An analysis of mental distress showed declines in mental health of children and adolescents during the pandemic year of 2020, followed by a slight improvement in 2021 and a worsening in 2022.¹ And survey data found that about one in five adolescents reported having experienced symptoms of anxiety or depression in 2021 and 2022.²

Parents’ Role

It’s important for parents to manage their own stress levels. When parents are anxious, their children can often feel it, says Khadijah Booth Watkins, M.D., MPH, a psychiatrist at Mass General Brigham in Boston, in an article the health system published in 2023. To help parents with their own stress as children return to school, Dr. Booth Watkins recommends parents make time for self-care, write down their worries, and talk with a friend.
“It’s okay to take a time-out so you can ground yourself,” she says. “Then you’ll be better equipped to help your child manage their own anxiety.”

Clinical Interventions

Once the school year is in full swing, if anxiety and behavioral changes in children persist, the next step is to agree the child needs to see a pediatrician or mental health professional. A clinician can perform an evaluation to help determine the nature and extent of the challenge, including whether a physical illness is present. The evaluation may include a clinically recognized screening instrument such as the Screen for Child Anxiety Related Disorders (SCARED) or the Patient Health Questionnaire-Adolescent.³

Continued anxiety might be a sign of a longer-term challenge known as school refusal, when the child regularly has trouble staying in school or refuses to go. Mental health professionals consider school refusal to be a symptom, rather than a diagnosis.⁴ It’s often associated with mental health conditions in children, such as social anxiety disorder or major depression. It can also be the result of bullying.

Clinicians have multiple tools and approaches available when encountering a child dealing with mental health challenges that may stem from returning to school, transitioning to a new school or school refusal. Cognitive behavioral therapy (CBT) is often promoted as an effective treatment for anxiety disorders in children and adolescents. The Clinical Practice Guideline published by the American Academy of Child & Adolescent Psychiatry (AACAP) recommends considering CBT as a starting point “for milder, less distressing, and less functionally impairing anxiety presentations” in patients age 6 to 18.⁵ According to the US Preventive Services Task Force, CBT is the most commonly used approach to treating anxiety disorder.³ When a diagnosis of social anxiety, generalized anxiety, separation anxiety or panic disorder is present, AACAP notes there is evidence to support the recommendation that prescribers consider a selective serotonergic reuptake inhibitor (SSRI), a commonly prescribed class of antidepressants.

With appropriate interventions from clinicians, children struggling with back-to-school season can go on to make the most of a new school year.

According to Dr. Patel in the SMAHSA article, “Every child deserves to have a successful academic year, and by equipping young people with mental health support, we are setting them up for a healthier and brighter future.”.

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1 Bhandari N, Gupta S. Trends in Mental Wellbeing of US Children, 2019-2022: Erosion of Mental Health Continued in 2022. International Journal of Environmental Research and Public Health. 2024;21(2):132.

2 KFF, “Recent Trends in Mental Health and Substance Use Concerns Among Adolescents,” Feb. 6, 2024. Accessed Aug. 9, 2024.

3,6 US Preventive Services Task Force. Screening for Anxiety in Children and Adolescents: US Preventive Services Task Force Recommendation Statement. JAMA. 2022;328(14):1438-1444.

4 Kawsar MDS, Yilanli M, Marwaha R. School Refusal. 2022 Jun 5. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan–. PMID: 30480934.

5 Walter H, et al. Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Anxiety Disorder. Journal of the American Academy of Child & Adolescent Psychiatry. 2020; 59(10):1107-1124.