Anxiety in the classroom: Implications for middle school teachers

Author(s): Kristen Moran

Source: Middle School Journal , October 2015, Vol. 47, No. 1 (October 2015), pp. 27-32
Published by: Association for Middle Level Education (AMLE)

Stable URL: https://www.jstor.org/stable/43958586

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Anxiety in the classroom: Implications for
middle school teachers

Krísten Moran

Abstract: Anxiety is a prevalent mental health concern in chil- affect a child's overall ability to concentrate and to learn
dren and adolescents that can have a negative effect on their (Packer 8c Pruitt, 2010), and can impair overall academic
personal relationships as well as their academics. Teachers are performance (Muris 8c Meesters, 2002) . Anxiety disorders
in a position to assist in recognizing the signs of anxiety and may be associated with an overall negative effect on a child's
supporting students in the classroom. Practical suggestions on thinking and ability to make decisions. In addition, anxiety
how teachers can support middle school students with anxiety can disturb an adolescent's ability to build effective rela-
are provided.
tionships with their peers (Packer & Pruitt, 2010).
Most teachers will have at least one student in their
Keywords: anxiety , middle school , teachers ; interventions
classroom with an anxiety disorder (Children's Mental
This We Believe characteristics:
Health Matters, 2009). "Because school plays such a signif-
icant role in adolescents' identity development, teachers
• Educators value young adolescents and are prepared to teach
them are in a unique position to recognize and provide essential
• Comprehensive guidance and support services meet the supports for students. . ." (Johnson, Eva, Johnson, 8c Walker,
needs of young adolescents 2011, p. 10). According to Reinke, Stormont, Herman,
Puri, and Goel (201 1) , in their study involving 292 teachers
• Health and wellness are supported in curricula, school-wide
programs, and related policies from five school districts, "89% of teachers agreed that
schools should be involved in addressing the mental health
According to Cohen (2013), "Schools are more competi-
needs of children" (p. 9). The teachers in their study stated
tive and stressful, children are more overscheduled, par-
they needed additional knowledge, including recognizing
ents are worried about finances and safety, and society is
signs of mental health concerns, and strategies for working
based on a win-lose model..." (p. 2). It is no wonder that
with students exhibiting problems.
anxiety disorders are the most common mental health
disorder in children and adolescents (Children's Mental The purpose of this article is to educate middle level
teachers about anxiety, including the various types of anxiety
Health Matters, 2009; Mychailyszyn, Mendez, 8c Kendall,
disorders that arise in adolescents. In addition, implications
2010; Packer & Pruitt, 2010). The median age of onset for
for middle school teachers' professional practice are shared
anxiety disorders is 11 years old (Kessler et al., 2005),
to increase support for these students in the classroom.
usually developing sometime during adolescence (Packer
8c Pruitt, 2010). Oftentimes, children and adolescents do
not have the life experiences to effectively handle anxiety
experienced with change (Mader, 2012).
Understanding anxiety disorders
According to the Anxiety and Depression Association of Anxiety can be described by using "a simple formula: Add up
America (ADAA; n.d.), research has shown that children all the things that cause us stress, and then subtract all of our

with untreated anxiety disorders have a higher risk of nega- abilities to cope. The net result is our anxiety level" (Cohen,
tive outcomes, such as increased substance use. Anxiety can 2013, p. 2). Although anxiety can be considered a normal

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part of childhood and adolescence, anxiety becomes a dis- with peers (ADAA, n.d.). A student's level of worry is often
order when it interferes with functioning in various aspects made worse if others notice or recognize their anxiety
of one's life, such as school and social relationships in chil- (Packer 8c Pruitt, 2010).
dren (ADAA, n.d.). The Diagnostic and Statistical Manual of
Mental Disorders (DSM-V) categorizes anxiety disorders by, Panic disorder
"the types of objects or situations that induce fear, anxiety, or
In order for a student to be diagnosed with panic disorder,
avoidance behavior, and the associated cognitive ideation"
he/ she must experience at least two unanticipated panic
(American Psychiatric Association [APA], 2013, p. 189).
attacks without cause (ADAA, n.d.). A panic attack is "an
Mental health professionals use the DSM-V and the criteria
abrupt surge of intense fear or intense discomfort that
included to diagnose specific anxiety disorders. Although
anxiety in youth does not often present itself as one specific
reaches a peak within minutes" (APA, 2013, p. 208),
accompanied by a variety of symptoms (i.e., sweating,
type of disorder (Kendall et al., 2010), it is important for
dizzy, nausea, chest pain, palpitations) . Because a student
educators to understand potential signs of the disorders. It is
cannot predict a panic attack (Ollendick, 1998), this can
also necessary to recognize there are many characteristics
lead to anxiety about when they might experience the
shared between the different anxiety disorders (APA, 2013).
next attack, making it very difficult to concentrate. Panic
According to Packer and Pruitt (2010), the two most fre-
attacks can cause sheer terror in students, often producing
quent anxiety disorders in middle childhood and adoles-
physical symptoms such as feeling weak, faint, dizzy,
cence are generalized anxiety disorder (GAD) and social
chilled, and having a pounding heart. The automatic
anxiety disorder. Other anxiety disorders associated with this
reaction for those that experience panic attacks is the
age are panic disorder and specific phobia (ADAA, n.d.).
need to escape (Packer 8c Pruitt, 2010).

GAD
Specific phobia
GAD manifests itself as a hard-to-control, excessive worry,
about many different aspects in students' lives. According Although children and adolescents may have certain fears
to the DSM-5 (APA, 2013), the type of worries associated as part of normal development, it can become a specific
with GAD can change over time. These students tend to be phobia when they experience this fear for at least 6
perfectionists, doubt their abilities, and seek outside months and do not recognize that this fear is irrational
approval (ADAA, n.d.; Packer & Pruitt, 2010). Although (APA, 2013). A specific phobia is a fear of a specific object
some students with GAD can internalize symptoms of this or a specific situation in which the person will avoid the
anxiety disorder, making it hard to identify (Naparstek, object or situation. For example, a student refusing to
2009), some physical signs that a student is struggling enter a dark room because of a fear of spiders is a specific
include fatigue, headache, muscle tension, lightheaded- phobia. It can be common for a person to have multiple
ness, nausea, and trembling (Packer & Pruitt, 2010). objects or situations that cause fear or anxiety (APA,
Teachers may also note an inability to relax, a lack of 2013). Specific phobias can result in a child or adolescent
concentration (Naparstek, 2009; Packer 8c Pruitt, 2010), experiencing behavioral issues, an inability to follow
and avoidant behaviors (Keeley 8c Storch, 2009). directions, and/or possible social embarrassment from
their peers (Packer 8c Pruitt, 2010).
In his multiple-systems theory of emotion, Lang
Social anxiety disorder
(1968) indicated that symptoms of anxiety can be cate-
This type of anxiety disorder can best be described as a gorized as cognitive, physiological, or behavioral. Table 1
"Marked fear or anxiety about one or more social situa- provides an overview of the type of symptoms typically
tions in which the individual is exposed to possible scru- seen in each of these three areas, despite the type of
tiny by others" (APA, 2013, p. 202). Students with social anxiety disorder.
anxiety tend to appear shy, withdrawn, and avoid eye
contact (Keeley 8c Storch, 2009). Physically they may
experience heart palpitations, sweating, blushing, and Implications for teachers
tremors (Packer 8c Pruitt, 2010). They also have fewer Although it is not the responsibility of teachers to diag-
friendships and relationships due to trouble socializing nose students with anxiety, many roles are appropriate

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Table 1 Symptoms of Anxiety in the classrooms providing lessons to assist students with
effective skill development in a variety of areas. It would
make sense to provide classroom lessons on anxiety,
■ Cognitive Physiological Behavioral I
H Symptoms Symptoms Symptoms H including education about anxiety, relaxation skills, and
positive self-talk. Mindfulness programs can also assist
H Lack of focus Headaches Avoidance H
H Lack of Stomachaches School refusal H students in managing their symptoms (Wright 8c
H concentration Nausea Classroom disruption H
Sulkowski, 2013).
H Inability to make Heart Trouble developing H
H decisions palpitations relationships H
H Catastrophic Sweatiness Trouble maintaining H
H thinking Dizziness relationships H Intervention
H Fainting Inability to relax H
■ ■ It is known that not all students will respond to the
H Muscle tension H universal prevention efforts of a MTSS within the school
H Insomnia H
(Wright 8c Sulkowski, 2013) and may need additional
H Fatigue H
H Weakness H targeted services. Teacher can more easily observe and
H Trembling H identify potential mental health symptoms because they
H Blushing H interact with students on almost a daily basis (Johnson
et al, 2011). It is important to note that internalizing
symptoms, such as anxiety, can be difficult to detect
(Tomb 8c Hunter, 2004). Teachers should take note of
for teachers in
relation to
the signs and symptoms, students
including which signs they see an
dle school. Many school systems are
in the student, when are they noticing these signs (i.e., u
systems of support (MTSS) to address
specific time of day or particular situation) and where
demic, behavioral, and emotional needs of students
(i.e., classroom, hallway, lunchroom). It is also impor-
(Sulkowski, Wingfield, Jones, & Coulter, 2011). The tant to estimate the length of time the signs are present.
three tiers of MTSS allow for schools to address both
This is not always easy as many students may try to hide
prevention and intervention efforts with students. their anxiety. Lastly, it is important to take note of the
Therefore, implications for teachers will be discussed
intensity of the symptoms (Sink 8c Igleman, 2004).
within this context. Potential classroom accommoda-
Teachers who notice many of the cognitive, physiologi-
tions are shared.
cal, and behavioral symptoms of anxiety should share
concerns with the school counselor (Sink 8c Igleman,
2004).
Prevention School counselors are educated in mental health
issues and are aware of resources available to students who
Teachers can assist in developing prevention efforts in the
schools to minimize the development of anxiety disordersare having symptoms of anxiety. Although school counse-
in students. It makes sense to implement universal pre- lors do not provide long-term therapy to students, they are
able to talk to the student in more depth to find out just
vention programs in the schools since the onset of anxiety
disorders are typically in childhood and adolescence how debilitating their anxiety symptoms are and how it is
(Greenberg, Domitrovich, & Bumbarger, 2001). Theseaffecting their lives. School counselors can work closely
efforts can focus on key areas of "academics, peer rela- with the student and parents to get the appropriate ser-
vices inside and outside of school. Services inside of the
tionships, and social-emotional development" (Tomb &
Hunter, 2004, p. 88) , allowing for the reduction of riskschool may include counseling services or referral to the
student support team. If the services inside the school will
factors that can provide for the manifestation of the dis-
order (Tomb 8c Hunter, 2004). Collaboration with school not meet all of the needs of the student, the school
counselors will allow for the development of these efforts counselor can provide access to outside resources, such as
as they are focused on a comprehensive program that private practitioners and support groups, which can work
addresses prevention for the entire student body. They are with the family and child.

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Classroom accommodations This pass allows for the student to access a safe person
or safe place for approximately 5-10 minutes in order
According to Dubois, Feiner, Brand, Adan, and Evans
to work through their symptoms. This place and/or
(1992), support by school personnel can have a positive
person must be decided on ahead of time and could
effect on a child's development. Teachers can provide include the school counselor, the nurse's office, a
numerous accommodations within the classroom that will
coach, or an administrator. It can also allow a student
assist and support the student with anxiety. Some strate-
to take a quick bathroom break or get a drink of water.
gies could be part of a formal 504 plan or IEP (indivi-
It is important for the teacher to provide limits if
dualized education plan) if a student has met the criteria.
being misused by the student.
It is also important to note that many of these are inclusive
5. Classroom seating: Where a student with anxiety sits in
strategies that may be beneficial for all students (Mader,
the classroom can provide a reduction in their anxiety
2012), not just those with anxiety. Strategies include the
symptoms. It may be helpful to allow the student to sit
following:
close to the door so if they need to leave the classroom

1. Consistent daily routine: Most students with anxiety they can do so without distracting the class or drawing

will perform best in a classroom that is well organized attention to themselves (WorryWiseKids, n.d.).

with a consistent schedule and clear expectations 6. Test accommodations: A study by Ramirez and Beilock
(Johnson et al., 2011). It is helpful to post the routine (2011) found that students who were able to write
in the classroom and to let students know changes about their fears for approximately 10 minutes prior
ahead of time (Brown, 2010). to taking a high-stakes test were able to reduce their

2. Task-focused environment: Instead of focusing on the worry. In addition, extra time on tests and a quiet

ability of the students within the classroom, which can environment can allow for reduction in overall anxiety

be anxiety producing for some, it can be helpful to (WorryWiseKids.org, n.d.).

have a task-focused environment (Roeser 8c Midgley, 7. Alternative assignments: There may be particular
1997). This type of environment provides for variety in assignments that cause students to feel anxious
learning, challenges students, and assists in determin- depending on the type of anxiety the student is
ing personal goals, ultimately allowing for less compe- experiencing. For example, a student with social
tition between students and an overall more anxiety would have a severe fear of oral presentations.
conducive, respectful environment in the classroom. Providing an alternative assignment would make sense
An example may include allowing students to work in to reduce the anxiety the student may experience.
groups to determine the solution to a problem ratherAlternatives may include providing the presentation to
than working individually, where students are less the teacher individually or allowing the student to
willing to volunteer their answers (Ames, 1992). videotape the presentation and provide to the teacher

3. Group activities: Initiating positive peer interactions for grading. Another example of tasks that could be
can be very beneficial for students with anxiety, espe- anxiety producing may be answering questions out

cially those with social anxiety. By working with care- loud in class or answering questions at the board or

fully selected students for small group activities, the smart board. Letting the student know ahead of time
student feels a connection to others (Emmer & that the teacher may call on them can allow for a

Evertson, 2009; Johnson et al., 2011). Groups assist inreduction in anxiety (WorryWiseKids.org, n.d.).
building their confidence and allow students to 8. Copies of notes: Although copies of notes do not need to
develop relationships (Packer 8c Pruitt, 2010) in a be provided at all times for students that have anxiety, it
more comfortable environment. is comforting to these students to know they will not miss

4. Classroom pass: A permanent pass for a student with material if they do need to leave class because they are
anxiety allows him/her to leave class when they are experiencing symptoms. Notes are also helpful if a stu-
dent is absent from school. Assigning a class buddy (or
having symptoms without drawing attention to them-
friend) to make sure the student receives all of the
selves. According to Packer and Pruitt (2010), "The
ability to make a graceful exit is important to the material can be helpful for the student (WorryWiseKids.

student's self-esteem and peer relationships" (p. 45). org, n.d.). It will be important for the teacher to be

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 intentional about the student they choose, potentially predicted incidence of adult anxiety (Kendall et al., 2010;
asking the student with anxiety for input. Van Ameringen, Mancini, 8c Farvolden, 2003). As middle
9. Creative activities: These activities allow students to level educators committed to the development and health
of the whole adolescent, this article highlights important
express themselves freely, through writing, art, music,
pathways for professional practice.
and journaling. This provides an opportunity for stu-
dents to individualize their work and for teachers to

connect to their students (Johnson et al., 2011).

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Kristen Moran is an assistant professor in the School of Education at Campbell University in Buies Creek, North Carolina. Email: kmoran@
campbell.edu.

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