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Melanie Cole (Host): Hello. I’m Melanie Cole. Welcome to Anxiety in Schools, a special podcast series from Rogers Behavioral Health. This is episode number two of our six-part series where we look at anxiety and how it can impact learning. In this episode, we’ll discuss anxieties in school. And I would like to welcome Dr. Stephanie Eken. She’s the Regional Medical Director at Rogers Behavioral Health. Dr. Eken, please tell us what does anxiety look like and how does it interfere with learning?

Dr. Stephanie Eken, MD (Guest): Well, anxiety can look – it can come out in a lot of different ways in the learning arena at school. So, first of all, anxiety just in general can sometimes keep people from going to school or engaging in activities related to school or with their peers. So, that’s one way that we see anxiety affecting learning. So, if you are not at school, you are not learning. But also, how we think about ourselves happens with anxiety too. So, being really critical and that can of course reduce confidence whenever you are taking a test or completing and assignment. But even things like being a perfectionist which can be really anxiety based. Some people use perfectionism I say to their advantage, but if it becomes over the top and you become very anxious; then interestingly people will perhaps avoid school or procrastinate because they can’t do something perfectly. And then anxiety also just affects us cognitively, so our ability to pay attention to concentrate on things, to really think through things critically and make good decisions. All of those are places where we can see anxiety impact and absolutely can impact your ability to learn and do well in a school setting.

Melanie: Well we all have heard about teens being stressed out from test taking and standardized testing and such; how does anxiety in school manifest itself as far as a teenager and you mentioned refusal to go to school; but as far as test taking and cognitive ability and being able to concentrate and focus on learning?

Dr. Eken: Absolutely. Anxiety can impact that. So, when we think about taking tests; there is actually research that show us a little bit of anxiety actually for tests helps us perform a little bit better at our highest, however, when it becomes at high levels, then it’s really going to impact tests. So, some people worry about especially if the tests are timed, right, that that can be very stressful and then people can’t seem to manage time well and that can affect their performance. But stress in general, can absolutely affect us and so there are so many stressors for adolescents today. I say, man it must be hard to be a teenager because they have not only this constant idea of test taking and scores and getting into college and sort of doing all these activities to have the best resume to get into school. But they also have other worries to deal with such as what’s brought up in social media, right? They have a lot of feedback about themselves from peers and then they also just have much more exposure to media in general so that events like school shootings that are seems like in the news on a weekly basis. They are also having to contend with sorting through that amount of information and it is very stressful for a teen whose brain is developing and growing. So, absolutely can impact them in the school setting and on test taking and in fact, we put so much emphasis on tests these days that it can really lead people to sort of freeze in those situations and not achieve the level that they are capable of doing.

Melanie: You mentioned social media and what’s going on in the world; do you think kids are more stressed today than they were 30-40 years ago?

Dr. Eken: Yes. I absolutely think that the chronic stress that people, not just teens, it’s really our population, but teens in particular with social media have stressors that we just didn’t face before by the amount of information and decisions that they have to make. Are the going to access those outlets to spend their time on? It’s been shown repeatedly that the more time we spend on social media; actually the less happy we are because we are more stressed and more comparing and frankly the more screen time we have, is not good for us either. So, I definitely believe that that adds to the stress that teens are experiencing today, and it is higher than we have ever seen.

Melanie: Dr. Eken, give us some tips to help address it in the classroom and what are some things that the school can do to help parent education on anxiety for their children?

Dr. Eken: I think number one, just at schools being able to- number one for the teachers to be able to recognize and bring up to parents that they are seeing kids whose performance is changing, they are not achieving in the same way, maybe they are more withdrawn; that having those conversations between teachers and parents is important. But there are things the schools can do just from a temporary standpoint too to help with anxiety disorders. So, it’s really important that clinicians and schools try to collaborate together around helping kids get through the school day despite feeling anxious. So, perhaps temporarily if someone is struggling let’s say on a timed test situation; then a school may for a short period of time while the child is getting treatment take the time limit away or give them more time to complete a test. They might let them go in a different room so that there aren’t those distractors that you would typically have in a classroom with other students. So, there are what schools call accommodations that they can make to help people – sometimes they can excuse kids from being late to school so if they are having a lot of social anxiety; that they don’t go – they don’t enter the school when all the other kids are because that might be really overwhelming for them at the time. Maybe they can leave the classroom for short periods of time to go engage in something like deep breathing or some kind of mindfulness exercise. What we don’t want though is for that to continue indefinitely. Because what we want, is for the child to be getting cognitive behavioral therapy to help them overcome the anxiety and then we start to peel those accommodations away so that they can function as they previously did in the classroom setting.

Melanie: So, what about educating parents, some things that they can do at home, effective management strategies that they can use at home to help their children with some of these anxieties that they face?

Dr. Eken: I tell parents that anxiety likes to take advantage of typical parenting strategies. They have to think a little bit differently with - if you have a child or adolescent who has an anxiety disorder. So, for example, if you have a child that doesn’t have anxiety and they see that a thunderstorm is coming on the news. And they are like oh will I be okay while I’m – during this thunderstorm while I’m at school? Parents usually say oh yeah, go to school. The teachers will take care of you. Don’t worry about it, and they can move on with their day. With a child with anxiety, giving that reassurance over and over is actually problematic because the words that you are saying aren’t really being effective for them. And so, what they may want to do is they may want to stay at home right, because something bad could happen while they are at school and so what we tell parents is repeated reassurance is actually problematic.

It sort of feeds the anxiety. So, we will say if a child asks repeatedly about something like what’s going to happen to me during a thunderstorm. We’ll say things like oh I feel like your anxiety is talking right now, so we externalize that anxiety from the child. Oh, it’s your anxiety that’s speaking right now. Are you worried about this, let’s talk about it, let’s think about like rationally like you have been through thunderstorms before, nothing bad happened? What will they do at school to ensure that you are safe? So, repeated reassurance is not good for kids who are anxious and then also avoiding is not good and so we want to educate parents that if you are starting to see your child avoid activities, people, things that they have typically been able to do in an age appropriate and independent way; that you really have to think about getting more help for them. Because there are things you do by just encouraging your child, reinforcing them really being brave and using coping strategies; but if they are really starting to draw back, then we want to seek clinical help.

Melanie: Where do you see this anxiety in schools going in the future Dr. Eken? What do you think that the schools can do as we move along, and you have talked about society and social networks and test taking and all of these things; where do you think the schools fit into this picture of trying to reduce the anxiety, so these kids can focus better?

Dr. Eken: Well, I think they there are important things to not over-emphasize particular tests. So, I can feel in my own community when the tests are coming up about state testing and where someone’s going to – how their classroom is going to do, how the child is going to do. So, I think we number one have to just also realize that kids are kids and we need to let them be kids. So, I think obviously preparing kids for tests is appropriate but it’s also not the end all, be all for - in their particular lifespan so, I think we need to realistically let them know that heh, you just go to do the best that you can do. Certainly, how a child performs on a test in middle school is not going to predict how they do the rest of their life and into adulthood. So, I think having appropriate emphasis is important and also when we talk with schools; we talk a lot about homework as well and having a manageable amount of homework so that kids can be kids. Kids need to play, they need to be off of their computers, they need to be off of screens. So, even just helping kids think about and problem solve for themselves how can I complete work for school and have balance? And that balance is what’s so critical for all of us as human beings in terms of managing stress. And so, if schools and parents can work together to help find those balances for kids; I think that that’s what’s critical.

Melanie: Thank you so much for joining us Dr. Eken. It’s such great information and so important for listeners to hear. Rogers Behavioral Health is working each day to ensure that those with mental health challenges have access to the highest quality of care and most affective treatment available today. To learn more about the many ways Rogers can help children, teens, families and schools please visit www.rogersbh.org today. That’s www.rogerbh.org . I’m Melanie Cole. Thanks so much for tuning in.