Help Your Teen Manage Back-to-School Anxiety

Dr. Richard So, MD:

Welcome to Little Health, a Cleveland Clinic Children's podcast that helps navigate the complexities of child health one chapter at a time. In each session, we'll explore a specific area of pediatric care and feature a new host with specialized expertise. We'll address parental concerns, answer questions, and offer guidance on raising healthy, happy children. Now, let's talk little health.

Did you know that most high school students report intense worry about returning to the classroom after summer break? I'm Dr. Richard So, a pediatrician at Cleveland Clinic Children's. And today, we're talking about back-to-school anxiety for teenagers. We'll talk about everything from friendship drama and school stress to the intense pressure to succeed. Joining me today is Brianna Eason.

Brianna Eason, LSW:

Hi, everyone.

Dr. Richard So, MD:

And Emily Cherney.

Emily Cherney, LISW-S:

Hi, Everyone. Glad to be here.

Dr. Richard So, MD:

Brianna and Emily are both social workers and behavioral health therapists at Cleveland Clinic Children's. Welcome to Little Health. Please tell us about yourselves. Brianna.

Brianna Eason, LSW:

My name is Brianna Eason. I'm a licensed social worker and I am a pediatric outpatient behavioral health therapist that sees patients individually, and I facilitate the in - person teen anxiety skills CBT support group.

Emily Cherney, LISW-S:

Hi, my name is Emily Cherney. I am a licensed independent social worker. I am located at Children's Rehab. I provide both individual therapy and run two therapy groups, and I also am a supervisor. I was hired about five years ago under Dr. Joe Austerman in the child psychiatry team to help create some therapy groups, including an anxiety group to help increase access to mental healthcare following the COVID pandemic, uh, which as we know, really led to an increase in child mental health concerns.

Dr. Richard So, MD:

So summer's coming to an end and it's back to school time. And there's a lot of fears for students, you know, "What am I gona wear? Am I gonna fit in?" A lot of fear for parents. It's like one of the themes that we have in Little Health is how do we over- overcome these fears, parenting. And now it's a little bit focused on teenagers. What's happening biologically and emotionally when a child experiences back-to-school jitters, you know? Is it more grumbling, more resistance? And, and then what, what do you think happens, you know, typical nerves versus a little bit more?

Brianna Eason, LSW:

Absolutely. So anxiety and excitement often mirror a lot of the same physiological responses as nervousness. So what that means is that you may experience some hot and cold flashes, stomach issues, you might have a headache, or something like sweaty palms. When kids feel these symptoms, they don't always experience them as excitement. And we often tell our kids and teenagers that you can feel nervous and excited at the same time, understanding that two things can be true at once. Going back to school and going to a new school is a change. It's a big transition. You go from three months being away at summer vacation and maybe you haven't seen your friends during that time. And so we're feeling a little anxious getting back, starting to reestablish and reacclimate back into the school setting, not knowing maybe where classes might be or your class schedule and teachers.

Likely there will be some anxiety there when we don't know what to expect and that's healthy. That's okay.

Dr. Richard So, MD:

How, how much anxiety is, like, or is there a certain amount that's healthy?

Brianna Eason, LSW:

Yeah, there is a healthy amount of anxiety that is healthy. For example, your first day of school, that's healthy. Going somewhere new that you may have never been to before, that's okay as well. Also, with teenagers maybe driving for the first time, that's a healthy amount of anxiety.

Dr. Richard So, MD:

Yeah. I think there's a little bit of anxiety, especially for, could be the incoming freshmen or even the upperclassmen. And they're a little bit different, but for, like, the incoming freshmen, I think summer activities such as, like, band or sport, like cross country, football team, soccer, there's something where before school starts, you have friends.

I like to look at anxiety when it's healthy. I refer to a lot of movies that a lot of kids say, like, I, I love the movie Inside Out, and the second one deals more with teenagers, you know? And just to keep it brief, what I got out of that movie was a little bit of anxiety is good for you. It's a little bit of your normal defense mechanisms, but if you have too much anxiety, you miss out on fun. How can parents tell the difference between those first weak nerves and anxiety issues that are beyond your typical nerves, where they might need help?

Brianna Eason, LSW:

Yeah, absolutely. That usually or sometimes looks like not socializing with peers as often as they would, assuming others don't like them or fear of judgment or rejection without having lack of evidence or understanding of a situation in its full context. Struggling academically, seeing a decrease in grades go down and not asking for support. Having panic attacks, procrastinating more than normal, especially in the morning getting ready for school, which then can lead to often -

Dr. Richard So, MD:

That's a really rough time.

Brianna Eason, LSW:

Yeah. It is.

Dr. Richard So, MD:

You know, for everybody who has kids going to school, you're on the clock.

Brianna Eason, LSW:

Yeah.

Dr. Richard So, MD:

And it's so easy for us to get stressed out. It's like, "Hey, get your butt in gear. We gotta go. Bus is coming." You know? And your kid hasn't eaten yet. All right? You know? How much does that parental stress or anxiety influence that child's emotional state?

Emily Cherney, LISW-S:

So it's interesting you mentioned movies earlier, Dr. So. So I'm gonna mention a movie that deals with this. Finding Nemo. So the central plot of the movie is that the father of Nemo, Marlon, is literally looking for Nemo as he is across an ocean. But one of the main themes also is that Marlon is projecting a lot of his fears about the world onto Nemo and some of the limiting beliefs that he has on Nemo and how this affects their relationship. So I noticed that a lot of parents oftentimes experience their own worries and sometimes they overshare some of those concerns with the child.

Dr. Richard So, MD:

Yeah. I say it in my practice a lot that, like, even babies or kids, you know, they're like horses. They know who's afraid. And if parents are nervous, the kids know. And then they will become frustrated, you know, and they'll mirror that type of emotions. And what do you tell these parents? How do you get them to have that emotional intelligence, you know, to calm themselves down, especially early in the morning or preparing for school in the first couple weeks?

Emily Cherney, LISW-S:

I think recognizing that, you know, that explicit telling of all your concerns, your child can have an impact on them. And sometimes recognizing parents, it's helpful for them to recognize, like, what's a sensational headline versus, like, what are legitimate fears that they should share with their kid? So obviously, there's times in a teen's life where, like, the teen might encounter safety concerns and it might be helpful for a parent to name some of those concerns, such as if they're aware their teen is going to a party where there might be drinking. But I think sometimes we overshare some of those fears and parents should rely on other adults in their life, their spouses, friends, fellow parents, and just like we advise our teens to do, seek out professional help if they feel like their own anxiety is really affecting.

Dr. Richard So, MD:

Yeah. That, that's not uncommon. Sometimes the apple doesn't fall far from the tree. But what about... We have a lot of pediatricians in the office. When do you think is a good time for us to refer, maybe talk about, like, the difference between, like, school avoidance versus school refusal a little bit? And when do you think... 'Cause what's gonna happen is, like, a lot of the parents out there, they'll call their pediatrician. You know, I do have pediatricians that listen to us, you know, what, what do you think we should do?

Brianna Eason, LSW:

That's a good question. One of the things that we often talk about is when there is school avoidance, a lot of the time kids will text their parents or call them or go to the nurse's office or go to the principal's office asking to be picked up. And then that leaves them to missing a good portion of their day. Or they'll wake up feeling sick to their stomach or having a headache or they may have that moment of a meltdown before going to school and they're refusing to get in the car, right? And that part is what we usually tend to look at.

Dr. Richard So, MD:

How many days? You know, that's, that's a really good question. It's like, okay, you know, I look, obviously in the office, I look for, okay, is it always every Monday? You know, was their kids sick over the weekend? You know? But as, even just as a parent of two teens, you know, I think my kid, he fakes, you know? But, like, what's a good timeframe when, uh, like, they're gonna call their pediatrician and they're gonna say, "Okay." And I'm, I'm obvious, like, "Oh, it's anxiety. He just needs to go talk to somebody." But then my wife goes, "No, no, no, no." But what is that time?

Brianna Eason, LSW:

I think as you navigate what that anxiety may look like, a good time would be figuring out first what the patterns are. Are they having a difficult time transitioning from the weekend into Monday? Is it a certain class that they're having a hard time in and also paying attention to what their grades are looking like? Are they going down? And then also following up with the teachers and asking them, "Hey, what are you seeing from my kid in the classroom setting?" Because parents don't have eyes in the, in the school.

Dr. Richard So, MD:

What do you think they're worried about?

Brianna Eason, LSW:

For the-

Dr. Richard So, MD:

The kids.

Brianna Eason, LSW:

The kids.

Dr. Richard So, MD:

Because as, as - [Absolutely.] as a parent, you know, you know, we, we were raised in a more authoritative way where we weren't into this emotional intelligence state where you just do what you're told. But these days we're teaching parents that you have to be a little bit emotionally intelligent or you almost have to get down to their level. So can you talk about that a little bit of, you know, how do, how do parents get down to the kids' level in a calm meaning way right before the school when you're gonna get there? So it could be getting ready for... Like what can you do? Can you prep?

Emily Cherney, LISW-S:

I think there's a few things you can do. So preparation is helpful because we're getting kids the ability to practice in real time. So say a kid is nervous about their first day of school. They're nervous about mastering that locker or finding their classes. You can allow them to go to the high school and walk around and practice going to the class.

Dr. Richard So, MD:

You can talk to the high schools too.

Emily Cherney, LISW-S:

And you can talk to the high schools. You can talk to the guidance counselor.

Dr. Richard So, MD:

Before school starts.

Emily Cherney, LISW-S:

Exactly. You can help them identify maybe an upperclassman that they know from the neighborhood or just a sibling of a friend. I think sometimes that is giving them the exposure that we know helps decrease anxiety. And it also helps build their confidence because they know, okay, I did this trial run. I can do it.

Dr. Richard So, MD:

'Cause I can see a parent going, "You have to go to school. If you don't go to school, they're gonna do this. " And they paint that negative picture. As a pediatrician and a parent, I'm like, "Hey, buddy, what's really going on? " What, like, what are the common things that you see?

Emily Cherney, LISW-S:

So I think oftentimes it is important to figure out why a kid might be nervous about going to school. And sometimes asking those open-ended questions can lead to that. I also, this might be a little controversial, but I think it's very reasonable for parents and guardians to offer a quarterly mental health day where a kid can take off no questions asked four times a year. And this can be an example of you're setting a limit, just like we have PTO at work, but you're also understanding your kid's anxiety. But I think where we get into school avoidance where if you miss one day a week, that's 20% of your education for the year. And then I think with that school avoidance, it can lead to long-term anxiety because the h - less you go, the harder it is to face it. '

Dr. Richard So, MD:

Cause, because you fall behind.

Emily Cherney, LISW-S:

You fall behind and also peers ask you where you've been or you don't have those opportunities to build relationships with peers.

Dr. Richard So, MD:

Yeah. Academic setbacks, difficulty maintaining those peer relationships, little bit of social isolation. So let's go. Y- your kid's at home. What are you supposed to do?

Emily Cherney, LISW-S:

Treat home like school as much as possible. So avoid sometimes when I work with families whose kids stay home, I advise them to set limits in the home. If they are at home and supposed to be at school, they should not be sleeping in. They should not be p- playing on their phones all day or playing video games. We can make home as much like school as possible, have them sit at a desk and do schoolwork during those hours.

Brianna Eason, LSW:

Yeah. And I would also add to that of just being able to prep them for success as much as possible. And I think that's really important, especially the nighttime routine and sleep hygiene, making sure that they're getting enough adequate sleep so that way they can appropriately manage and regulate their anxiety come the morning time, getting ready for school.

Dr. Richard So, MD:

Yeah, we're gonna get to that a little bit, but I, I just wanna dig a little bit deeper. So when, when my son... I, I think he just avoids it. And maybe I do just give him mental health days because he's got straight A, such a good kid. But I tell him, "Okay, okay. If you're staying home today," I go, "No phone, no computer, no. You have to go through all the electronics."

Brianna Eason, LSW:

Yeah. Yep. Yep.

Dr. Richard So, MD:

No tablet. And you can't make it rewarding to stay at home. I think that's an important message if, if you're taking that mental health day, what do you think on that one? You know, am I a bad parent for doing that? I, I almost wanna shut off the wifi.

Emily Cherney, LISW-S:

No, I, I totally agree because if you're making home really rewarding, it's gonna... Kids are gonna wanna skip more.

Dr. Richard So, MD:

Yeah. So, yeah. All right. Great. So g- going back to Br- Brianna is that all my patients that have mental health issues from a medical side, I do prescribe sleep. So if these kids are getting ready for school, it's like when, what would you do? When would you start so they could have success with regards to their sleep schedules?

Brianna Eason, LSW:

Avoiding phones before bedtime is a big one.

Dr. Richard So, MD:

How many hours?

Brianna Eason, LSW:

At least eight to 10 hours of sleep.

Dr. Richard So, MD:

Okay.

Brianna Eason, LSW:

Of sleep.

Dr. Richard So, MD:

No, no. With like this, the phone.

Brianna Eason, LSW:

Without the phone. So usually what I would recommend with parents is making sure that they get all their homework done first when they get home. And then they can get the reward of watching TV, going on their phone, but at least 30 minutes to an hour before bed, shutting off that phone completely.

Dr. Richard So, MD:

Yeah. I tell my kids that nothing... Like we even learn as college kids that nothing good happens after midnight and their phones are pinging. They're FOMO. Their fear of missing out if they don't answer that text. And, and I tell them, I go, "Listen." I go, "Don't do it. " I go, "They're still gona be your friend, okay, in the morning." And then every single teenager says, "Well, I use my phone as my alarm clock." I go, I tell parents, "Why don't you get them an old school alarm clock?" You know, I even have one parent who actually makes the dad puts all the phones in the basket and charges in the hallway. You know, that wouldn't be a bad idea on that one. But then the kids get nervous. Then they can't sleep. Well, what do you do?

Emily Cherney, LISW-S:

So I think it's really important for parents to model also not using their phones as much at night. But we know teens with anxiety, they ruminate a lot at night, which means their worries are constantly in their brains. And I think as parents, what you can do is ask your kid about their day. My mom, every single night as a teenager, before I went to bed, she made me sit down with her and have a cup of tea. And sometimes as like a teenager, I was annoyed by this. I wanted to go to bed. But she was trying to intentionally connect with me. And if I had those worries, I had a space to talk to someone with.

Dr. Richard So, MD:

Yeah. I like that open communication. You know, looking back, you must feel like, "Oh my God, she was doing the right thing."

Emily Cherney, LISW-S:

Yeah. I mean, as a child therapist and as a parent, I totally agree because even if I... Some nights I would talk to her for just a few moments, but some nights there would be a lot on my mind. And I had a chance to get it out and then I slept better.

Dr. Richard So, MD:

Yeah. I think the worst question that parents could ask their teenagers, "How is school today?" Because the typical answer is that you'll get good, fine, teachers suck. But the questions that I like to ask my kids, you know, right off the bat, "Hey, anything funny happen at school today?" And then that mentally brings them into a good place and they'll tell you. They'll talk. And then I'll follow it up, "Anything bad happened at school today?" Then they're still laughing and they're telling you something that bad happens, and it's almost masqueraded on that one. And then my favorite question, believe it or not to ask my daughters, is who do you eat lunch with today? There's a lot of hidden meaning behind that question, you know? Because if it changes, something happened. And then that just opens a little bit more communication. So yeah, with sleep in the office, I talk a lot about, like, box breathing, four-second inhales, maybe a three or four-second pause and then exhale really slowly.

We talk about body scans, but we could have a whole nother conversation about sleep in general. But I think if you're anxious about going to sleep, you just have to learn how to calm, call your pediatrician. Uh, we can go that way. And I really like the routines of the talking to your parents. I think I'm gonna start to have that one in my practice or at least prescribe that. Can you talk about a little bit about what are some options for teens who need some extra support? Those ones that are maybe chronically missing days or there's parental suspicion that something going on. Or believe it or not, you know the kid has diagnosed anxiety or depression.

Brianna Eason, LSW:

One thing that we often talk about is getting into some sort of mental health therapy. Individual therapy is often very helpful along with we have what Emily and I are a part of is Anxiety Center build through Cleveland Clinic where we have groups for all ages as young as six and upward also helps kids to be in a support group with kids and teens their age that also struggle with that anxiety as well. We find often that those support groups are more validating, hearing them from other kids who also may struggle in the same ways as them. It helps them to feel as not alone.

Dr. Richard So, MD:

Yeah, there's a lot of social isolation when you have these mental health issues and just to see that you're not alone. I get it. And there's other kids there going through the same problems.

Emily Cherney, LISW-S:

I would also recommend just working with the school as early as possible if there are concerns. You can create a behavior plan, an individualized education plan if it's necessary, or a 504, allowing them to develop those positive relationships with peers, but seeing if the school has a guidance counselor or a mental health specialist.

Dr. Richard So, MD:

Gotcha. Yeah. So we're talking today and what we're, we're talking about is change. How do you change your mindset? It's really hard because we have these bad routines in our teenagers where they're constantly on their electronics. Constantly. Over the summer, they're gonna be there. During your group sessions, they're, they're gonna have social media. They're gonna... After their group sessions, they're gonna... I like that they'll make friends. But how do you taper that down to the recommendation is less than three hours a day? You know, because there's that circadian rhythm of I have this dopamine fix if I have it, that's the thing that I've been doing over routines and then when I'm off it, I crave it. And then if when you don't have it, you get anxiety and then all of a sudden you're compulsively checking. I think that's gonna be one of the hardest things for these kids to do over the summer when they've had their phones and then they're getting in trouble.

Brianna Eason, LSW:

I agree. It's that instant gratification that teens are often looking at. Social media gives a very short overview of what school anxiety, friendships, peers, relationships look like. Digital life creates like that false narrative at times.

Dr. Richard So, MD:

Yeah, they give that picture that you have to be perfect. [Yes.] And I think it creates a lot of our mental health issues because it's like that inequality of I'm not fitting in. I'm not as good as everybody. I'm fear of missing out. I'm not doing what I'm supposed to be doing. That's a big problem that we have these days.

Brianna Eason, LSW:

It causes teens to struggle with being genuinely who they are and who they want to be. It, it forces pressure on them to be someone that they're not.

Dr. Richard So, MD:

Are there any, like, good, like, websites or, like, any, any, like, YouTube channels that you guys like, you know, where you would tell a kid to go through?

Brianna Eason, LSW:

Actually, we often reference apps as a helpful tool in our groups and how phones can be helpful if you use it in this way. So one of the apps we use called Clarity CB - the CBT Self-Help Journal where kids can go in and write down their anxious thoughts. And it'll actually help them reframe it to a more helpful and neutral thought to understand their anxiety a bit more.

Dr. Richard So, MD:

How can you make it more rewarding for them to give up some of the social media? I think that would be a good positive spin on it.

Emily Cherney, LISW-S:

Encouraging in - person interaction as much as possible. Joining extracurriculars, getting together with friends, going together as a family, going and doing things together, going out to eat together. When you're doing that, everyone avoiding their phones.

Dr. Richard So, MD:

Great answer. So I love the band, theater, swim team, track, cross country. And if you encourage your kids to do that, your social before school start. That is a lot of social pressure for any kid going back to school. Who am I gonna eat lunch with? Maybe you can get their schedules beforehand so they have someone to sit by. That would be establish a good routine. And so your social, that's actually normal social. Who am I gonna eat with? Robotics club. There's a lot of different clubs at a lot of different schools, and you have to encourage your kids to get into those types, you know, because that's what they're there for. Find people who are like you, because everybody feels isolated.

High schools are just really nervous in the beginning of school. You know, there may be academic pressure. There's so many new social dynamics and even performance expectations from parents or even coaches.You know, there's changes in routines. We need to empower these kids. What can these kids do to start these social conversations?

Emily Cherney, LISW-S:

I oftentimes ask kids, "What are the qualities of a friend you would wanna have? Tell me about that person and try to introduce yourself to that person. It's scary. But think about what you would do if a person who had similar interests walked up to you. A lot of teens I talk to say, "Yeah, I would, I would be interested in that friend." And it's easier if you have something in common. So it's easier if you're joining a club or you're wearing a shirt that has a band that you both are interested in. Those are jumping off points.

Dr. Richard So, MD:

Brianna?

Brianna Eason, LSW:

Yeah, I would 100% agree. I think what Emily and you as well, Dr. So said, about joining clubs and sports is a big one as well as maybe helping them to acknowledge that, especially for the kids who are going in as freshmen in high school, you guys are all experiencing something new. And it's okay that you may feel nervous. Maybe it's just saying hi to the next person that's sitting right next to you. Or maybe it's simple as just starting off baby steps and smiling at someone or waving at them. And then going on to having a little bit more communication with them because you saw them in the hallway or their locker is right next to yours and those might be some helpful strategies.

Dr. Richard So, MD:

I really like your point of both of you, everyone at this table about the parents' job of fostering that open communication and acknowledging the kid's feeling is probably one of the take-home messages today. I know you're nervous. And you say to them, "I was nervous. I'm nervous going to work. I'm nervous doing this podcast." And the conversation will just flow. And you have to tell that kid, no, that you're not the only one. We've talked about social isolation. I would probably to empower the kid in saying probably there's five to 10 other kids just like you waiting for a kid to ask them to eat lunch with. And all you have to say, "Hey, you can sit with me. " Or you could just even say, "Hey, can I sit with you? " Okay? First day of school, most people, they're not gona say no.

It's just like adults going to the bar. The difference is we can order something. All right? But we're all nervous. There is fear. Okay? And it's that natural anxiety where it's our defense mechanisms, but if you have too much, you're gonna miss out.

Emily Cherney, LISW-S:

And I think as parents, you can focus on celebrating successes. Successes are not always a kid gets an A or a kid becomes the lead of the school play. Sometimes it's trying out for the school play and recognizing that it took a lot of courage to do that. It took a lot of courage to ask a friend to eat lunch with you. Introduce yourself to someone new. Even if that person was not as polite as your teen would want them to be, I think it's important to build resilience and recognize that sometimes the things that teens are aiming for are not always going to happen, but we have to continually try.

Dr. Richard So, MD:

What a great talk today, Emily and Brianna. How can our parents connect with you?

Emily Cherney, LISW-S:

So you can call Cleveland Clinic Children's and ask about having your teen join our teen anxiety group. And there's both a virtual and an in - person option at Hillcrest.

Dr. Richard So, MD:

It's hard to watch our kids struggle with anxiety, especially with school and these social situations. But your willingness to listen and support them positively helps make a huge difference. To schedule an appointment at Cleveland Clinic Children's, please call 216.444.KIDS. That's 216.444.5437.

Thanks for listening to Little Health. We hope you enjoyed this episode. To keep the Little Health tips coming, subscribe wherever you get your podcasts or visit clevelandclinicchildrens.org/littlehealth.