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Emma was nine when her anxiety about school really began. When her twin sisters were born six years earlier, her mother had taken a break from her full-time career and stayed at home for four years. Her father worked from home and one set of grandparents lived with them. "There was always somebody there," recalls her father, Ben. "It was a very stable environment."

When Emma's mother returned to work three years ago, things started to change. All three children experienced separation anxiety—but no one more than Emma.

Still, things didn't come to a head until the family moved during the summer of 2002 and the children had to change schools. Emma had been in a private school, close to home—loving, small, nurturing—and she had only ever been taught by female teachers. But for Grade 4, Emma, now 10, moved to a public school into a class of 34 kids—two-thirds of whom were boys—and a six-foot, three-inch male teacher who had the unenviable task of trying to keep them all in line.

Within about four weeks, Emma started to complain of headaches and stomachaches. At first, her parents believed her problem was physical and took her to the doctor for tests, all of which indicated that nothing was wrong. By the middle of October, the school was regularly calling Ben in the middle of the day to pick up Emma, who still complained of headaches. One night before school, she blew. "She ended up getting very violent," Ben says of his normally reserved daughter. "We kept saying, you've got to go.' She had a meltdown, gritting her teeth, screaming, hanging on, in a rage. That just freaked us out. Next morning, we looked for help."

High anxiety

It's probably safe to say that there isn't anyone who doesn't think back on their school days without remembering times of anxiety. What we don't realize when we're going through it, of course, is that many of our peers are going through the same thing. Indeed, certain extraordinary school-related stresses seem to land on kids at predictable stages. In some cases, however, children may feel so anxious about school or about what's going on in their lives that they develop a fear of school and even, in some cases, refuse to attend. If that happens, extra help is often needed.

Predictable stages

While children can have trouble with anxiety at any time during their school lives, there do seem to be certain ages that routinely pose more difficulty than others. The first problem time is often in Grade 1. The transitions both from half-day at school to full-day, and from running around and playing to sitting at a desk, are exhausting for many children. Almost all kids in the age group go through periods of being difficult, cranky and overwhelmed.

Another potential trouble time is Grade 7, when children typically move away from their elementary schools. At this point, more of the problems are social rather than academic. "Often it is related to something really unpleasant – not necessarily bullying but being ostracized, teased, not fitting in, having a terrible hurt with respect to someone of the opposite sex," explains Janet Morrison, a child psychoanalyst in Toronto. "Children between 12 and 15 are so intensely and painfully self-conscious. They think everybody is judging them all the time-the whole world is looking at them."

Morrison has known children who have not been able to go to school for days because of a skin breakout or because their clothes aren't cool enough. "The rules are changing," she says. "It's not just about doing what your mother or your teacher tells you. It could be specifically about not doing what they tell you. You're not known as part of your family anymore. You have to be able to cut it on your own." The challenge – and it's enormous if you're a 12- or 13-year-old is to be uniquely important and to stand out, but to stand out in just the right way.

But in Morrison's mind, it is the 14-year-old who has it the worst. It's the culmination of self-consciousness and it's the beginning of real pressure to be dating and to be cool. "Everybody feels the pinch to be having a kiss, to be having a joint, to be having a beer," says Morrison. "Kids who are busy can ignore it for a couple of years, but by 14 you really can't."

On top of all of the social pressure for many kids are concerns that may be difficult to pinpoint. Sharon Dembo is director of the Toronto-based Child Psychoanalytic Program. Recently, she saw a teenager who was a high achiever at school but who became increasingly less able to get herself to school every day. As a result, she was unable to do the work required of her and was in danger of failing high school. "I wouldn't categorize that person as anxious per se," says Dembo, "but at that teenage level I saw it more as an unwillingness or fearfulness of growing up, of becoming independent."

In fact, school refusal can often be a side effect of an anxiety around something happening in the family. That may occur during a divorce or around a parent's illness, which may make the child reluctant to leave home. It may also happen after a prolonged period of togetherness as a family, including summer holidays, or following a stressful change such as a move or change in school. One teenager Dembo treated simply folded because of the overwhelming amount of work that was required. "These can be very, very bright children; they just get overwhelmed with the workload they have so they can't commit to finishing anything," she explains. "They're at risk of dropping out if they're not supported." And of course bullying may be at the root of school anxiety and refusal.

The ultimate transition for many kids is between high school and university. And as Morrison says, it's often the kids who have 'behaved' the best and who have had a seemingly smooth school life who have the most difficulty making the change "They haven't developed any independence at all," says Morrison. "They haven't rebelled. They have no idea who they are." Being on their own for the first time can be very stressful for kids, particularly for those who haven't developed an identity separate from their parents.

What can parents do?

Understandably, many parents find it painful to explore social and school issues with their kids because it brings back a lot of unpleasant memories. As a result, they may seem impatient and lash out at their children, telling them not to make such a big deal about little things. Really, however, they're likely just uncomfortable. The first thing parents can do, then, is to put aside their own feelings and put themselves in their child's position.

• "Try to have hope that this will get better and will end—and then try to listen," says Morrison. "Their concerns are as real as any concerns adults have about their careers, about how people view them in the professional world."



• If a child is refusing to go to school, get him or her back as quickly as possible. The longer the child is out, the worse it is. Very young children in particular need supportive parents to help get them back to school. "Some parents give a message of 'I'm sure you'll be fine' and others have a question mark look on their faces," says Dembo, "and children can pick up on that."



• Don't undermine the symptoms, rather, address the issues. If that means investing a little money in a wardrobe you can agree on or finding good cover-up makeup for skin problems, then do it.



• Help them find things that interest or soothe them, such as music, art or exercise. "If kids have developed skills in earlier years, it really helps," says Morrison. "If your child has learned how to play the flute, he or she is going to enjoy being in band. It's about their skills, not about their pimple or their haircut.



• Enlist teachers' help if a child is feeling overwhelmed by school work. The school needs to understand that the child is trying hard but is having difficulty so her actions won't be misinterpreted.



• When children can't do what they have to do, if they can't get themselves to school – and the issue isn't bullying – and their world is shrinking and fear is taking hold of them, it's time to get help from a specialist.



• Make time to talk regularly about what's happening at school and with friends. Not only does it let parents help their kids with problems as they occur but it also conveys an important message – that the lines of communication are always open.