Wendy K. Silverman, director of the Child Anxiety and Phobia Program at Florida International University, has been teaching children how to conquer their fears for more than 20 years. As a researcher and board-certified clinical child and adolescent psychologist, she sees youngsters whose extreme anxiety can keep them out of the classroom. With school about to resume, we talked to Silverman about her research and about what parents can do to help fearful students.

Q: What is school anxiety and how prevalent is it?

There is no formal disorder known as ``school anxiety disorder'' or ``school phobia.'' Rather, as many as 5 percent of school-age children exhibit severe anxiety relating to school, including refusal to attend school. (The prevalence of any anxiety disorder is about 10 percent among children and adolescents.) For many children, the reasons relate to different aspects of the school environment such as needing to separate from parents, encountering new classmates or teachers or perhaps more generalized worry. For example, with all the attention paid this summer to H1N1, I would not be surprised if we see more children showing anxiety about attending school due to worries about catching the flu.

Q: What are the symptoms of ``school anxiety''?

A: The most common signs will be outright refusal to go to school. This might mean the child screams, kicks, cries or refuses to get out of bed. They may also refuse to leave the house or leave the car upon arrival at school. Other signs can be more subtle. Children might begin complaining of headaches, stomach aches or other somatic [physical] problems the night before or the morning of school. It is not unusual for children to vomit the night before or the morning of school. Once in school, the child might be so disruptive or report such distressing problems that the parent may be forced to take the child home. A child also might begin expressing worrisome thoughts such as how much he is going to miss the parent, whether or not the teacher will like him, whether he will know anyone in his class or concern about the work being too difficult.

Q: How does anxiety compare with the usual jitters of back to school?

A: It differs in terms of its intensity and to the extent that it leads the child to be able to avoid school. And even if the child is going to school but with high levels of personal distress (such as crying, reporting somatic problems, vomiting) then these, too, would raise red flags.

Q: In cases like this, what should a parent do?

A: The first step is to speak with school personnel including teachers, counselors or psychologists to ensure that there is not something going on in the school setting that might make it difficult for the child to attend. Sometimes, for example, the child may be a victim of bullying or have learning difficulties. For children who are displaying headaches, stomaches, frequent vomiting and other physical symptoms, it is important to rule out any medical conditions with the child's pediatrician. Once these possibilities have been ruled out, it is important to conduct a thorough evaluation. It is not unusual that such children suffer from other problems besides anxiety such as depression and ADHD. At the Child Anxiety and Phobia Program, we provide comprehensive evaluations that involve talking with the child, talking with the parent and having both the child and parent complete a number of questionnaires. I would add that because this process is part of our large, funded research project, families can get state-of-the-art evaluations at no cost. If the child is found to be experiencing some type of anxiety problem, we invite the family to participate in the clinical trial we're running at FIU.

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