Anxiety and OCD in the Classroom: Parents, Schools, and Health Care Professionals

Available with English captions and subtitles in Spanish.

A conversation with Lisa W. Coyne, PhD, Fairlee C. Fabrett, PhD, and Jeff Szymanski, PhD, on how parents, educators, and clinicians can help children who experience anxiety in their most common setting: school.

Supporting Kids at School

Anxiety can interfere with learning in a variety of ways. Many factors may contribute to a child’s anxious behaviors.

For example, a child may not finish their homework because they’re afraid of making mistakes. They may experience racing thoughts or panic that interferes with their ability to take in new information. They may not participate in class because they’re afraid they will do or say the wrong thing.

Watch now to learn more about:

  • Why anxiety is often overlooked in kids and teens
  • How parents and teachers can recognize anxiety
  • How to help students who have anxiety in the classroom

According to Coyne, one of the biggest challenges in addressing anxiety in children and teens is because it is underdiagnosed.

“Anxiety is quiet,” she states. “The kids who get noticed are those with disruptive behavior disorders that take up the lion’s share of the attention. So that quiet child who’s quietly doing their work in the corner, who might be suffering mightily inside, is going to get missed.”

Another challenge in addressing anxiety disorders in this age group is when adults offer misguided help. “With someone who is anxious, our first impulse is usually to help them not feel anxious, to help them feel better,” Coyne explains.

Some reactions can actually prevent children from confronting their anxiety, however.

For example, a child may wish to stay home from school due to fears. Adding to the issue, the fight-or-flight response created by anxiety can create physical symptoms, such as headaches, racing heart, and muscle tension.

As tempting as it may be for a parent to let a child miss school when they are distressed, it is important to ensure that kids go to class. Parents can use tools of empathy for the child’s experience while also expressing confidence in the child’s ability to cope.

“Sometimes paying attention to it and actually taking it seriously is a whole step in its own because you don’t want your kid to be struggling this much,” says Fabrett.

In the classroom, teachers can keep an eye out for signs of anxiety in students. According to Coyne, Fabrett, and Szymanski, signs children may be experiencing anxiety include:

  • Frequent trips to the restroom
  • Trouble making friends
  • Seeming distracted when spoken to
  • Turning in late assignments
  • Tearfulness
  • Placing intense pressure on themselves
  • Disruptive, angry, or irritable behavior

Among other helpful suggestions, the experts describe how to develop and follow through with a 504 plan.

The plan identifies how a mental health condition may impact a child’s learning, behaviors that can be modified, and changes that can be made in the classroom to support the child.

“Collaboration is really important—getting everyone on the same page—because we might have the best intentions in our hearts, and we might make things worse for our kids,” adds Fabrett.

By recognizing and supporting children and teens who are experiencing anxiety, parents, educators, and clinicians can empower students to excel in the classroom.

Fabrett concludes, “They’re going to rise to our expectations if they have some help. I think it’s better to do that than to remove all expectations and requirements from their life because we want to accommodate them. I think we do better if we keep [expectations and requirements], but we help them with therapy, with tools, and with support.”

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Audience Questions

  • What are the challenges and opportunities that arise in a classroom environment for adults in helping a child or teen with anxiety or OCD? What should parents and educators know about this topic?
  • What do we know about how excessive anxiety impacts a student’s ability to take in and process information?
  • How does school refusal come into play for a student with anxiety or OCD?
  • What should we know about classroom accommodations? What might some of their downsides be?
  • Are public schools required to offer accommodations?
  • What are some signs of anxiety or OCD for a teacher to look out for in their classroom?
  • How often does anxiety manifest physiologically?
  • How can puberty and developmental changes affect an adolescent’s onset of anxiety symptoms?
  • How common is it for children to have both ADHD and anxiety?
  • How can a teacher help a student having a panic attack in class?
  • How can parents, teachers, and clinicians best collaborate to help a student?
  • How do you support a child or teen who is struggling with social anxiety in a school setting?
  • What can school staff do to help children who are staying home for long periods of time and missing school due to their anxiety?
  • How much should clinicians know about what a patient’s challenges look like in the classroom? How can they get that information?
  • How common is skin picking or hair pulling? What should a parent or adult do when a young person is engaging in these behaviors?
  • How do you support a child or teen if their teachers or parents dismiss their OCD symptoms?
  • Do symptoms of oppositional defiant disorder (ODD) ever overlap with OCD or anxiety? Is it common for these disorders to co-occur?
  • What should we know about challenges that may arise outside of the classroom with team sports or extra-curricular activities?

The information discussed is intended to be educational and should not be used as a substitute for guidance provided by your health care provider. Please consult with your treatment team before making any changes to your care plan.


About Dr. Coyne

Lisa W. Coyne, PhD, is an assistant professor of psychology in the Department of Psychiatry, part-time, at Harvard Medical School, and is a senior clinical consultant at the Child and Adolescent OCD Institute (OCDI Jr.) at McLean Hospital. She is also an associate clinical professor at Suffolk University in Boston, a licensed clinical psychologist, and an internationally recognized acceptance and commitment therapy (ACT) trainer.

Dr. Coyne has published numerous peer-reviewed articles and chapters on anxiety, OCD, and parenting. She is the author of “The Joy of Parenting: An Acceptance and Commitment Therapy Guide to Effective Parenting in the Early Years,” a book for parents of young children.

About Dr. Fabrett

Fairlee C. Fabrett, PhD, is the director of training and staff development for McLean’s child and adolescent division. Dr. Fabrett is the coordinator for the child and adolescent tracks of the McLean APA psychology internship. She is also the director of McLean’s post-baccalaureate child and adolescent clinical fellowship, through which she provides supervision and mentorship to recent college graduates. Dr. Fabrett is trained in cognitive behavior therapy and dialectical behavior therapy and has expertise in acceptance and commitment therapy.

As a native of Mexico, Dr. Fabrett has lived experience balancing the expectations placed by her culture and those imposed by her adopted country and culture. She strives to use her own acculturation story as a basis for understanding the stories and experiences of the trainees and patients she works with. Dr. Fabrett believes that race, ethnicity, socioeconomic status, and the breadth of experiences constitutive of identity are vital elements when providing treatment, creating training programs, and establishing supervision practices.

About Dr. Szymanski

Jeff Szymanski, PhD, a clinical psychologist, is the founder of Getting to the Next Level Consulting. Dr. Szymanski has over 25 years of experience in mental health as a clinician, supervisor, trainer, and administrator. He served as the executive director of the International OCD Foundation for 15 years following his role as the director of psychological services at McLean’s OCD Institute.

Dr. Szymanski is a lecturer on psychology in the Department of Psychiatry, part-time, at Harvard Medical School, where he supervises pre-doctoral psychology interns through McLean’s internship program. He is the author of “The Perfectionist’s Handbook,” has appeared in over 150 media stories, and has presented at a multitude of conferences as well as domestic and international trainings.