Ask An Expert / Anxiety Disorders

What is the best high school school environment for a student with generalized anxiety disorder and social anxiety?

The key is not so much size, as the school's willingness to support the child

Rachel Busman, PsyD
Rachel Busman, PsyD

Senior Clinical Psychologist, Anxiety Disorders Center; Director, Selective Mutism Service

Child Mind Institute

For our daughter, who has generalized anxiety disorder and social anxiety, the school environment is a key component in managing her symptoms. What kind of supportive environment has been found to be the most appropriate?

Specifically, I am wondering about the size of the school — smaller being easier to navigate, easier to form relationships and work on exposure to anxieties — and the importance of having a caring teacher, one who gets to know the child and is stable throughout her high school career. Thoughts on flexibility within scheduling, etc.

What should parents be looking for and what should they be asking of high schools?

There isn’t any one perfect school environment. As you say, smaller schools can make it easier to form relationships and work on exposures, which can make a big difference. But a very small school that caters to her anxiety too much might not be providing her with enough opportunities to do her exposures (i.e. face her fears). On the other hand, some kids are actually more anxious in smaller groups, because they feel like they’re getting too much attention. Depending on your daughter, a small school could be too much pressure or too little. Finding the right environment is tricky, and it depends on your daughter’s specific needs.

Regardless of school size, putting together a good, supportive team at the school is crucial. It is wonderful if there is one really special teacher or staff member at the school who’s committed to helping your daughter. A person like that could serve as the “point person.” But since in high school you generally have several different teachers, it’s important to put together a good, supportive team of adults at the school. The school psychologist, clinical social worker, administrators, and a teacher or team of teachers can all be involved. The goal is to put together a group of people who understand your daughter’s strengths and weaknesses and know how to work with her. As a child psychologist I like to be involved too, because I can talk to schools in an objective way and help them understand what anxiety disorders are, and how they are treated.

It’s also a good idea to work with the school to come up with a plan detailing how her symptoms should be handled and the kinds of support you expect from the school. For example, if your daughter has panic attacks and needs to sit in the school psychologist’s office to calm down, that should be written down and all her teachers should know about it. Some high schools are very accommodating and flexible, but you want to have it formalized regardless, whether it’s through a 504 accommodation plan or an IEP. That way, guidelines are clear and everyone is on the same page.

The most important thing is to find a school that is willing to learn about the diagnosis, understand the symptoms and how they are treated, and then willing to fold that treatment into school. Also, of course, it’s important for your daughter to keep working on exposures with her therapist outside of school, too. In severe cases, kids may need a specialized school placement, but that would come after in-district accommodations have been exhausted.