While each child is different, the following compilation includes commonly implemented interventions for anxious children. These items may serve as a starting point for families who are looking for specific suggestions for problem areas, or for parents who are just learning of the types of issues that their anxious child may be contending with.

Classroom environment

Anxious children perform best in a calm, supportive, but organized classroom. Because change and uncertainty can be unsettling, a structured classroom, calmly disciplined will let children feel safe and know what to expect. An ideal situation is a teacher who maintains authority positively, using reason and respect rather than fear for punishment.

• Seating within classroom
  Anxious children often struggle with the unlikely fear that they will get in trouble, seating away from more rambunctious classmates will be less distracting, and may help them focus on their work rather than feeling responsible for the class.
• Following directions
  Concerns about getting the directions wrong either because of distraction or misunderstanding are common. Signaling the class first when giving directions (flashing lights, clapping hands) and when possible having directions written on the board or elsewhere may assure anxious children that they have understood the directions.
• Class participation
  Fears of getting the answer wrong, saying something embarrassing, or simply having other kids look at them may be concerns for an anxious child. Determine the child's comfort with either closed ended questions (requiring a yes or no) or with opinion questions, start with whichever is easiest. Use a signal to let the child know that his turn is coming. Provide opportunities for the child to share knowledge on topics in which he or she is most confident.
• Class presentations
  Children with extreme social anxiety may have difficulty with oral reports. Consider having the child present to the teacher alone, or have the child audiotape or videotape the presentation at home.
• Answering questions at the board
  For children with social anxiety, the combination of getting the answer wrong, and being visible to the whole class may be so overwhelming that they may opt to avoid school altogether. Consider having the child exempt from going up to the board until they are ready to handle that challenge, or, begin to approach that situation by eliminating the risk of being wrong, by simply asking the child to write the date on the board.
• Testing conditions
  Extended time on tests will ease the pressure on anxious children, and just knowing that the time is available may obviate the need to use it. Sometimes anxious children become distracted when they see other children working on their tests or turning them in, they may inaccurately assume that they don't know the material as well. Testing in an alternate, quiet location may be preferable for some children. Consider the use of word banks, equation sheets, to cue children whose anxiety may make them "blank out" on rote material.
• Lunchroom/recess/unstructured activities
  Free choice times can be a welcomed and necessary break from the pressures of school, but fears of rejection in the cafeteria or on the playground can take the fun out of free time. Bridge the gap socially by creating ties between small groups of children. A lunch bunch with two or three children can create a shared experience which kids can then draw on later. When working in pairs or small groups, don't always have children choose the groupings themselves, alternate this with a "counting off" technique or drawing straws to allow variability in the groupings.
• Safe person
  Having one person at school who understands the child's worries and anxieties can make the difference between a child attending school and staying home. A guidance counselor, principal, nurse, or teacher can be identified as a point person for the child to check in with briefly (5-10 minutes) to help dispel worry thoughts, take deep breaths and return to class.
• Cool down pass
  Pressures build for anxious children, being able to leave the situation briefly to get a drink of water or wash their face can allow them to clear their heads and return to class on a less anxious track. Since anxious children may be hesitant to ask for this and risk being the center of attention, use an orange card which the child simply places on his desk, or the teachers desk, which signals they are out on break. In general anxious children are exceedingly honest and responsible and will not take misuse this privilege.
• Assemblies/large group activities
  Some children become anxious in crowds, until a child has mastered the auditorium, allow them to sit where they feel most comfortable (e.g., at the end of the row in the back of the auditorium), see if they can gradually rejoin their class.
• Return after illness
  Ever responsible, anxious kids may be very distressed about work they have missed while they were out. Assign a responsible buddy to copy notes and share handouts. If tests are given the day of the child's return, give them the option to take the test at another time and use the test-time to make up any other missing work.
• Field trips
  Compounding the daily stress of the anxious child, field trips include the factors of being away from home and parents, and a change in routine. Accommodate the child's level of readiness so that he or she can participate as fully as possible. Consider having the child in the "teachers's group," or having parents accompany the group until the child is ready to handle an excursion without these supports in place.
• Change in routine/substitute teachers
  Because anxious children try very hard to please and predict what is required in a situation, changes of any sort may be experienced as very stressful. When possible, send a note home the day before to alert the child/family to a change in routine, this will allow the child to process the change in his or her comfort zone and will make the transitions go more smoothly the next day.
• Fire/safetydrills
  While these drills are for a child's safety, anxious children may be very distressed by imagining that these events were actually happening. If there is an opportunity to signal the child in person just before the alarm sounds, this may buffer the surprise of the drill and allow children to mobilize with less distress.
• Homework expectations
  If children are spending inordinate amounts of time on homework because of OCD redoing, rechecking, rereading, or simply worrying that the assignment wasn't done thoroughly enough, the teacher can set a reasonable amount of time for homework and then reduce the homework load to fit into that time frame. Teachers can also provide time estimates for each assignment (this could be helpful to the entire class), so that the anxious child can attempt to stay within 10% of the estimated time. Eliminate repetition by having the child do every other math question, reduce reading and writing assignments, consider books on tape if a child is unable to read without repetition, for a child with writing difficulties, consider having a parent, teacher, or another student "scribe" for the child while he or she dictates the answers.

Brought to you by The Children's and Adult Center for OCD and Anxiety.