Most Back to School Nerves Fade but Some Warrant a Closer Look

Most first-day nerves fade within a couple of weeks, and for the large majority of children that is the whole story.

A smaller group stays stuck. That pattern is worth a closer look, because anxiety that persists tends to respond better to anxiety treatment the earlier it is addressed.

Dr. Annie Deming, a pediatric mental health specialist at Intermountain Health, laid out the distinction for parents heading into back-to-school week.

“It’s really normal for kids to be a bit nervous about school starting,” Deming said, particularly for younger children starting school for the first time or adjusting to a new environment.

When Nerves Are Worth a Closer Look

Plenty of children drag their feet about school without anything being wrong. A few rough mornings in September is not a diagnosis, and reluctance on its own is not an anxiety disorder.

The line Deming draws is behavioral rather than emotional. It is not about how worried a child says they are. It is about what the worry stops them from doing, and for how long.

“If they’re refusing to go to school or if every single morning it’s a fight to kind of get them out of the door, that’s more problematic,” she said.

Other warning signs she named include pulling away from friends, changes in eating or sleeping, emotional outbursts, and physical symptoms such as stomachaches and headaches.

None of these is diagnostic on its own. What clinicians weigh is how long the pattern has lasted, how intense it is, and whether it is interfering with ordinary daily life.

Physical complaints deserve particular attention because they are so often treated as a separate medical question.

A child with recurring morning stomachaches may cycle through pediatric visits without anyone connecting the pattern to school avoidance.

Mental Health and Addiction Connection

Anxiety disorders are among the most common mental health conditions in children and adolescents, and they frequently appear alongside substance use later in adolescence, which is known as a dual diagnosis.

Untreated anxiety is a recognized risk factor for developing a substance use problem, in part because substances offer fast, accessible relief from symptoms a young person has no other tools to manage.

That association is why behavioral health providers treat persistent childhood anxiety as more than a comfort issue.

It is a risk relationship across groups of children, not a prediction about any individual child, and most anxious nine-year-olds will never develop a substance use problem.

Treating anxiety early is worthwhile on its own terms, and it may also lower that longer-term risk.

Understanding Dual Diagnosis

Co-occurring disorders, also called dual diagnosis, means a person has both a mental health condition and a substance use disorder at the same time.

The two interact. Anxiety can drive substance use, and substance use can worsen anxiety, which makes treating either one in isolation less effective.

Integrated treatment addresses both conditions together, with one coordinated team rather than separate providers working in parallel. For adolescents, this generally means a treatment program with adolescent-specific clinical staff, family involvement built into the treatment plan, and coordination with the school.

What Parents Can Do Now

Deming’s recommendations are practical and low-cost. Create consistency through routines around sleep, meals, and screen time, while making room for children to talk about how they feel.

“Something that kids really do value are concrete ways that they can feel connected to parents and to their family while they’re away from them,” she said.

That might be a note in a backpack, asking specific questions after school rather than a general “how was your day,” or simply reminding a child that someone is available to talk.

She also made a point parents often skip past. Their own reactions are allowed.

“It’s OK for parents to get frustrated or upset or scared or anxious,” Deming said. “We’re human too. We need those moments to have those feelings.”

Treatment Approaches That Work for Anxiety

Cognitive behavioral therapy is the most established treatment for childhood and adolescent anxiety.

It teaches children to identify anxious thought patterns and test them against what actually happens, paired with gradual exposure to avoided situations.

For school avoidance, treatment usually includes a structured return-to-school plan built with the family and the school together.

Dialectical behavior therapy is often used with adolescents who have difficulty regulating strong emotions, and it appears frequently in dual diagnosis treatment for teens because those skills apply to both anxiety and substance use.

Medication may be appropriate for moderate to severe anxiety and is a conversation for a child psychiatrist or pediatrician, generally alongside therapy rather than instead of it.

Finding Comprehensive Treatment

Start with your pediatrician, who can screen for anxiety and refer to a specialist. School counselors and school psychologists are also a direct route, and school-based services remove the transportation and scheduling barriers that stop many families.

When comparing mental health treatment facilities, ask whether the program treats adolescents specifically rather than adapting adult programming.

Ask how family involvement works. If substance use is part of the picture, ask directly whether the program provides integrated dual diagnosis treatment or refers out, since referring out is where coordination tends to break down.

TCD.com’s treatment centers directory lists mental health treatment facilities and dual diagnosis programs nationwide, searchable by location, age group served, and insurance accepted. You can call 800-908-4823 (Sponsored) for more information about treatment options.