By Saranga Bhalla, DO

As physicians, we have all taken numerous exams throughout our lives so we know what test related anxiety feels like. Mild test taking anxiety is normal and common. By some estimates,  40% of students experience test anxiety (1). At times, that anxiety can actually be helpful as  the heightened physiological response may improve our motivation to study, help us focus and  be more productive. Anxiety is our body’s way of communicating that there is danger in our  environment and leads to our “fight or flight” response. However, that exaggerated response to  taking a test when there is no actual danger, also has negative consequences. According to  Nathaniel von der Embse, an assistant professor of school psychology at the University of  South Florida, his 30 year review of test anxiety published in 2018, showed that test anxiety  correlates with negative educational outcomes, especially in the middle grades.

So how can you tell if a child has typical anxiety before a test or if this is something more?  Usually these are kids where the worrying is so prominent that it interferes academically,  behaviorally and/or emotionally. Not all kids will verbalize they are worried about an upcoming  exam. You should look for certain signs such as school avoidance on the day of the test,  stomach distress, headaches, and/or difficulty sleeping. While academic decline may be an  indicator of test anxiety, it’s important to remember that many students who have A grades  and are perfectionistic also worry about their performance.

Research shows parental pressure is associated with greater worry, irrelevant thoughts, and  stronger physical symptoms relating to anxiety during tests (3). Other causes include  procrastination of studying, fear of failure, and poor performance on a previous test (4).  Students with disabilities and students in gifted/honors classes tend to experience high rates  of test anxiety (2).

According to Dr. von der Embse, there are 3 phases of test anxiety. The 1st phase occurs  before the exam. “Test anxiety is really a cognitive, emotional and physical reaction to  evaluation and the consequences of evaluation,” he says. Parents and teachers can help by  explaining the purpose of the test and how the results will be used. Parents can also help by  not emphasizing the date of the exam. According to therapist Jane Pernotto Ehrman, “The  pressures for students around test anxiety are both internal and external,” she said. “It starts  externally with parents saying you’ve got to eat well, go to bed early, you’ve got a big test  tomorrow.” Instead, there should be a focus on everyday lifestyle routines such as maintaining  a healthy diet, getting adequate sleep nightly, and engaging in effective study habits.  Additionally, focusing on effort rather than results can help reduce the pressure kids feel around  testing.

The 2nd phase is during the actual exam when anxiety can lead to shallow breathing, breath holding, heart racing and/or sweating. This can negatively affect focus, attention span, and  memory, leading to further anxiety. Teaching kids deep breathing, mindfulness, and other  relaxation strategies can help reduce physical symptoms of anxiety. For example, having a  child practice breathing in for four seconds, holding for four seconds, and exhaling for four  seconds can help control the anxiety.

The 3rd phase is after the exam. According to Dr. von der Embse, this phase is often  overlooked but can be a way for parents and kids to talk about the test results and what they  are used for.

Shannon Brady, an assistant professor of psychology at Wake Forest University, believes the  goal is learning to manage stress, and not simply reduce it. She believes that rethinking stress  can be very helpful for both children and parents. Dr. von der Embse believes parents,  teachers, and school psychologists can educate kids on the signs and symptoms of test  anxiety and then teach them strategies on how to manage those feelings.

Of course, these measures may not be enough for everyone. Students who have taken the  above steps to prepare for tests but still suffer severe anxiety at the idea of them should  consult a mental-health professional.

Author Profile:

Saranga Bhalla, DO
Board-Certified Child & Adolescent, and Adult Psychiatrist
Princeton Mental Health, LLC.

REFERENCES:

(1) December 14, 2023/Living Healthy/Children’s Health- Cleveland Clinic How To Help Your Child Overcome Test Anxiety by Ethan Benore, M.D.

(2) Nelson, J.M.; Harwood, H. (2011). “Learning disabilities and anxiety: A meta-analysis.” Journal of Learning Disabilities. 44 (1): 3–17.

(3) Putwain, D.W., Woods, K.A., Symes, W. (2010). “Personal and situational predictors of test anxiety of students in post-compulsory education.” British Journal of Educational Psychology,  80, 137-160

(4) ADAA-Anxiety Disorder Association of America. “Test Anxiety” 26 April 2012

Journal of Affective Disorders- “Test anxiety effects, predictors, and correlates: A 30-year meta analytic review”; Nathaniel von der Embse, Dane Jester, Devlina Roy, James Post Volume 227, February 2018, Pages 483-493