mental health

When to seek help for your child's mental health

Written by Emmanuelle Khoury, Ph.D, social worker.

Montreal, Canada


I think she is growing up, and so begins to dream dreams, and have hopes and fears and fidgets, without knowing why or being able to explain them.

Louisa May Alcott

What are we talking about when we say mental health and well-being? And what does a mental health challenge in a child look like?

The World Health Organization explains that mental health or well-being is a state in which a person can cope with normal stresses of life, be productive and make a contribution to the community.

When we think about school-aged children, this might mean feeling stressed or worried about school work, friends, sports, but still being able to deal with it.  ‘Dealing with it’ might mean that the child’s behaviours don’t change drastically, that she sleeps well most of the time, that there aren’t changes to her interest in school or her family life.

Common Mental Health Difficulties in Children

However, according to the Canadian Mental Health Association, 1 in 5 school aged children experience mental health difficulties.  Click here for some resources from the Headspace on mental health in youth. Some of the common ones include anxiety and depression:

ANXIETY – anxiety is a normal feeling of tension or worry.  It’s a response to stimuli or events in our everyday lives.  Some anxiety can even be helpful.  But if the anxiety is too intense or is non-stop, it may lead to fear, worry and panic. 

DEPRESSION -  everyone feels sad or down, but when those feelings turn to hopelessness and distress it often shows up in behaviours such as mood swings, crying, and trouble concentrating that impact life, family and school


When should you seek help for a child’s mental health?

Much as parents and caregivers sometimes deliberate whether or not to take a child to see the doctor if she’s had a fever for less than 24 hours (it might just be a normal cold or a passing bug!), they may also find it is hard to know when certain moods, behaviours or thoughts are worrisome. 

Signs of mental health difficulties include very typical variations in moods and behaviours that are part of normal development.  These might include loss of interest in school, slipping grades, avoiding friends, changes in sleep patterns, less energy or more energy, and feeling sad or worried.

Parents, teachers, or other significant adults in the life of a child should be concerned when these changes are intense, are constant (it’s not just a phase), and are bothersome for the child or cause problems in her life.  And just like going to the doctor for a fever that doesn’t feel quite right, even if it has only been 24 hours, if your child’s mood, behaviour or thoughts don’t feel right then you can also go see the doctor or consult with a mental health professional.  If your child is older, spend some time asking her about your concerns and take the time to listen to her response.  Your child might be carrying around feelings of fear or shame related to the changes so you can let her know that you are there to help her work through these difficulties.


Some great Canadian resources to get more information include the Canadian Mental Health Association and Kids Help Phone.

For more info on mental health in youth, visit the CAMH website and take a quick course on Youth and Mental Health 101.

Does your student have test anxiety?

Written by Cindy Hovington, Ph.D. Founder of

Montreal, Canada

I still have vivid memories of my test anxiety. In college, I literally handed in blank exams. My anxiety was so high that I could not remember anything, even if I had studied way ahead of time. I remember my inner dialogue during exams, “What’s wrong with me, why can’t I answer these questions! I studied so much for this! I should know this. I am going to fail this exam.”. I eventually learned to improve my self-talk and self-esteem and my anxiety began to decrease. I learned to take better notes, to study more effectively and more importantly, I built up my confidence. The anxiety never completely disappeared, but I was able to pursue graduate school and learn to work through it. When working privately with students, I always tell them about my struggles so that they know they can also work through their own struggles including test anxiety. I think there are many students out there silentley struggling with this, which is why I thought it would be important to write an article about this.

What is test anxiety?

Test anxiety is defined in research as “comprising psychological, physiological, and behavioral reactions that occur in association with concern about the negative outcomes resulting from failure or poor performance in evaluative situations” (Zeidner, 1998). It is estimated that 25-40% of students exhibit some level of test anxiety (Putwain 2007, Ergene 2003) with girls showing higher rates (Hembree 1988). Test anxiety is strongly linked to lower grades and lower academic performance (Segool et al. 2013). This relationship between higher levels of test anxiety and lower grades is highest in students between the ages of 11-14 (von der Embse et al. 2018). Research has shown that levels of test anxiety are higher for standardized state/government exams compared to regular classroom exams (von der Embse et al. 2018).

What are signs of test anxiety?

The Anxiety and Depression Association of America provides the following as symptoms of test anxiety:

  1. Physical symptoms. A headache, nausea, diarrhea, excessive sweating, shortness of breath, rapid heartbeat, light-headedness and feeling faint can all occur. Test anxiety can lead to a panic attack, which is the abrupt onset of intense fear or discomfort in which individuals may feel like they are unable to breathe or having a heart attack.

  2. Emotional symptoms. Feelings of anger, fear, helplessness, and disappointment are common emotional responses to test anxiety.

  3. Behavioral/Cognitive symptoms. Difficulty concentrating, thinking negatively and comparing yourself to others are common symptoms of test anxiety.

Why do we forget when we are nervous?

Stress affects memory. When you forget while writing an exam it is because your anxiety has blocked access to the information you stored in your memory. The information is still there, you simply can't access it due to the stress. This is caused by your stress hormones (cortisol and norepinephrine). Memory can be either short-term (also called working memory) or long-term. When studying, this information needs to become a long-term memory.  Dr. Sonia Lupien, one of the leading scientists on stress,  gives a simple analogy for memory processing, "You can think of the three stages of memory processing in the following way: encoding is like listening to songs, consolidation is like recording those songs (or burning a CD), and retrieval is like playing back the songs". Research shows that a little stress during encoding can actually boost memory, while too much can hinder your ability to encode the information. For example, if you are teaching new material and tell the students that they will be tested on this, a student with test anxiety might not encode well as of this point since their stress levels will rise up. In addition, the stress a student experiences while writing the exam can hinder their recall ability. A simple thought such as "If I fail this test I will not get into University" can cause our brain to perceive the current situation (taking a test) as a "threat", which in turn will release stress hormones. When your brain perceives a situation as a "threat", it doesn't differentiate between writing an exam or being face to face with a bear. Your brain also doesn't need you to think in a time of stress, it needs you to react quickly, known as the fight or flight response. The part of your brain involved in thinking is blocked off and your ability to access memory is blocked as well. This is why you can't remember!! For more info, click here.

Dr. Lupien outlines 4 key "stress ingredients" including Novelty, Unpredictability, Treat to the Ego and Sense of control (she uses the acronym NUTS). Unfortunately, tests touch upon all of these factors. Being aware of these "stress ingredients" may help you address the problem. (**Stay tuned for an upcoming article on Anxiety in Children for more details on what happens to the brain when you have general anxiety.) 

Tips for reducing test anxiety:

Dr. Judy Willis highlights 8 steps that can help reduce a student's test anxiety in her book Ignite Student Learning:

  1. In class practice tests: Have students take a practice test and have them correct it on their own rather than have another student correct it. In class practice tests are especially important when practicing for standardized tests, which cause even higher levels of test anxiety in elementary school students than classroom exams (Segool et al. 2003). Practice tests help reduce test anxiety since the "novelty" aspect from Dr. Lupien's stress ingredients is removed.

  2. Eliminate "pop" quizzes: Dr. Willis also mentions that teachers should give advanced notice of exams to help reduce test anxiety.

  3. Visualization: Before handing out the test, ask students to close their eyes and visualize their successful performance on the test. Many professional athletes use visualization to help build confidence for a specific play and to mentally practice it.

  4. Have pre-exam "priming sessions": She defines "priming sessions" as 2-minute discussions with the entire class on what they think will be the key points covered on the test you are about to hand out. Write only keywords on the board. This will help "prime" the students memory and help them with recall during the exam. After you have done this with them a few times, they can begin to do this on their own. Give them a few minutes before the exam to do this. Concept maps are a great way to do this!!

  5. Practice relaxation rituals: Two minutes of deep breathing or any form of meditation can help them relax. Here are some tips on classroom meditation.

  6. Include test de-stressors: Add a little joke on the second page of the exam, or a little comic strip. After 20 min, allow students to stand and stretch or encourage students at some point to take a drink of water from their bottle and close their eyes for 30 seconds to refocus.

  7. Show students that incorrect answers do not equal being a poor learning: Students have lots of stress placed on them to do well and to get it all correct right away. Don't be afraid to acknowledge your own mistakes to show them that we all make mistakes and more importantly we learn from them.

  8. Allow time for test corrections to help build metacognition: Use some classroom time to have students go over the errors and correct them. This correction will help students better understand their mistakes and build on their knowledge. Dr. Willis also mentions that students should describe what type of mistake they made. For instance, was it an error in arithmetic or did they not understand that concept?

I would add to the above list the importance of helping a student build their self-esteem and academic confidence. Provide them with positive and meaningful feedback when possible (see our past article on this topic) and speak to their parents to increase their awareness about reducing the pressure placed on them. Also, talk to them about brain functioning during stress. In my own experience of giving workshops on brain science in schools for over 10 years, I learned that if students understand how their brain functions, they have more control over their learning. If the level of anxiety seems worrisome and none of the tips above have helped them, ask their parents to speak to the child's doctor to seek professional help for anxiety. 

I believe it is imperative that we start to address test anxiety a lot more in the classroom. I never spoke of my own anxieties to anyone, I just fell into a mental loop of thinking I was not "smart enough", which resulted in lower grades on more exams. Students need to learn early on that test anxiety is not a wall they have hit in their academic careers. Rather, it is just a bump in the road and with hard work they can move passed it.