Childwise

By Dr. Moshin Ali, MD

Test anxiety threatens ACT result

Dear Childwise:

My teenage daughter has developed severe test anxiety, usually to do with math.

The funny thing is, she’s very smart and good at math, and she makes straight As on her homework, quizzes, etc. But when faced with a big exam, she totally freaks out and has actually failed exams because of it. Now she has started dreading major tests, and I’m afraid she will totally bomb the ACT. She says it’s the timed aspect that makes her panic. Do you have any suggestions on how she can deal with this fear?

Worried

Dear Worried:

Your smart daughter is suffering from an all-too-common problem, test anxiety. This is one form of performance anxiety and is associated with thoughts as well as physical sensations in her body that interfere with her functioning in a given situation.

It is a great idea to focus on trying to overcome this problem. After all, she may not need to use trigonometry for most of her life, but she will certainly face stressful performance situations very often. Educators are very familiar with test anxiety, and one place for her to start may be a test preparation course, such as those offered by Princeton Review or Kaplan. I found such a course very helpful for the SAT (two decades ago!) and was able to use those strategies on hundreds of tests since then.

Key strategies include management of test anxiety as well as budgeting time rationally during tests. If such a course does not help enough, a psychologist or psychiatrist skilled in cognitive behavioral therapy should be consulted. Happy test-taking!

Can stomachache start in the head?

Dear Childwise:

I have an 8-year-old boy who sounds like the same boy Alison Lebovitz described in her January column, “The Boy Who Cried, ‘Full’.” He is always full but always has room for dessert. If he does not throw up that night, he throws up early the next day, all day. We have spent thousands of dollars on tests, x-rays and gastroenterologists that cannot find anything wrong. Could this be a psychological, not physical, problem? I would appreciate any advice you can give. Thank you,

MA

Dear MA:

Psychological and physical problems are not usually mutually exclusive—they often occur together. It is certainly possible that psychological problems are contributing to your son’s vomiting. Fortunately, there is quite a lot that can be done to address the problems.

One place to start is to keep a diary of his daily life with a focus on health-related issues, symptoms of illness, eating and sleeping patterns, medication usage and emotional condition including stress, excitement, tests, school problems, etc.

Although this is not easy to keep, it may provide a lot more information about what is triggering the vomiting than the tests and x-rays did. Keeping such a diary can also be the start of treatment, because many people find that they improve healthy behaviors if they pay attention to how they are living. Sleep cycles may improve, diets may get better, and stress may decrease once the stressor is noted in the diary. If triggers are identified, such as eating right before sleeping, they can be avoided.
I think the next step should be to take your son and his diary, with a couple months’ notes, to a trusted family doctor and ask whether referral to a specialist is necessary, be it a gastroenterologist or child psychiatrist. Your doctors will be in a much better position to evaluate and treat your son once detailed information is collected. Although I cannot suggest that your son has this diagnosis, you can learn a lot online about the condition called “cyclic vomiting syndrome,” which is related to migraines. Good luck!

The advice in “Childwise” is provided this month by Mohsin Ali, MD. Dr. Ali is director of psychiatry services at Fortwood Center, Inc. He is trained in the evaluation and treatment of psychiatric problems in children, adolescents and adults. The responses provided by Dr. Ali are formulated from general theoretical principles and are not intended to represent or replace professional consultation or intervention specific to a particular child or family.

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