By Marianne Khlat, Clinical psychologist and pediatric care case manager

School provides children with more than academic instruction. Daily routines, familiar classmates, and predictable schedules create a sense of stability that supports emotional wellbeing. When that structure is disrupted, whether by school holidays, relocation, regional instability, or major life changes, some children adapt easily, while others experience significant emotional distress.

According to the World Health Organization, anxiety and depressive disorders are among the leading causes of illness and disability among children aged 10-19 globally. When left unaddressed, the consequences, such as social withdrawal, chronic absenteeism, and impaired academic functioning, can extend far into adulthood.

Periods of school closure and restricted peer contact are directly associated with increased rates of anxiety, depression, loneliness, and behavioral difficulties in youth, reported by a 2026 review of international research published in COVID (Trinh, 2026). While these findings were drawn from pandemic-era data, they reflect a broader, permanent principle: the routine and structured social connection provided by school plays a vital role in stabilizing a child’s psychological wellbeing.

For families and clinicians in the Middle East and Africa, these patterns interact with a nuanced cultural context. In many regional communities, children’s mental health issues are still frequently mischaracterized as a result of poor discipline, weak character, or faulty parenting, rather than clinical concerns requiring timely, structured support.

Recognizing clinical indicators of emotional distress

Emotional distress in children often presents through subtle behavioral or physical changes.

According to clinical guidance published by HealthPark Pediatrics (2025), physical complaints like recurring headaches and stomach aches without a clear medical cause, are common ways that anxiety and stress manifest in children, particularly in anticipation of social situations or returning to school. Sleep disturbances and changes

in appetite are also common signs of emotional strain. During routine assessments, clinicians should consider changes across three key domains:

• Physical Complaints: Children frequently manifest psychological stress physically. Recurrent headaches, stomach aches, and nausea with no clear medical cause are common expressions of anxiety, particularly when occurring in the morning or in anticipation of school. Sleep disturbances and sudden shifts in appetite are also key indicators of emotional strain.
• Age-Specific Behavioral Shifts:
  • Younger Children: Often become tearful, excessively clingy, or temporarily regress in previously mastered developmental milestones (such as bedwetting or sleep independence). Separation anxiety is especially common in this group.
  • School-Aged Children: May show increased oppositionality, irritability, or outright resistance to returning to daily routines.
  • Adolescents: Are more likely to socially withdraw, isolate themselves from peer networks, or disengage from activities they previously enjoyed.
• Emotionally Based School Avoidance (School Refusal): Driven by intense, anxiety-based distress about attending school, this condition can develop gradually over weeks rather than overnight. Misidentifying school avoidance as simple defiance or bad behavior can delay appropriate intervention and reinforce avoidance patterns.

While temporary hesitation is normal, prolonged changes in behavior such as progressive withdrawal, mounting distress at school drop-off, or a teenager stopping engagement in typical activities are key signs to warrant professional attention.

Partnering with families during periods of transition

The home environment is one of the most powerful drivers of a child’s psychological health. A study in European Psychiatry (Romero et al., 2024) confirmed that strong family support is directly linked to more effective coping mechanisms in children experiencing anxiety and depressive symptoms.

In many Gulf family systems, close extended networks, strong intergenerational bonds, and a cultural emphasis on collective wellbeing are profound strengths to draw upon.

However, stigma remains a barrier to seeking help. Research in the Asian Journal of Psychiatry highlights that cultural beliefs shape whether distress is recognized or hidden. It underscores that interventions must account for the region’s unique cultural and religious diversity to be truly effective.

Children are highly attuned to caregiver stress and often absorb emotional cues through observed behaviors rather than explicit conversations. Signs such as a tight grip at school drop-off, excessive reassurance-seeking before bedtime, or visible worry during morning routines can impact their wellbeing may influence how children interpret periods of uncertainty.

Clinicians should encourage caregivers to model calm, predictable emotional responses during periods of transition, as children often look to trusted adults for cues about how to interpret uncertainty. Supporting parents in maintaining consistent routines and responding with reassurance rather than avoidance can strengthen a child’s sense of psychological safety.

Healthcare professionals can recommend several evidence-informed strategies to help families support children through periods of disruption, including:

• Gradual Re-entry: Reestablishing home routines (such as school-year bedtimes and mealtimes) a week or two before school starts.
• Low-Pressure Conversations: Creating casual opportunities for children to talk about what they are anticipating, without forcing disclosures or unintentionally amplifying their worries.
• Predictable Scaffolding: Maintaining clear, consistent structures at home to provide an emotional safety net that children can rely on.

Early intervention: Why timing matters

Anxiety disorders are highly treatable, yet they typically emerge well before secondary school and frequently go unnoticed or untreated for years. Research examining early identification in primary schools (Pilot and Feasibility Studies, 2022) highlights a persistent gap between the onset of symptoms and access to care, driven by both structural barriers and cultural stigma.

Unaddressed distress compounds, so timing is critical. An evidence review by the National Institute for Health and Care Excellence (NICE) concluded that actively reducing symptoms of emotional distress during transitions directly improves a child’s long-term ability to concentrate, engage academically, and build resilience for future adversity. On the other hand, allowing distress to persist can create deep avoidance patterns.

From a clinical perspective, early intervention often begins before a formal psychiatric referral is necessary. A pediatrician, school counselor, or trained family practitioner can conduct an initial assessment, provide psychoeducation, and determine whether referral to specialized mental health services is appropriate. Families who receive validation, psychoeducation, and timely support early in the care pathway are significantly more likely to engage with ongoing treatment and support. In addition, many healthcare plans and employer-sponsored wellbeing programs now offer confidential access to child psychologists and parenting consultations, helping bridge the gap between early concerns and specialized mental health care.

Building resilience: What the evidence supports

Resilience is a dynamic capacity that develops through repeated, manageable experiences of challenge met with adequate support.

A comprehensive meta-analysis in Frontiers in Psychiatry (Cai et al., 2025), which evaluated over 15,000 youth across 38 randomized controlled trials, confirmed that structured resilience interventions result in significant improvements in youth mental health. More importantly, children with a higher baseline of resilience are less likely to develop clinical anxiety and depression later on.

Clinicians can encourage families to reinforce resilience through consistent routines, age-appropriate independence, regular physical activity, and opportunities for manageable challenges.

When professional intervention is required, evidence-based approaches like Cognitive Behavioral Therapy (CBT) and play therapy are highly effective. Helping a child face feared situations gradually, within a structured and supportive framework, can alter the trajectory of anxiety.

Children who navigate periods of major disruption successfully are not necessarily born with a tougher temperament. Rather, they are those whose distress was recognized early, acknowledged without alarm, and met with timely, evidence-based support.

About the author
Marianne Khlat is a licensed clinical psychologist and paediatric care case manager at Workplace Options, a TELUS Health Company, where she specializes in supporting children and families across the Gulf and Africa region through culturally sensitive clinical intervention, including the Child and Family Wellbeing Program, a global service that provides personalized support for children, caregivers, and families. She holds a

Community Development Authority (CDA) psychology license and brings specialist expertise in child and family wellbeing, early intervention, and social-emotional development.

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