• Psychiatrists note steps to be taken to cope with exam-related stress and how to recognise any mental health morbidities

Although exam-related stress is common among children during examination seasons, it is

crucial to closely evaluate whether stress in children before exams is caused solely by

exam-related factors or whether it is a sign of more serious, long-term conditions, as it is not

uncommon for exam-related stress to share symptoms with other mental health conditions.

Either way, there are a number of simple yet effective steps both children and parents can take

to deal with stress at the domestic level.

This was highlighted during a recent discussion on exam-related stress, conducted by the Sri

Lanka College of Child and Adolescent Psychiatrists (SLCCAP), at which SLCCAP President

and University of Kelaniya Faculty of Medicine Consultant Child and Adolescent Psychiatrist

Prof. Miyuru Chandradasa, and SLCCAP Vice President and Karapitiya Teaching Hospital

Consultant Child and Adolescent Psychiatrist Dr. Darshani Hettiarachchi participated. They

pointed out that maintaining children’s mental health during exam seasons is a responsibility of

both children and parents.

Exam-related stress

Prof. Chandradasa explained that there is a relationship between stress, memory, and

enthusiasm, which in turn affects a person’s performance at an examination. Adding that there

are several types of memories, including short-term and long-term memories, he pointed out

that that as an exam approaches, in the event a student has not engaged in academic activities properly (an example being having been left with an amount of work that is not commensurate

with the time available to the student), has an ultra-sensitive personality, or experiences stress

due to rapid changes in the exam dates, such a situation increases exam-related stress.

This stress, he explained, may affect the transmission of information between the said types of

memories. In addition, stress decreases the enthusiasm one needs in order to continue with

academic activities, which decreases knowledge being stored in long-term memory. Stress may

even affect a student during an exam, regarding which Prof. Chandradasa said that stress

affects a person’s ability to recall information that has been stored in their long-term memory.

Discerning exam-related stress from other issues

The discussion also paid attention to the possibility of exam-related stress developing into or

co-existing with depression, regarding which Dr. Hettiarachchi pointed out the importance of

distinguishing the two conditions. Among the signs of exam-related stress are the fear of failing

exams, the feeling of inadequacy or having inadequate knowledge, doubts about being able to

recall one’s knowledge during exams, and depriving oneself of important needs such as food

and sleep out of fear that such needs affect exam-related preparation. While these may be

attributed to exam-related stress, she added that if such signs continue to develop beyond the

aforementioned state – examples being the continuous inability to sleep, a feeling of exhaustion,

the inability to study at all, the tendency to get angry easily, a lack of appetite, not showing any

interest in what one found interesting earlier, showing pessimistic attitudes towards everything,

and in extreme cases, suicidal ideation – and last for more than two weeks, and render a child

unable to perform their daily tasks, it could be a sign of depression.

“If the initial signs have developed into such a state, it is highly advisable that students or their

parents seek the assistance of a psychiatrist,” Dr. Hettiarachchi said.

The experts also discussed procrastination in students, especially those preparing for exams,

adding that it could lead to a number of issues. According to Prof. Chandradasa, there could be

several reasons for procrastination, with one of them being a sign of attention-deficit disorder.

“Studies conducted in Sri Lanka have shown that 7% of all children have attention-deficit

disorder. The signs of this condition include not completing work, not paying attention, easily

being distracted, and avoiding even easy questions in a question paper. In such a situation, it is

important to see a child and adolescent psychiatrist and obtain treatments for attention deficit

disorder.” In addition, according to him, procrastination in those who are not habitual

procrastinators may be a sign of depression.

Dealing with exam-related stress

Meanwhile, in response to a question on taking medication before an exam in order to deal with

exam-related stress, Prof. Chandradasa said that while medicines could help manage

exam-related stress successfully, one could also attempt to employ other methods that do not

involve medicines, such as various relaxation exercises. However, according to him, if a person

has an ultra-sensitive personality and/or finds it difficult to deal with exam-related stress through

such relaxation methods, such persons could avail themselves of medicines, which could prove

useful in such cases. Although medicines for this purpose with no possibility of addiction or complications are

available, according to Prof. Chandradasa, it is important to ensure that one does not start

depending on such medication in stressful situations in one’s life and instead use these

medicines only as a short-term measure. In the event of the need for long-term assistance to

deal with stress, he added that one could use cognitive behavioural therapy (CBT), which helps

address thought processes that cause stress and fear.

In addition, with regard to a question on using social media to deal with stress, Prof.

Chandradasa further said: “Even though spending a number of hours a day to prepare for

exams is common in parts of Asia, especially due to high exam-related competition, such

practices are not as common in Western countries. When facing high competition and when

spending a large amount of time in a given day to study, we might experience a feeling of

boredom or disinterest, or fear and anxiety, due to the sense of uncertainty regarding the results

of an exam. In such situations, we seek a way to deal with this pressure. Around 20 years ago,

there were no smartphones for this purpose, and the available options were taking a walk or

listening to music. Since activities such as walking do not stimulate us greatly, there is little room

for such to be addictive.”

Adding that in the case of social media, however, there is a tendency for addiction, Prof.

Chandradasa explained that social media-based activities often result in a rapid surge of

dopamine in the brain, which provides quick relief. The danger of this situation is the tendency

to develop an addiction to such quick relief, which results in more time being spent on social

media.

“If you are a person that finds it difficult to impose certain behavioural limitations, you may

experience a non-stop stressful cycle through the use of social media,” he emphasised, adding

that one of the steps that could be taken in such situations is temporarily deleting social media

apps from the phone, especially several months preceding the exams.

Preventing exam-related stress

The two experts extensively discussed what good practices and precautions one could employ

to maintain their mental health during exam seasons.

According to Dr. Hettiarachchi, one should pay attention only to limited things each day before

the exam. Among them are adequate sleep, adequate and nutritious food, relaxation-related

exercises, adequate rest, and studying only the most essential lessons. Among them, sleep is of

great importance, as it helps maintain memory and mood, as well as physical energy, on the day

of the exam, and therefore, it is important to have a minimum of 5.5-6 hours of uninterrupted

sleep the night before an exam.

Meanwhile, Prof. Chandradasa spoke of the impacts of using digital devices on sleep and rest,

saying: “Imagine we plan to sleep at 12 midnight, and that even by 11.30 p.m. we are still using

a device with a screen, perhaps to watch a video or to play a video game, then the mind thinks

that although it is 11.30 p.m., this is still a time when an important task is being performed. It is a

hormone called melatonin that makes us feel sleepy. Now when the brain sees the use of a

device with a screen, the pattern of releasing melatonin changes, which reduces the amount of

sleep we get. In addition, when sleep gets delayed and we feel bored, we continue to use such devices such as phones, which further delays sleep. This is a vicious cycle. This may even lead

to serious issues such as a condition called sleep-wake cycle alteration.”

Adding that it is extremely important to pay more attention to sleep-related hygiene, he

suggested sleeping on time, sleeping a sufficient number of hours, waking up at a set time,

ceasing the use of devices with screens at least 30-60 minutes before sleep, refraining from

using the bed to study, and refraining from keeping electronic devices nearby when sleeping.

Exercises, both physical and mental, are one of most effective ways of dealing with and

preventing stress and relaxing, according to the two psychiatrists. Dr. Hettiarachchi explained

that to maintain mental health, it is important to maintain physical health, which could be

achieved in several ways, including physical exercise lasting at least 30 minutes, a healthy diet,

engaging in relaxation-based exercises at least 15 minutes a day, limiting the use of electronic

devices with screens, and engaging in pleasurable activities. They further said that starting

relaxation exercises at least three months before exams could help avoid stressful situations

during exams, while other activities such as meditation and listening to music could also have

positive impacts on a person sitting for exams.