[This is an excerpt fromThe Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students, by Nancy Rappaport and Jessica Minahan. The Behavior Code is available from Harvard Education Press.]

If social demands are thought to be the primary cause of the student's anxiety, and if the student's behavior is very disruptive, the team may consider providing the student with an alternative lunch setting.

The cafeteria is a noisy and overwhelming place in which negotiating social interactions that are difficult in the first place becomes even more paralyzing. Where do I sit? Who do I talk to? What if no one wants to trade food with me? What if I spill? This is a prime setting for social exclusion and cliques. Some students can navigate the situation, especially with staff support, but others are not so successful. Even if the student manages to get through lunch without an incident, she might be overwhelmed. For some students, a quiet, structured lunch in the classroom with one or two peers and an adult may be better. If the teacher designs the lunch group (sometimes referred to as "lunch buddies") around a common activity such as cartooning or board games, it's much easier to have peers volunteer to join, reducing the stigma of a separate lunch. Teachers are often surprised at the popularity of such lunch groups, which indicates that the cafeteria may be stressful for some students without anxiety as well.

We have also used lunch groups as a way to concretely demonstrate that students have friends who want to spend time with them: "See how many kids want to be in lunch group with you?"

In elementary schools, recess after lunch can have as many as eighty students on the playground at a time. This can be stressful for anyone, but especially for students with anxiety. Whenever possible, alternative recess with a small group is ideal, such as playing later, when the gym is free, or going to a different yard on the side of the school instead of the overcrowded playground.

Teachers will be amazed at the behavior change they'll see in some students by modifying lunch or recess. The children will often be calmer and less anxious later in the day and less likely to explode. They may also feel less anxious earlier in the day because they are not anticipating the stress of the cafeteria.