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Students with Exceptionalities » Anxiety- Generalized Anxiety Disorder

Anxiety- Generalized Anxiety Disorder Anxiety- Generalized Anxiety Disorder

Anxiety (Generalized Anxiety Disorder)

Interventions at School

There are many ways that schools can help a child with generalized anxiety disorder succeed in the classroom. Meetings between parents and school staff, such as teachers, guidance counselors, or nurses, will allow collaboration to develop helpful school structure for the child. The child may need particular changes (accommodations/modifications) within a classroom. Examples of some accommodations, modifications, and school strategies include the following:

  • Establish check-ins on arrival to facilitate transition into school
  • Accommodate late arrival due to difficulty with transitions
  • Because transitions may be particularly difficult for these children, allow extra time for moving to another activity or location. When a child with anxiety refuses to follow directions, for example, the reason may be symptoms of anxiety rather than intentional oppositionality.
  • When possible, decrease homework load
  • Make available reading lists and handouts earlier in the term, this will assist students who sometimes may have to be absent due to their impairment
  • If the child is avoiding school, determine the cause of the child's reluctance and address it, initiate a plan to for him or her to return to school as quickly as possible. It may help ease anxiety if the child attends for a shorter school day temporarily.
  • Identify a "safe" place where the child may go to reduce anxiety during stressful periods. Developing guidelines for appropriate use of the safe place will help both the student and staff.
  • Develop relaxation techniques to help reduce anxiety at school. Employing the techniques developed at home can be useful.
  • Provide alternative activities to distract the child from physical symptoms . Calming activities may be helpful.
  • Encourage completion of activities and assignments, yet allow extra time on
     
  • Encourage small group interactions to develop increased areas of competency
  • Provide assistance with peer interactions. An adult's help may be very beneficial for both the child and his or her peers.
  • Encourage the child to help develop interventions. Enlisting the child in the task will lead to more successful strategies and will foster the child's ability to problem-solve.
  • Reward a child's efforts. Every good effort deserves to be praised.

Flexibility and a supportive environment are essential for a student with generalized anxiety disorder to achieve success in school. School faculty and parents together may be able to identify patterns of difficulty and develop remedies to reduce a child's challenges at these times.

At School   

At school, a child with generalized anxiety disorder may have a combination of the symptoms listed below.

  • Excessive worry and anxiety about a variety of matters
  • Repeated seeking of teacher approval
  • An inability to explain the worries. Children may not understand why they are so anxious.
  • Inability to stop the worry. Despite adult reassurance, the worries continue.
  • Difficulty transitioning from home to school. Children may develop difficulty entering school in the morning if they associate more worries with school. This may lead to late arrival times, long and tearful morning drop-offs, or tearful episodes at school.
  • Refusal or reluctance to attend school. Anxiety may lead a child to insist on staying at home.
  • Avoidance of academic and peer activities
  • Self-criticism and low self-esteem
  • Difficulty concentrating due to persistent worry, which may affect a variety of school activities, from following directions and completing assignments to paying attention
  • Other conditions, such as attention deficit hyperactivity disorder (ADHD), may also be present, compounding learning difficulties. Having one mental health condition does not "inoculate" the child from having other conditions as well.
  • Other anxiety disorders, such as social phobia, separation anxiety, or panic disorder. Anxiety disorders may not be recognized both because children may try to hide symptoms and because their symptoms are experienced internally and may not be easily seen.
  • Learning disorders may co-exist and should not be overlooked in this population. A child's difficulties in school should not be presumed to be due entirely to anxiety. If the child still has academic difficulty after symptoms are treated, an educational evaluation for a learning disorder should be considered. A child's repeated reluctance to attend school may be an indicator of an undiagnosed learning disability.
  • Side effects from medications. Medications may have cognitive or behavioural effects or physically uncomfortable side effects that interfere with school performance. After a child begins receiving medical treatment for symptoms, any mood changes or new behaviors should be discussed with parents, as they can reflect medication side effects. top

 


Accommodations

  • Model appropriate behaviour for the student in anxiety-provoking situations
    Example:

    Specify how to react to different situations. When a test paper tears, get tape or obtain another copy. When a pencil breaks during a test, raise your hand, re-sharpen the pencil, or use a different pencil.
  • Diminish stress within school situations
    Example:
    Allow the student to eat lunch in a small group of familiar peers. If uncomfortable speaking in front of the class, the student may read his or her speech into a recorder.
  • Forewarn the student of transitions, and have "tasks" for the student to focus on during transitions
    Example:
    If the student is worried about a school trip, provide tasks that distract from anxiety, such as checking attendance, or holding the door at the site.
  • Address student individually, outside of class whenever possible, about fears
    Example:
    Help the student generate solutions to be implemented when he/she is overwhelmed or "shutting down," or in the presence of fear-provoking situations or stimuli. Preferably discuss outside of class, when the student is not already at a high stress level.
  • Identify alternatives to avoid unnecessary exposure to anxiety-provoking stimuli
    Example:
    Allow the student to enter school from the side or back so he/she does not have to pass the area where he/she was frightened or traumatized. If the student's parents are divorced, provide writing assignments beyond "family traditions for winter vacation" so the student does not have to think/write about divorce.
  • Have the student examine worry/anxiety episodes in a larger context to identify improvement
    Example:
    Help the student examine how he/she has handled similar situations over the past year to see improvement (or conversely, to identify what has changed making it harder to use strategies that worked previously).

Modifications 

  • Embed desirable, familiar, or safe content in instruction
    Example:
    Use questions about pets, sports, or preferred literary/TV characters to make new or anxiety provoking content more comfortable to the student ("What would someone you admire/your hero do in this situation?").
  • Add literature (bibliotherapy) that addresses the student's fears, or exemplifies coping strategies
    Example:
    Use a short story or film that deals with bullying, death of a relative, spending a night apart from parents, or getting sick on a school trip.

Specialized Instruction

  • Have the student employ specific problem-solving steps
    Example:
    Model a "Situation-Alternative-Consequences" (SAC) approach for the student: S: situation identified -  A: alternatives enumerated -
    C: consequences predicted.
  • Devise a desensitization approach agreeable to the student
    Example:
    If the student fears speaking in front of the class, allow the student to: have the speech read by a peer; read the speech into a recorder outside class; introduce other students doing speeches; do the speech with a peer reading some part. Finally, have the student read his/her own speech.
  • Provide group, interactive bibliotherapy activities (group dialogue, peer pairs) that address fears or topics worrisome to the student
    Example:
    Read a book to students and accompany the book with either discussion, role-playing, art activities or creative writing. For example: an adolescent group/pair can compose a diary for a character in a book, write a letter from one character in the book to another, role play an incident in the book with a student taking the part of a key character, or draw pictures in sequence of important incidents in the book.
  • Use visuals to help "pace" the student when he/she is anxious about a parent being away, stressed about completing work, or perservating on a particular upcoming event or activity
    Example:
    Develop a "time schedule" with specific symbols that the student places on a visual board for specific time intervals. This allows the student to see how much time remains before something is over or before something new begins. The student's "want" is visually included on the board as the "end goal."
  • Have the student practice positive self-talk
    Example:
    Introduce positive "scripts" to practice in anxiety-provoking situations, such as "break the task down" with "I have done this many times, so now I'll just start by doing one problem, then checking to see if it's correct."
  • Help the student evaluate the evidence for his/her negative conclusions
    Example:
    The student says "I'm worried that people will see what a loser I am if I play on the soccer team". Ask him/her: "did any good things happen last time you played soccer? Is there another sport that you play better?"
  • Challenge the student's negative cognitions
    Example:
    The student says "I can't go to school because I'm worried people will make fun of me." Ask him/her: "What do students do when they arrive at school? Which students are glad to see you?"
  • Help the student identify automatic negative thoughts
    Example:
    The student says "I can't let my mother go on the subway. The train might explode." Ask the student: "What happened the last time your mom took the subway? Did she come home safely?"
  • Help the student examine other perspectives

    Example:
    The student says "I can't go to the school dance because everyone will notice that I'm nervous." Ask the student, "How would your best friend/someone you admire handle a situation like this? What does your friend think you should do?"
  • Provide the student with competing responses to negative thoughts or behaviours

    Example:
    The student says "I'm afraid I'll start crying in class." Ask the student, "If you start to feel sad, what can you do before you start to cry? Can you read something that makes you laugh? Can you distract yourself by doodling?"

Behavioural Planning

  • Develop a consistent de-escalation procedure familiar to staff

    Example:

    When worried, the student will: 1) take 10 breaths; 2) identify how a preferred "hero" would handle the situation; 3) access designated staff; 4) do alternative, less stressful work; 5) do reading for five minutes in an alternative area (corner of room, library), then answer questions.

 

 

 

 

REFERENCES

http://www.massgeneral.org/schoolpsychiatry/info_anxiety.asp#looklike_school

 

Teaching Students with Anxiety Disorders by Robert Walden, published Jun 21, 2007

 






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