Notes from:

Understanding Anxiety Disorders and Kids: Practical Strategies for the School Setting

Presented by Bob Shuppel, M.Ed., S-LPCC, VP of Family Center by the Falls

OSCA Workshop on April 13, 2011, at Solon Community Center

Purpose: to develop basic understanding of anxiety and to discuss strategies and interventions for the school setting to support learners

Understanding Anxiety Disorders

Anxiety is a psychological and physiological state that presents a feeling of nervousness, fear, worry or apprehension which negatively impacts the students’ life activities. Frequently diagnosed anxiety disorders that can impact students in the school setting include: Generalized Anxiety Disorder (GAD), Panic Attacks, Agoraphobia, PTSD, and OCD. The New England Journal of Medicine (2008) reports that 10-20% of children and adolescents have anxiety disorders and that it is under recognized and under treated.

Generalized Anxiety Disorder

  • Physical Symptoms: muscle aches/soreness, trouble falling or staying asleep, stomach problems, jumpiness, restlessness, feeling tired
  • Psychological Symptoms: Irritability, feelings of dread, inability to control anxious thoughts, inability to relax, difficulty concentrating, fear of losing control or being rejected, polarized thoughts and statements

Panic Attacks

  • Intense fear or discomfort that develop abruptly and last 30 seconds to ten minutes or more; not always prompted by a precipitating event
  • Symptoms: Shivers, trembling, chest pain, fear of dying, abdominal distress, pounding heart, smothering feeling, dizziness, chills, sweating, choking feeling, lightheadedness, hot flashes, shortness of breath

Agoraphobia

  • Anxiety about being in places or situations from which escape might be difficult
  • Student often avoids those situations. Examples: anxiety in the lunchroom because of the sensory or social overload, anxiety coming to school because “locked in” to a set schedule/place

Post-traumatic Stress Disorder

  • Lived through an event that could have caused them or someone else to be killed or badly hurt. Examples: physical or sexual abuse, disasters, violent crimes, war, a friend’s suicide
  • Students may show impulsive or aggressive behaviors when dealing with PTSD
  • Students may have low self-esteem, feel isolated and have trouble trusting others

Obsessive Compulsive Disorder

  • Recurrent and persistent thoughts, impulses, or images that are unrealistic, irrational and unwanted
  • Not simply excessive worries
  • Repetitive behaviors or rituals
  • Disrupts student’s normal routine, academic functioning, social activities or relationships

Strategies for the School Setting

Proactive

  • Use a collaborative process to consider accommodations and modifications
  • Use an anxiety scale and data to measure the impact of the student’s anxiety in the school setting
  • Interventions: schedule check-ins, allow late arrival, identify a safe place, teach relaxation techniques and positive self-talk, provide structure
  • Work with the student to create interventions so he/she will own the plan too

Reactive

  • Respond calmly to the student’s crisis; use calm body language and expressions
  • Say as little as possible; a person in crisis has lost ability to reason at that point
  • Provide TIME and SPACE for the student to return to a calm state – may very well take up to an hour
  • Allow to vent; sometimes they need to vent and see if the person can handle that level of intensity of emotion
  • Once the student is calm; address the student’s fears, address faulty thinking and polarized talk, encourage recognition and acceptance of emotions
  • Communicate with the student/teachers/parents as appropriate to support the students strategies for managing anxiety

Supporting the student with Anxiety:

  • Questions for Students with Anxiety (when they have calmed):
  1. What is the evidence?
  2. What is the logic?
  3. Are you oversimplifying the result of your actions?
  4. Are you confusing a habit with a fact?
  5. Are your interpretations of the situation too far removed from what is real to be accurate?
  6. Are you confusing your version of the facts with the actual facts?
  7. Are you thinking in all-or-nothing terms?
  8. Are you using words or phrases that are extreme or exaggerated?
  9. Are you taking selected examples out of context?
  10. Are you using cognitive defense mechanisms?
  11. Is your source of information reliable?
  12. Are you thinking in terms of certainties instead of probabilities?
  13. Are you confusing a low probability with a high probability?
  14. Are your judgments based on feelings rather than on facts?
  15. Are you over-focusing on irrelevant factors?
  • The Five R’s
  • REALIZE that anxiety is part of my thoughts
  • RECOGNIZE ten ways anxietymay affect my life:
  1. Perfectionism causes impossibly high standards
  2. “Rejectionitis” exaggerates
  3. Negative focus destroys all the positives
  4. White-n-black phenomenon
  5. Refusing the positive
  6. Stretch-or-Shrink
  7. Creates excuses
  8. “Should” and “ought”
  9. Mistaken identity
  10. Saying “my fault”
  11. REFUSE to let anxiety control my life, to use distorted thinking
  12. REPLACE the negative and irrational thoughts; change your thinking
  13. RELAX and reprogram the mind with visualization, positive self-talk and use of physical and mental relaxation techniques, give yourself time and space to return to a comfortable state of mind
  • Recognize that the Executive Functions may be more difficult for some students than others (brain not fully “wired” for these functions until age 23-25)
  • Ability to stop a task or behavior when asked to do so
  • Ability to move easily between tasks
  • Ability to control emotions
  • Ability to get started on a task
  • Capacity to hold information (i.e. list of multiple directions for a task)
  • Ability to manage multiple tasks
  • Ability to impose order (planning/organization)
  • Ability to accurately monitor one’s self or one’s behavior