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Spec. Ed. Presentation
Transcript of Spec. Ed. Presentation
Exceptionalities: Kioyaki Intelligence Study
(2012) Generalized Anxiety Disorder
in Children Anxiety: An Overview Academics Behavioural Differences :
Generalized Anxiety Disorder
Overanxious Disorder of Childhood Social / Emotional What do you know about anxiety and how it manifests itself in children? - We all experience anxiety
- When stressors outweigh our coping mechanism/resources, we learn to adapt DSM III-R vs. DSM IV Social Phobia / Avoidance
Emotional regulation difficulties
Self-doubting and self-conscious, 'needing' reassurance
Difficulty with problem solving, assertiveness, maturity, and personal autonomy
Deficient social skills, roles & expectations
Peer rejection, social withdrawal, one best friend
Lower self-perceived social competence, 'Expect' to be disliked
Prefer extensive social isolation Prevalence - Most common emotional disorders among children and adolescence (Schniering, Hudson, & Rapee, 2000; Suveg, Jacob & Thomassin, 2009)
- 21% experience clinical signs and symptoms of anxiety over the course of the year (Anderson, Williams, McGee, & Silva, 1987)
-25.7% in children 8 years of age (Suveg, Jacob & Thomassin, 2009)
- Anxiety disorders rarely occur in isolation (Biedel & Alfano, 2011) Future intelligence predictors in 6th grade students (N=238) Anxiety is no longer adaptive when..... - It causes significant distress
- It is out of proportion to the real threat involved
- fear and avoidance interfere with normal activities Anxiety Intervention Plan Anxiety Intervention Plan Continued... Anxiety Intervention Plan
Continued Some More... Academics Continued... Practical Implications for Teachers Physical Affected sleeping and eating
Continuous high levels of tension (Dadds and Barrett, 2001)
Somatic complaints with no physical basis (Strauss, 1987) Psychological Affects attention and concentration
Seek excessive reassurance
Respond negatively to criticisms and evaluation (Keeton, Kolos & Walkup, 2009) Comorbidity Obsessive Compulsive Disorder (OCD)
Avoidant Disorder (AD)
Separation Anxiety Disorder (SAD)
Self-regulation Difficulties (Borkovec, 1983)
Cognitive Processing Delays (Ellis & Hudson, 2010) Metacognitive Model of GAD Agenda Emotional & Behavioural Exceptionalities
Knowledge Building About GAD
Anxiety In General
GAD - An Introduction
GAD vs OAD
Social / Emotional
Practical Implications for Teachers
Question & Discussions Emotional &
"A learning disorder characterized by specific behaviour problems over such a period of time, and to such a marked degree, and of such a nature, as to adversely affect educational performance, and that may be accompanied by one or more of the following...."
MOE, 2002, p. 16 Behavioural Exceptionalities: An inability to build or to maintain interpersonal relationships
Excessive fears or anxieties
A tendency to compulsive reaction
An inability to learn that cannot be traced to intellectual, sensory, or other health factors, or any combination thereof Behavioural Exceptionalities Continued... Small Group Chat What behavioural exceptionalities have you seen through your own experiences?
How have they been dealt with? - Concentration difficulties (Dadds and Barrett, 2001)
- Marked self-consciousness
- Extreme need for reassurance by others
- Fears of negative Evaluations by peers (Strauss, 1987)
- Fears of poor performance (Bidel, 2011) - Inconsistent school attendance/school refusal
(Masi et al., 2004; King et al. 2000; Beidel and Alfano, 2011)
- Refusal, go late, or unable to remain for the whole day
- Related to academic achievement
- Related to social development
- Failure to participate in school - Flexible deadlines
- Visible daily schedule
- Reduced workload
- Access parents as a resource
- Confront fear sources
- Test taking
- Class Participation
- Classroom Environment
- Resources Adapted from Dunn, Buron- 2003 Adapted from Dunn, Buron- 2003 Create a “safe” place for the child to go to calm down
Talk to the child about where anxiety comes from (survival instinct)
Provide activities to distract the child
Provide smooth transitions with consistent routines
Teach the child relaxation techniques
Ask the student of helpful interventions
Find books that address children with anxiety:
"When my Worries get too Big"
Play soothing music during down time
Incorporate exercise during the school day
Create low competition environment by creating cooperative activities Treatments Questions / Concerns / Anxieties? Case Study #1 Case Study #2 Stephanie Grabham
Nancy Soo So, What is GAD? Pervasive, excessive and uncontrollable worry and anxiety.
“Free floating anxiety”
Prevalence in children: 1.7% - 5.9%.
Average onset is 6–10 years of age.
Lifetime prevalence of 5% in the general population. American Psychiatric Association, 2000 Completed by a qualified clinical professional Diagnostic Criteria (DSM IV-R) 1. Causes 3. Treatment 2. Signs &
Symptoms Origins of GAD:
Biopsychosocial Model Easy to administer
High correlation (r=0.42) with future intelligence Adapted from Dunn, Buron- 2003 Adapted from Dunn, Buron- 2003 Jared, age 13, has excessive anxiety, worry, and somatic complaints. His mother describes him as overly concerned about everything. Jared says he worries about most things, but especially about not being good enough for his parents, being teased by other kids, not doing well at school, making mistakes, and about being in another car accident where he or his parents get injured. Jared ruminates for days about things that have already occurred, such as what he said in class the previous day or how he did on last week's test. Once he begins to worry, he says, "I just can't stop, no matter how hard I try." Jared reports that when he is always worrying about either the past or anticipating an upcoming event, he has headaches, stomachaches, and often has a rapid heartbeat. His mother (who also worries a lot, but not nearly as much as Jared) says that Jared is extremely self-critical and needs constant reassurance. How would you apply the ABCDE technique to this situation?
What are the symptoms Jared has of GAD?
Using the Biopsychosocial Model, discuss potential causes for his disorder Sara is 14 years old, in grade 9, and lives with her brother (16 years old) and her single mother. Sara and her family recently moved into a new city, and while she likes her new home, she misses her old town and her friends. Although Sara has always been a bit of a worrier, she noticed that her worrying increased after moving. At first, she worried about making new friends and losing her old friends, but after awhile she began to worry about her relationship with her family and her performance at school. By the time she finished her first semester at school, Sara was worrying about "everything" and feeling tense and irritable almost everyday. Lately, she has begun to have difficulty sleeping and seems to always feel tired. For Sara, school has also become a challenge. Since she's so anxious about her homework, she ends up ruminating about it and doesn't complete it. Consequently, she lies to her teacher at school and her marks have begun to suffer. She is also distracted and inattentive in class, and occasionally disrupts the class with emotional outbursts. She is hypersensitive and she is desperate to escape her mind. Sara's teacher is thinking that Sara may have a 'behaviour' exceptionality, and would like to speak to the in-school team to come up with a plan to meet Sara's emotional, behavioural, and academic needs. Anxiety Disorders Association of Canada, 2013 http://www.workbookpublishing.com/fearplan.swf 2. Psychological Treatments ABCDE Technique CBT, ages 8-17, 16 sessions, focus on 4 key components:
Recognizing anxious feelings/reactions
Clarify anxious feelings
Develop coping plan (i.e. self talk)
Evaluate performance/administer self-reinforcement 1. Medical Treatments A combination of approaches effective in diminishing the incidence of symptoms and avoidance behaviours in children (Silva, Gallagher, & Minami, 2006) A - Activating Agent (identify the stressor)
B - Belief system (identify rational and irrational beliefs)
C - Consequences (mental, physical, behavioral)
D - Dispute irrational beliefs
E - Effect (changed consequence) Amy refuses to go to the doctor because she thinks she will be diagnosed with a terminal disease. She locks herself in her room whenever her mom says it's time to go. What would be some of the behaviours that children with anxiety would exhibit? Normal Relief from anxiety (Anxiolytics) Sedation (Sedatives)
Drowsiness/decrease reaction time Hypnosis (Hypnotics)
Confusion, Delirium. Ataxia Surgical Anesthesia Depression of respiratory and vasomotor center in the brain stem Coma Death 1) Benzodiazepine
4) Buspirone Benzodiazepines SSRIs (Selective Serotonin Reuptake Inhibitors)
SNRIs (Serotonin-Noradrenaline Reuptake Inhibitors) Buspirone What accommodation would you make for Sara?
- Assessment Social Impairments: Extreme worry = core feature of GAD
Positive worry beliefs
Worrying about worrying Emotional feedback
cycle of worry 1) Seek frequent reassurance
2) Negative beliefs about worry leading to uncontrollable worry and failure to interrupt
the worry process. (Ellis & Hudson, 2010) Type 1: Type 2: **See the Ontario Curriculum Unit Planner: Special Education Companion pp. 16-22 for many more teaching strategies** Principles of Medical Pharmacology 7th Edition: Kalant, Grant & Mitchell Anxiety Disorders Association of Canada, 2013 ; Silva, Gallagher, & Minami, 2006 - Alfano, Beidel, & Wong, 2011 ; Bidel, 2011 ; Mash & Wolfe, 2010 ; Dadds and Barrett, 2001 Let's
Try! Albert Ellis (Greenberg, 2011) MOE, 2002, p. 16 - Center for Knowledge on Healthy Child Development, http://www.kidsmentalhealth.ca/parents/anxiety.php#Generalized%20Anxiety%20Disorder%20(GAD) Waller (2006) The FEAR Plan F = Feeling Frightened?
E = Expecting bad things to happen?
A = Attitudes and Actions that can help
R = Results and Rewards - 20 Classroom Interventions for Children with Anxiety Disorders (2013)
- worrywisekids.org Generalized Anxiety Disorder References Alfano, C. , Beidel, D. , & Wong, N. (2011). Children with generalized anxiety disorder do not have peer problems, just fewer friends. Child Psychiatry and Human Development, 42(6), 712-723.American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4th Ed., Text Revision). Washington DC: American Psychiatric Association.Anderson, J.C., Williams, S., McGee, R., & Silva, P. A. (1987). DSM-III disorders in preadolescent children: Prevalence in a large sample from a general population. Archives of General Psychiatry, 44, 69-76.Anxiety and Depression Association of America. (2013). Generalized Anxiety Disorder. Retrieved May 15, 2013, from http://www.adaa.org/understanding-anxiety/generalized-anxiety-disorder-gad.Anxiety Disorders Association of Canada. (2013). Generalized Anxiety Disorder. Retrieved May 18, 2013, from http://anxietycanada.ca/english/pdf/GADEn.pdf.Barrett, P. M. (1998). Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders. Journal of Clinical Child Psychology, 27(4), 459-468.Beidel, D. (1991). Social phobia and overanxious disorder in school-age children. Journal Of The American Academy Of Child And Adolescent Psychiatry, 30(4), 545-552.Beidel, D., & Alfano, C. (2011). Child Anxiety Disorders: A Guide to Research and Treatment, 2nd Edition. Retrieved May 20, 2013, from http://bf4dv7zn3u.search.serialssolutions.com.myaccess.library.utoronto.ca/?ctx_ver=Z39.88-2004&ctx_enc=info%3Aofi%2Fenc%3AUTF-8&rfr_id=info:sid/summon.serialssolutions.com&rft_val_fmt=info:ofi/fmt:kev:mtx:book&rft.genre=book&rft.title=Child+anxiety+disorders&rft.au=Deborah+C.+Beidel&rft.au=Candice+A.+Alfano&rft.date=2011-01-13&rft.pub=Routledge+Ltd&rft.isbn=9780415873734&rft.externalDocID=9780203864258.Borkovec, T., Robinson, E., Pruzinsky, T., & DePree, J. A. (1983). Preliminary exploration of worry: Some characteristics and processes. Behaviour Research and Therapy, 21, 9–16. References Chansky, T. E. & Kendall, P. C. (1997). Social expectancies and self-perceptions in anxiety-disordered children. Journal of Anxiety Disorders, 11(1), 347–363.
Dadds, M. R. & Barrett, P. M. (2001). Practitioner Review, Psychological Management of Anxiety Disorders in Childhood. Journal of Childhood Psychology and Psychiatry, 42, 999-1011.Dunn, Buron, K. (2006). When my worries get too big! A relaxation book for children with live with anxiety. Shawnee Mission, KS: Autism Asperger Publishing Company.Ellis, Danielle M., and Jennifer L. Hudson. (2010). The Metacognitive Model of Generalized Anxiety Disorder in Children and Adolescents. Clinical Child and Family Psychology Review, 13(2), 151-63. Greenberg, J. S. (2011). Comprehensive stress management (12th ed.). New York, NY: McGraw-Hill.Health Central. (2013). 20 classroom interventions for children with anxiety disorders. Retrieved May 20, 2013, from http://www.healthcentral.com/anxiety/school-258065-5.html. Keeton, C.P., Kolos, A.C., & Walkup, J.T. (2009). Pediatric Generalized Anxiety Disorder: Epidemiology, Assessment, and Management. Pediatric Drugs, 11(3), 171-183.Kendall, P. C. (1994). Treating anxiety disorders in children: Results of a randomized clinical trial. Journal of Consulting Clinical Psychology, 62(1), 100-110.King, N., Tonge, B. J., Heyne, D., Ollendick, T. H. (2000). Research on the Cognitive-Behavioural Treatment of School Refusal: A Review and Recommendations. Clinical Psychology Review, 20(4), 495-507.Mash, E. J., & Wolfe, D. A. (2010). Abnormal child psychology (4th ed.). Belmont, CA:Wadsworth.