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Anxiety Disorders & Non-verbal Learning Disabilities . What’s a Teacher to Do?. Nonverbal Learning Disabilities. NLD is a controversial diagnosis – some believe it is simply on the autism spectrum; others argue it is its own disability
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Anxiety Disorders & Non-verbal Learning Disabilities What’s a Teacher to Do?
Nonverbal Learning Disabilities • NLD is a controversial diagnosis – some believe it is simply on the autism spectrum; others argue it is its own disability • Characterized by problems with non-verbal tasks (understanding non-verbal cues, pictures, space and time relationships etc.) • In older students other characteristics emerge • NLD presents similarly to Aspbergers in some ways. Certainly the anxiety that students with Aspbergers experience is similar to that of students with NLD
Characteristics of NLD • Impaired ability to organize the visual spatial field and thus respond to new or novel situations. • Has difficulty producing in situations where speed and adaptability are required • May have physical difficulties and look awkward when moving • May appear confused much of the time • Often has an exceptional memory for rote material • Very concrete in understanding of conversation – misses metaphors, figures of speech; does NOT understand irony or sarcasm
Characteristics of NLD • Often perceived as a “smart alek” or smart mouth • May talk a lot – cocktail talk (little content) or talk about how something works or is done, rather than do it • May have excellent oral reading skills but this may hide weak comprehension • In spoken or written language they tend to talk/write about every minute detail – not ever getting to the main point • Written work is difficult because of motor difficulties as well as the difficulty in seeing/getting to the main point
Characteristics of NLD – High School • Do not see the whole picture • Can be confused by their surroundings • Confused by or missing social interactions – not getting the teen communication styles • Difficulty anticipating what comes next • May have perfectionist and/or obsessive/compulsive tendencies
Older students with NLD • Early compensatory behaviors do not work as effectively • Rote memory fails when the shift occurs to application and interpretation • Prone to developing depression and/or anxiety disorders
Accommodations for students with NLD • Extra time to get places; verbal support and explanation of how to get to to places • Extra assistance to organize self • Because of strong verbal skills they present as much more able than they are – remember 65% of communication is non-verbal and chances are, this student has missed it • Tell them how to do things – don’t show them (give running verbal descriptions when you are showing – for example when solving a math problem)
Anxiety Disorders… • Is anxiety bad? • When is anxiety bad? • What is the difference between normal and abnormal anxiety? • Childhood Anxiety disorders are characterized by: • Pattern of excessive worry or uneasiness • Interferes with development and day-to-day functioning at home, school or in the community • Frequency, duration and intensity
Types and Subtypes • Separation Anxiety Disorder (SAD) • Generalized Anxiety Disorder (GAD) • Social Phobia • Panic Disorder (with or without Agoraphobia) • Agoraphobia • Specific Phobia • Obsessive-Compulsive Disorder • Posttraumatic Stress Disorder • Acute Stress Disorder
Developmental Considerations • Some anxiety is normal so must be careful to determine if anxiety is age appropriate • Lack of communication skills can mean that some children and adolescents are unable to express what is bothering them • Anxiety can manifest as somatic symptoms, anger, frustration or escapist behaviors
Epidemiology • Waddell et al(2002) study suggests 6.4% of children experience Anxiety Disorders at any one time. • The Costello et al (2003) study – 3% of all children affected by anxiety disorders at any one point – 3 month point 9% - estimated occurrence for children of 1 event by age 16 was 3X higher – so 30% of children by age 16 will be affected by Anxiety Disorders • Equal number of boys and girls when young; by adolescence, more prevalent in girls.
Types of Anxiety Our Students Experience • May be anticipatory • May be situational
Comorbidity among Anxiety Disorders • Concurrent mental health problems such as depression and other anxiety disorders are common • Highest comorbidity with depression is anxiety disorder • Childhood Anxiety disorders manifest first, before depression • Separation Anxiety often leads to adult onset Panic Disorder • Drug and alcohol misuse in adolescents is often comorbid with anxiety disorders
Treatment and Prevention • Protective factors include: • Emotional stability • Secure attachment • Positive parenting • Ability to use effortful control • Perceived control • Self-esteem and self-efficacy • Coping strategies • Defense mechanisms • Emotional regulation • Social supports
Supports for Students with Anxiety Disorders • Recognize and honor the need for safe place to go when anxiety is high (requests to leave classroom etc.) • Some students benefit from listening to music or loosing themselves in another activity (reading etc.) • Ask the student to identify interventions they find helpful and work hand in hand with Student Support to find ways to offer those interventions to students in a non-obtrusive manner
Supports for Students with Anxiety Disorders • Decrease situations that induce stress (allow alternative assignments if presentations are stressful – ie: record and play the presentation; do a taped powerpoint/breeze presentation) • Discuss strategies and possible solutions PRIVATELY with the student (and possibly with a parent/advocate) – ensuring no other students are around
Supports for Students with Anxiety Disorders • Follow a daily routine in the class so students know what to expect. If there is to be a change (field trip etc.) let the student know well in advance • Help students break assignments into smaller segments to prevent feelings of being overwhelmed (offer to take in the smaller segments as they are completed)
Specific Questions to Ask the Student/Parent • Is there a preferred seating location • Are there concerns about getting directions wrong (if so, develop a signal or way of having them indicate they don’t understand directions) • Are there concerns about having to participate • Are there concerns about class presentations • Are there concerns re: doing questions on the board • Are there concerns regarding testing conditions
Specific Questions to Ask Student • What can help after a return from illness • Are field trips a stressor (if so, excuse the student)
Recommended Readings/Viewing • Kendall, P.C., Compton, S.N., Walkup, J.T., Birmaher, B., Albano, A.M., Sherrill, J., …Piacentini, J. (2010). Clinical characteristics of anxiety disordered youth. Journal of Anxiety Disorders, 25, doi:10.1016/j.janxdis.2010.01.009 • Manassis, K., Hudson, J.L., Webb, A. & Albano, A.M. (2004). Beyond behavioral inhibition: Etiological factors in childhood anxiety. Cognitive and Behavioral Practice, 11, 3-12. Downloaded University of Calgary, September 29, 2011. • Pediatric Playbook – Anxiety – Dr S.. Goldman, Children’s Hospital, Boston http://youtu.be/xHzrcGZyEtc • Dr. Arlene Young, Simon Fraser University http://www.youtube.com/watch?v=loRC9T8qUGk&feature=youtu.be • www.worrywisekids.org
References • Ainsworth, M. D. S., Blehar, M. C., Waters, E., & Wall, S. (1978). Patterns of attachment. Hillsdale, NJ: Erlbaum. • Anderson, E. R., & Hope, D. A. (2008). A review of the tripartite model for understanding the link between anxiety and depression in youth. Clinical Psychology Review, 28(2), 275-287. doi:10.1016/j.cpr.2007.05.004 • Albano, A.M., Chorpita, B.F., & Barlow, D.H. (2003). Childhood Anxiety Disorders in E.J. Mash & R.A. Barkley (2003). Child Psychopathology, 2nd ed. (pp. 279-329). New York: Guilford Press. • Bar-Haim, Y., Dan, O., Eshel, Y., & Sagi-Schwartz, A. (2007). Predicting children's anxiety from early attachment relationships. Journal of Anxiety Disorders, 21(8), 1061-1068. doi:10.1016/j.janxdis.2006.10.013 • Barlow, D. H. (2002). Anxiety and its disorders: The nature and treatment of anxiety and panic. New York: Guilford Press.
References • Birmaher, B., Khetarpal, S., Brent, D., Cully, M., Balach, L., Kaufman, J., et al. (1997). The Screen for Child Anxiety Related Emotional Disorders (SCARED): scale construction and psychometric characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 545–553. • Brown, T., & Barlow, D. (2005). Dimensional versus categorical classification of mental disorders in the fifth edition of the diagnostic and statistical manual of mental disorders and beyond: Comment on the special section. Journal of Abnormal Psychology, 114(4), 551-556. doi:10.1037/0021-8743X.114.4.551 • Brumariu, L. E., & Kerns, K. A. (2008). Mother–child attachment and social anxiety symptoms in middle childhood. Journal of Applied Developmental Psychology, 29(5), 393-402. doi:10.1016/j.appdev.2008.06.002 • Clark, D. M. and Wells, A. (1995). A cognitive model of social phobia. In Heimberg, R. G., Liebowitz, M. R., Hope, D. A. and Schneier, F. R. (Eds.), Social Phobia: diagnosis, assessment and treatment (pp. 69–93). New York: Guilford Press.
References • Clark, L. A., & Watson, D. (1991). Tripartite model of anxiety and depression: Psychometric evidence and taxonomic implications: Psychometric evidence and taxonomic implications. Journal of Abnormal Psychology, 100(3), 316-336. doi:10.1037/0021-843X.100.3.316 • Costello, E.J., Egger, H.L., & Angold, A. (2004). Developmental epidemiology of anxiety disorders. In T.H. Ollendic & J.S. March (Eds.). Phobic and anxiety disorders in children and adolescents: A clinicians guide to effective psychosocial and pharmacolgoical interventions. (pp. 61-91). New York:Oxford University Press. downloaded October 2, 2011 from University of Calgary ebook collection. • Costello, E. J., Mustillo, S., Erkanli, A., Keeler, G., & Angold, A.(2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60(8), 837–844. doi:10.1001/archpsyc.60.8.837. • Dallaire, D. H., & Weinraub, M. (2007). Infant–mother attachment security and children's anxiety and aggression at first grade.. Journal of Applied Developmental Psychology, 28(5-6), 477-492. doi:10.1016/j.appdev.2007.06.005
References • De Bolle, M., & De Fruyt, F. (2010). The tripartite model in childhood and adolescence: Future directions for developmental research. Child Development Perspectives, 4(3) 174-180. doi: 10.1111/j.1750-8606.2010.00136.x • Eley, T.C. & Gregory, A.M. (2004). Behavioral genetics. In T.L. Morris & J.S. March (Eds.). Anxiety disorders in children and adolescents. (pp 71-97). New York:Guilford Press. • Guy, W. (1976). The clinical global impression scale. The ECDEU assessment manual for psychopharmacology—revised (Vol DHEW Publ No ADM 76-338), Rockville, MD: U.S. Department of Health, Education, and Welfare, Public Health Service, Alcohol Drug Abuse, Mental Health Administration, NIMH Psychopharmacology Research Branch, Division of Extramural Research. pp. 218–222. • Higa-McMillan, C. K., Smith, R. L., Chorpita, B. F., & Hayashi, K. (2008). Common and unique factors associated with DSM-IV-TR internalizing disorders in children. Journal of Abnormal Child Psychology, 36(8), 1279-1288. doi:10.1007/s10802-008-9250-8
References • Kiff, C. J., Lengua, L. J., & Bush, N. R. (2011). Temperament variation in sensitivity to parenting: Predicting changes in depression and anxiety. Journal of Abnormal Child Psychology. doi 10.1007/s10802-011-9539-x • March, J., Parker, J., Sullivan, K., Stallings, P., & Conners, C. (1997). The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 554–565. • Muris, P.R. (2007). Normal and abnormal fear and anxiety in children and adolescents. Burlington, MA:Elsevier Science and Technology. Downloaded October 2, 2011, from University of Calgary ebook collection. • Muris, P., & van der Heiden, S. (2005). Anxiety, depression, and judgments about the probability of future negative and positive events in children. Journal of Anxiety Disorders, 20(2), 252-261. doi:10.1016/j.janxdis.2004.12.001 • Roelofs, J., Meesters, C., ter Huurne, M., Bamelis, L., & Muris, P. (2006). On the links between attachment style, parental rearing behaviors, and internalizing and externalizing problems in non-clinical children. Journal of Child and Family Studies, 15(3), 319-332. doi:10.1007/s10826-006-9025-1
References • RUPP Anxiety Study Group. (2002). The Pediatric Anxiety Rating Scale (PARS): development and psychometric properties. Journal of the American Academy of Child and Adolescent Psychiatry, 41, 1061–1069. • Shamir-Essakow, G., Ungerer, J. A., & Rapee, R. M. (2005). Attachment, behavioral inhibition, and anxiety in preschool children. Journal of Abnormal Child Psychology, 33(2), 131-143. doi:10.1007/s10802-005-1822-2 • Shelton, R. C. & Hunt, A. J., 2008. Anxiety disorders. In S. H. Fatemi, & P. J. Clayton (Eds.), The medical basis of psychiatry (pp. 133-159). Totowa, NJ: Humana Press, Inc. doi:10.1007/978-1-59745-252-6 • Silverman, W. K., & Albano, A. M. (1996). Anxiety Disorders Interview Schedule for DSM-IV: child and parent versions. Boulder, CO: Graywind Publications Incorporated • van Brakel, A. M. L., Muris, P., Bögels, S. M., & Thomassen, C. (2006). A multifactorial model for the etiology of anxiety in non-clinical adolescents: Main and interactive effects of behavioral inhibition, attachment and parental rearing. Journal of Child and Family Studies, 15(5), 568-578. doi:10.1007/s10826-006-9061-x .
References • van Brakel, A. M. L., Muris, P., Bögels, S. M., & Thomassen, C. (2006). A multifactorial model for the etiology of anxiety in non-clinical adolescents: Main and interactive effects of behavioral inhibition, attachment and parental rearing. Journal of Child and Family Studies, 15(5), 568-578. doi:10.1007/s10826-006-9061-x • Waddell, C., Hua, J., Godderis, R., McEwan, K. & Wong, W. (2004). Preventing and treating anxiety disorders in children and youth. Vancouver, BC:Children’s Mental Health Policy Research Program. Downloaded October 1, 2011, from University of Calgary ebook collection. • Waddell, C. Offord, D.R., Shepherd, C.A, Hua, J., & McEwan, K. (2002). Child psychiatric epidemiology and Canadian public policy-making: The state of the science and art of the possible. Canadian Journal of Psychiatry, 47, 825-832. • Wood, J. J., McLeod, B. D., Sigman, M., Hwang, W., & Chu, B. C. (2003). Parenting and childhood anxiety: Theory, empirical findings, and future directions. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 44(1), 134-151. doi:10.1111/1469-7610.00106
References • Wood, J. J., McLeod, B. D., Sigman, M., Hwang, W., & Chu, B. C. (2003). Parenting and childhood anxiety: Theory, empirical findings, and future directions. Journal of Child Psychology and Psychiatry, and Allied Disciplines, 44(1), 134-151. doi:10.1111/1469-7610.00106