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Running head: ANXIETY DISORDERS

Anxiety Disorders Laurie Berceau Special Education 2010

4/22/13

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Abstract

This paper is a brief review of Anxiety disorders and how they present in an educational setting, I am writing this paper as an assignment for a Introduction to Special Education class. I will discuss and define such anxiety issues as test anxiety, generalized anxiety, school phobia, etc., including the prevalence of the disorders and the effects on the functioning of school age children and adolescents. After a brief overview of the causality and history of anxiety disorders, I will list some of the interventions used to treat these disorders with emphasis on techniques, which can be used in a school setting. Inclusion of special education students will be explored, ending with a summary of the discussion and some of my personal thoughts and opinions.

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Anxiety Disorders and Students The purpose of this paper is to offer a brief review of anxiety disorders and the effects of such conditions on the functionality of students during the primary and secondary years of their education, and to describe some of the most efficacious interventions which could be used in a special education classroom, as well as a general education class. I will include definitions and symptoms of the disorder and its various categories. Then a brief history of anxiety, its prevalence and causality. As some categories of anxiety, such as Obsessive Compulsive Disorder (OCD) and Post Traumatic Stress Disorder (PTSD) are generally treated in medical settings, I will not be including these in my section on school interventions. In conclusion, I will offer a summary of the main points of the paper and my thoughts on the full inclusion of students with anxiety disorders in the general education classroom. Definitions Anxiety is a natural human response and functions as a biological mechanism to warn us of danger or a threat. The fight or flight response is a result of millennia of adaptation by our distant ancestors. Anxiety becomes a pathologic disorder when it is extreme, pervasive and beyond a persons control. Anxiety has also been known by other names such as hysteria, shyness, reclusive, nervous wreck, high strung, battle fatigue, the vapors, shell-shocked, overly sensitive, stage fright, etc. According the Diagnostic and Statistical Manual (DSM IV-TR) used by mental health professionals, anxiety disorders are characterized by irrational fears of a stimulus or situation that is excessive and uncontrollable. These fears persist over time and result in a wide range of physical and affective symptoms, which effect behavior and interfere with a persons functioning (Rowley & Hermida 2010). Some common symptoms include restlessness, sleep disturbance, irritability, muscle tension, irregular heartbeat, repetitive behaviors, lack of

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concentration, nausea, stomachaches and other physical complaints. Though anxiety disorders share many symptoms, certain categories present differently and respond better to differing forms of treatment. Acute stress disorder (ASD) and Post Traumatic Stress disorder (PTSD) occurs after a person has experienced a traumatic event with physical symptoms, which the person can re-experience the event and the symptoms when faced with similar behavioral triggers. PTSD is the chronic form of this disorder. Obsessive-compulsive disorder (OCD) shows repetitive, at times odd actions, which help the person who is afflicted reduce the anxiety produced by intrusive and unwanted thoughts. Panic disorder is described as recurrent and persistent panic attacks (intense fear, chest pain, dizziness and shortness of breath), often accompanied by agoraphobia (fear of being unable to escaped a situation where panic attacks my ensue). These anxieties are very often seen in medical emergency rooms and are treated with a combination of medications and psychotherapy. Generalized Anxiety Disorder (GAD) is characterized by excessive worry over several areas of a students life that last longer that six months. These worries often cluster around schoolwork and performance on test, sporting events and speaking in front of an audience. The student may be exceptionally well behaved and compliant, yet choose not to participate in new activities because of the overwhelming feeling of distress. This student may be perfectionistic with low levels of frustration tolerance and an intense fear of failure. Test anxiety is usually included in this category. Specific phobias are an extreme fear associated with a single situation, which is considered excessive when compared with to the realistic danger of the situation. Some common phobias are fear of dogs, injections, storms, and loud noises or even costumed characters. School phobia or refusal is often a very visible problem, especially with very young children entering Kindergarten or a new elementary school. The child can exhibit reluctance to come to school, or want to leave early, with the

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presence of physical complaints, at times crying and can escalate into tantrums. Actually the cause of this type of anxiety is more appropriately labeled as separation anxiety, as the child is reacting to the separation from the primary caregiver. School refusal can also be caused by learning problems, fear of bullying or family dysfunction with or without underlying anxiety (McLoone, Hudson & Rapee, 2006). Social anxiety disorder is caused by excessive fear of social situations, which can be generalized to almost all social interactions, differing from social phobia, and can result in avoidance and withdrawal from almost all social relationships and events (Rowley & Hermida, 2010). This impacts the student severely in being able to learn necessary life skills, occupational skills and academic achievement (from the withdrawal from classroom and small group learning activities). Prevalence Anxiety is one of the more prevalent psychiatric disorders, which occur in the general population, and is also very common in childhood emotional disorders. Estimates of this prevalence range from 10% to 21%. Females are more likely to have anxiety disorders one and a half to two times as often as males (McLoone, Hudson & Rapee, 2006). I suspect, though this is not supported by my research, that minority students are under represented as far as diagnosing anxiety and over represented in behavior disorder placements and drop out rates. Students who suffer from test anxiety can score up to 12 percentile points below non-anxious peers, which could also lead to assumptions of intellectual disability (Bishop, 2006).

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Causation Anxiety symptoms are believed to derive from disrupted neurotransmitter systems, with heightened sympathetic nervous system response. Specifically, the neurotransmitters serotonin and dopamine. Some researchers have discovered a few genetic at risk factors for two groups of anxiety disorders. The specific phobia group and the panic-generalized anxiety-agoraphobia group. There has also been research into the link between abnormal blood flow to the brain and panic disorder (Shaw, 2010). Although factors in a persons environment are clearly important as the person reacts and processes external stimuli. Co-morbidity is a frequent factor in anxiety disorders with higher reported levels of depression and substance abuse, family dysfunction and learning problems (Rowney & Hermida, 2010). Extreme trauma such as war, rape, death of a loved one, child abuse, divorce, etc. are known to trigger anxiety symptoms, especially in children (Walkley, 2002). History As early as 400 BC some form of anxiety was observed by Hippocrates, the Greek medical practitioner. He described very shy people as being hyper sensitive and loving darkness as life (Cunic, 2012). Hysteria was a term used to describe symptoms of panic or phobic anxiety, especially among women. During the 1600s hysteria was thought to be possession by the devil and a cause for involvement in witchcraft, again principally among females. A civil war doctor in the mid 1800s treated soldiers and civilians for irritable heart syndrome, which presented as irregular heartbeat, sweating, and dizziness. His treatment included digitalis and opium. By the early 1900s the new phenomena of electricity was used to treat anxiety symptoms by hooking up the sufferer to various machines and running an electric currant through the person. Psychoanalysis was gaining popularity and Sigmund Freud began describing

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some of his patients as suffering from a social neuroses or free floating anxiety. The discovery of barbiturates had some physicians prescribing them for anxiety symptoms well into the 1970s, when the extent of the drugs addictive qualities became known. A South African doctor in the 1950s pioneered the development of systematic desensitization techniques. During World War I and World War II, conditions of PTSD were being referred to as shell shock and battle fatigue. (Cunic, 2012). The current classification system of anxiety disorders comes from the DSM IV, TR. Intervention Techniques The most effective therapy for many forms of anxiety is the medical treatment of medication therapy in conjunction with Cognitive Behavior Therapy (CBT), and muscle relaxation training. These interventions involve the parents and other family member in counseling and education. With young children, the use of medication may not be appropriate, yet the school is a necessary partner in following through with behavior techniques and goals. Relaxation training can be helpful to children in the special education classroom as well as the general education class. This is also a part of systematic desensitization or graded exposure where the child is introduced to anxiety provoking situations, in small steps while rehearsing coping skills and being positively re-enforced. CBT uses thought restructuring by challenging beliefs about fearful events and reframing them, using self-talk, rehearsal and self-monitoring. Classroom accommodations, such as allowing extra time for tests, reading questions aloud and having extra time to complete homework are also helpful interventions. An Australian study noted a drop in anxiety symptoms to sub-clinical levels in 75% of students by using a school wide prevention and intervention program called Friends (McLoone, Hudson & Rapee, 2006). Small group counseling with a school counselor or social

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worker has also been shown to be effective. These interventions have parent and family components, which help to facilitate success. Summary Anxiety is one of the most prevalent and I think, under reported of disorders encountered in school age populations. The school seems to be a primary source of identification and referral for these students. By making use of appropriate screening and assessment, I think that the children already being served in special education classrooms will benefit from anxiety intervention methods and school wide prevention programs. These methods would be compatible with the goal of full inclusion in the general education curriculum, which is manifestly achievable. Coping with test anxiety is an extremely important issue for these students as the reliance on tests to measure achievement and school accountability is increasing. I think family functioning can also benefit as parents learn methods to support their children, as well as practicing techniques to benefit themselves, as there is often a family history of anxiety disorder.