Other Health Impairments:

Generalized Anxiety Disorder

Erin Cho, Sarah Segal, Serena Phan
 Table of Contents
Definition, DSM-5, IDEA What Should Educators
know
Anxiety in Children
Resources

What Anxiety Can Look Like Handout

Manifestations

How to Support Students

 Anxiety: An Umbrella Term

Separation Anxiety
Selective Mutism
Specific Phobia
Social Anxiety Disorder
Panic Disorder
Generalized Anxiety Disorder
Agoraphobia
Substance/Medication-Induced anxiety disorder
 Generalized Anxiety Disorder

DSM -IV Medical Definition

Excessive anxiety and worry
(apprehensive expectation),
occurring more days than not for
at least 6 months, about a
number of events or activities
(such as work or school
performance).
A mental health disorder that
produces fear, worry, and a
constant feeling of being
overwhelmed. It is characterized
by excessive, persistent, and
unrealistic worry about everyday
things.
DSM-IV Criteria
Excessive anxiety and worry (apprehensive expectation),
occurring more days than not for at least 6 months, about a
number of events or activities (such as work or school
performance)

The person finds it difficult to control the worry.

The anxiety and worry are associated with at least three (or
one in children) of the following:
Restlessness or feeling keyed up or on edge
Being easily fatigued
Difficulty concentrating or mind going blank
Irritability
Muscle tension
Sleep disturbance (Difficulty falling asleep or staying
asleep, or restless unsatisfying sleep)
DSM-IV Criteria
The anxiety, worry or physical symptoms cause
clinically significant distress or impairment in social,
occupational, or other important areas of
functioning.

The disturbance is not attributable to the

physiological effects of a substance (ex: drug or
medication) or another medical condition (ex:
hyperthyroidism)

The disturbance is not better explained by another

mental disorder.
IDEA: Sec. 300.8 (c)(9)

Other health impairment means having limited strength, vitality, or

alertness, including a heightened alertness to environmental stimuli,
that results in limited alertness with respect to the educational
environment, that—
Is due to chronic or acute health problems such as asthma,
attention deficit disorder or attention deficit hyperactivity
disorder, diabetes, epilepsy, a heart condition, hemophilia, lead
poisoning, leukemia, nephritis, rheumatic fever, sickle cell anemia,
and Tourette syndrome; and
Adversely affects a child’s educational performance.

*This list does not include all possible health issues that
could result in a diagnosis of other health impairments.*
IDEA: Sec. 300.8 (c)(9)

An “adverse effect” on educational performance may be

measured by a student’s grades, but may also include
consideration of other ways in which a student’s condition
affects his school activities. School districts tend to read
“adversely affect” narrowly and focus solely on academic
performance. The courts take a broader view of
educational performance and include consideration of a
student’s academic, social, health, emotional,
communicative, physical and vocational needs.
 Anxiety in Children

Anxiety can develop at any age. It is the most

common health disorder (“Understanding”)
How common is it?
32% of adolescents in the US have anxiety
(National Research Council and Institute
of Medicine)
Anxiety is more prevalent in females than
males
Important to know
Only 7% of those who need mental health
services related to anxiety receive it
(“Understanding”)
 What Anxiety Might Look

Panic Excessive Worry

Symptoms include
Worry about
Rapid heartbeat
Safety
Sweating
School shooting concerns, concern
Chest pain
of resource officer
Dizziness
Social Interactions
Stomach Distress
Examinations

Avoidance Other
Avoidance of
Physical manifestations
Going to school
Headaches, chills, stomaches
Attending class
Inattention and lack of focus
Going home
Concentration difficulties
Lunch time
Disruptive behaviors
Tests
 Manifestations

Cognitive/Academic Behavioral
Restlessness
Excessive question-asking
Being easily startled
Inability to focus on current tasks
Inability to relax
Difficulty completing a task & transitions
Clingy behavior with family members

Health/Physical Social
Frequent stomachaches, headaches, or Difficulty building and maintaining
other physical conditions interpersonal relationships with peers and
Sleep problems faculty
Extreme tiredness (fatigue) Social isolation
Muscle aches or tension
Student Supports
 Tiered Interventions/Services
Designed to teach skills of feeling empathy, anger management tools,
stress management, problem-solving, goal setting, coping with anxiety,
Tier 1: and more.
Strong Kids 12-week program with 30-60 minute interventions.
Pre-k to 12th grade program.

A 12-week program, 90-minute lessons.

Integrates mindfulness and more.
Tier 2: Topics include differentiating +/- thoughts.
Topics are taught to create more awareness and mindfulness of thoughts,
MBCT-C feelings, and body sensations in the presence of anxiety and without
anxiety.

A 16-week program, 50-minute sessions.

Uses a workbook within the sessions.
Tier 3: Some bit of exposure to anxiety-inducing situations.
Teaches coping skills to utilize in anxious situations.
Coping Cat
 Other Supports
Counseling Services
1 on 1 Support
Tier 3 intervention
Referral to outside supports
Provide validation for student’s
feelings
Accomodations
504 Plan
Preferred seating
Access to decompression zone
Extended time on tests
Alternative testing area
Access to fidget resources/tools
Support staff resource when
needed
 What educators should
know about GAD
Ken Schuster, PsyD, says that anxiety “tends to lock up the brain,” making school hard for
anxious kids.
Anxious kids might ask many questions, including repetitive ones, because they are
worried and want reassurance.
This may cause students to be labeled as disruptive
Anxiety in children can cause aggression. They might attack another child or a teacher,
throw things or push over a desk because they feel out of control and may not know how
to regulate those feelings
Anxious kids will break eye contact, they might look down, they might start writing
something even though they’re not.
They’re trying to break the connection with the teacher to avoid what’s making them
feel anxious
sometimes kids get so anxious that they freeze. They might have been paying
attention to the lesson, and they might even know the answer, but when they’re
called on, their anxiety level becomes so heightened that they can’t respond.
Types of Support Schools Should Provide

Staff Development Class Curriculum

Incorporating breaks &
Training on activities to help relieve
anxiety disorders anxiety
Which symptoms Occasional outdoor
lessons
to look out for
Tier 1 lessons that help
How to support
students build coping skills
students and identify their reponses
to anxious situations
Individual Accomodations
Types of Support Schools Should Provide

School Environment Family Involvement

Establish a welcoming Share community

environment resources with families
Create safe spaces Provide info on anxiety
Open disorders and ways
classrooms/areas for parents can support
students to come their child at home
during lunch or breaks Communicate with
Implement a Check families for students
in/Check Out System receiving additional
Normalize anxiety support (IEPs & 504
plans)
 References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.).
https://doi.org/10.1176/appi.books.9780890425596

Generalized anxiety disorder (GAD). Boston Children's Hospital. (2022). Retrieved

September 20, 2023, from https://www.childrenshospital.org/conditions/generalized-anxiety-disorder-gad

Jarrett, M. A., Black, A. K., Rapport, H. F., Grills-Taquechel, A. E., & Ollendick, T. H. (2015). Generalized anxiety disorder in younger
and older children: Implications for learning and school functioning. Journal of Child and Family Studies, 24, 992-1003.

Merrell’s Strong Kids. (n.d.-b). https://strongkidsresources.com/

Munir, S., & Takov, V. (2023). Generalized Anxiety Disorder. National Library of Medicine . Retrieved September 20, 2023, from
https://www.ncbi.nlm.nih.gov/books/NBK441870/

Mychailyszyn, M. P., Beidas, R. S., Benjamin, C. L., Edmunds, J. M., Podell, J. L., Cohen, J. S., & Kendall, P. C. (2011). Assessing and
treating child anxiety in schools. Psychology in the Schools, 48(3), 223-232.

Oldham, C. R., & Loades, M. (2017). Disorder‐specific versus generic cognitive‐behavioral treatment of anxiety disorders in
children and young people: A systematic narrative review of evidence for the effectiveness of disorder‐specific CBT compared
with the disorder‐generic treatment, Coping Cat. Journal of Child and Adolescent Psychiatric Nursing, 30(1), 6–17.

Semple, R. J., & Lee, J. (2014). Mindfulness-based cognitive therapy for children. In R. A. Baer (Ed.), Mindfulness-based treatment
approaches: Clinician’s guide to evidence base and applications., 2nd ed. (pp. 161–188). Elsevier Academic Press.

Teacher’s Guide to Anxiety. Child Mind Institute. (2023b, February 23). https://childmind.org/guide/teachers-guide-to-anxiety-in-the-
classroom/
Handout