An aspect of the Center for
written by: Flora
I attest that the following
report is a product of my own original work.
discusses Generalized Anxiety
Disorder in school-aged children. The
contiguity between the adult and child disorder are discussed. Background information on the disorder,
including statistics and characteristics of the disorder, are provided. The purpose of this paper is to discuss the
psychological and pedagogical treatments and techniques that can be
order to keep this disorder under the control of the student who
it. Resources were compiled from
websites and journals of psychology.
Anxiety Disorder In the
always on edge,” “I can’t sleep at night, it’s as though as soon as my
hits the pillow, my brain just goes on overdrive,” “I dread being alone
night, “ “Will I ever be myself again?” “What if I don’t get the
promotion?” These questions, that is,
questions that are in the “what if” form, are the epitome of the
processes that plague the adult with Generalized Anxiety Disorder. The same chronic “what if” worrying is
in the mind of the child with Generalized Anxiety Disorder, only the
are more similar to “Will I pass this test?” “What
if I am not picked for kickball?” “What if
I am picked for kickball, but I mess up in
everyone?” “Will I freeze in front of my
class when it is my turn to present again?” Again,
the “what if’s?” are there, only the
questions and worries are
applicable to the child’s life.
Anxiety Disorder (GAD) is one of the six major classifications of
Disorder, which is the most common childhood disorder.
The other classifications include eating
disorder (anorexia and bulimia), obsessive-compulsive disorder, panic
phobia, and post-traumatic stress disorder. GAD
is characterized by an excessive and
overwhelming worry that is not
the result of any recent experience (Turnbull, Turnbull, Shank and
Considerable impairments in academic functioning, as well as familial
social functioning, are associated with pathological anxiety. Other characteristics that define the
disorder include difficulty to relax, stomachaches, headaches,
fear of failure. The most important
detail to keep in mind with GAD is that the characteristics are chronic
the control of the patient (Schlozman, 2002).
adolescent GAD was once referred to as “over-anxious disorder” and was
considered a childhood syndrome. The Diagnostic and Statistical Manual of Mental
Disorders (DSM-IV) indicated a clear continuity between the
of the childhood syndrome and those of the adult disorder.
The anxiety and/or worry in both adults and
children are self-referent, and rarely, if ever, are related to the
of others. Adult patients with GAD have
reported be “worriers” all their lives, and that the onset of the
developed mostly in adolescence. Very
few studies have been conducted upon anxiety in children and
though GAD is the most prevalent of the anxiety disorders to have an
the age of 18 (Leger, Ladouceur & Dugas 2003).
is one of the most commonly found disorders among people in the United
three to four percent of the population, most of which
are female (NMHA, 2004; Richards, 2004).
Not only does
the disorder have a dramatic impact on the general population, it has
devastating influence on our youth.
An estimated three to ten
percent of school-aged children suffer
from GAD (Manassis & Hood 2002). In
a study conducted by Dr. Peter Muris, et al, seventy percent
of children in the
study claimed to worry every now and then. The
sample was a nonclinical group of
children between the ages of eight
and thirteen (N=193). The study found
that just over six percent of
the children in the group met the DSM-III-R criteria
for GAD (Muris, Meesters, Mercklebach and
GAD can be
characterized by excessive physiologic symptoms and difficulty with
and cognitive processes (Gliatto, 2000). Those
who suffer from GAD are not only
inundated with worry and fear, but also with possible twitching,
headaches, and insomnia. Additionally,
people with GAD are overly irritable, frustrated, and have an inability
concentrate (Richards, 2004). These
symptoms have highly detrimental affects on the patient’s lifestyle. There is a high comorbidity rate for GAD in
both adults and children (Kendall, Brady, Verduin, 2001). In reference
school-aged children, school refusal symptoms are directly associated
GAD. School refusal symptoms include,
but are not limited to, the student’s lack of attendance, and can cause
emotional distress at the mere thought of going to school (King, Tonge,
& Heyne, 1999). Previous studies
have shown connections between environmental factors and childhood GAD. These environmental factors include prenatal
problems, developmental difficulties, family conflict, and psychosocial
adversities (Manassis and Hood, 1998).
pressures that a child is put under in a classroom setting are both
and varying. There are pressures to
succeed in the class itself, pressure to be successful on standardized
pressure to be able to accomplish a skill successfully – and even more
to be as successful as one’s peers. On
top of the pressures that are created from academics, there is also the
pressure to be socially successful. Being
picked last for kick ball or not being asked
to the Homecoming
dance can be extremely devastating to a student.
In addition to these pressures, there can
also be pressure that is applied from home. These
are issues that many children have to cope
with as students, and
to the majority of these students, life will continue (Richards, 2004). However, for the student with GAD, the
ability to cope is not nearly as strong as it is in those students
disorder. While these pressures to a
“normal” student may seem like a small weight on his or her shoulders,
pressures to a student with GAD can feel like a life or death situation.
terms of GAD and the classroom, the disorder and the setting are part
reciprocal relationship. GAD has
negative influences upon students in the classroom, just as the
often times the catalyst of anxiety for the student with GAD. Thus, the vicious cycle begins.
Students with GAD can often have
school-phobic behaviors. Either academic
or social situations, or both can cause these phobias. However,
cognitive-behavioral treatments have been proven successful in the
of school-phobic behaviors (Deluty and DeVitus, 1996).
reinforcement is one of the many cognitive-behavioral treatments that
successful in curbing the reactions to worrying situations. This occurs when an event that follows a
response increases the probability that the response will reoccur. Cognitive reinforcement is frequently a
treatment used in coalition with other treatments, such as relaxation
training. Relaxation training is a
technique that involves
the mind and body. The student learns to
relax different major muscle groups through a variety of
exercises. This is a progressive
treatment that helps the student to gain control over his or her body
his or her mind to concentrate on the specific muscle groups. Through exercising the different muscle
groups the student learns to identify sensations of tension, and
these sensations as stimuli to relax (Deluty and DeVitus, 1996). This treatment puts the student in a
situation where he or she is in control and concentrating.
The feeling of being in control and the
ability to concentrate are foreign skills to the student with GAD,
making the successful completion of this treatment positive on many
utilization of outside specialists who do not work directly with the
can also be helpful to the GAD-classroom relationship.
Traditionally, with GAD a mental health
specialist will work with the school staff as opposed to the student. This method is more to the benefit of the
staff in the sense that they are gaining more information directly from
specialist as to how they can better the classroom environment. The specialists suggest appropriate treatment
regimens, make referrals as necessary, and show the teachers how to
clinical techniques into classroom management techniques (Schlozman,
with many other disorders that impact student learning, medication is a
possible route for treatment. Positive
correlations between the use of antidepressants for the treatment of
been made. There were more side effects
than there were with a placebo, but not to the extent that treatment
had to be
cancelled. Antidepressants have only been proven to be successful on a
basis (Flynn and Chen, 2003). One fact to keep in mind with any drug
that the side effects are unique to the user. Antidepressants
can be helpful for some, but they
may be unhelpful to
others. Side effects of the drugs have
the ability to cause even more problems in the classroom.
The student may become physically ill because
of the drug, and therefore cause the student to miss class more often
before. These results can also lead the
student to be apprehensive towards other forms of treatment, possibly
causing treatment to be yet another stimulus of anxiety.
However, the use of medication can be
beneficial, especially at the beginning of treatment, but a pill alone
the cure-all for GAD.
Issues Related to the Classroom
Just as there are
treatment options available outside of the classroom for GAD, there are
in-classroom treatments that can be conducted by the teacher with
without the assistance of a psychological professional.
Teachers can begin by utilizing a stress
intervention model. First, the teacher
appraises the situation by identifying the stimuli that cause the
fear in the student. Is it taking a test? Is it public speaking? Is
it reading aloud? The stimuli are
identified best through
documented observations conducted by the teacher and/or instructional
assistant. Second, an assessment of the
student reaction to the stimuli is conducted. This
assessment measures the level of stress or fear
that is caused by
the identified stimuli. Next, a
background check on the student’s psychological status is made. Looking at notes that were made by previous
teachers, or inquiring about the child’s family history can complete
task. A decision is then made as to
whether or not intervention is necessary, and this can be a very grey
times. In general, intervention should
be considered when there is a significant change in student behavior,
behavior is either extremely severe or minimal in relation to the
response. If intervention is decided
upon, the teacher monitors the concrete behaviors of the student and
the intervention has upon him or her (Deluty and DeVitus, 1996).
restructuring is another cognitive-behavioral treatment that can also
implemented by the classroom teacher. This
treatment involves the reduction or removal, if
possible, of any
misinterpretation of environmental events. The
student needs to feel safe and comfortable in
therefore the student needs to know that he or she does not need to
his or her peers making fun of him or her. A
positive classroom environment must be established.
The teacher needs to challenge faulty logic
and irrational self-statements that the student makes.
Students with GAD suffer from extreme
self-doubt, and this will come through in the comments he or she makes. In this situation it is impertinent that the
teacher replace such comments with statements that will build up the
as opposed to shut him or her down. It
is also very important that the teacher not go overboard in this
well, for this can cause the student to feel on the spot, thus causing
anxiety. Finally, the teacher
progressively constructs a frame of reference with coping strategies
student. The ability to cope with situations that may seem “everyday”
is highly challenging for the student with GAD, the construction of
coping skills will improve the student’s ability (Deluty and DeVitus,
Similar to how
coping strategies need to be developed in the student with GAD, so do
problem-solving strategies. This is
where problem-solving training comes into play. The
teacher helps the student to establish a
sequence. First, the student must learn
to prepare for the solution of the problem. Instead
of becoming overwhelmed with worry when a
problem should arise,
the student must see that every problem has a solution, and that he or
she can in fact find that solution.
Once the student is prepared, he or she will
then define the problem and the possible goals of the solution. An important factor in this step is that the
goals that are defined must be attainable. The student creates alternative solutions,
and then the decision making process occurs. Once
the decision is made, it is implemented. The
student must finally verify the success
of the decision, and this can be done with the help of a teacher or
peer. This treatment may feel unnatural
possibly excessive at first, but this process will eventually become
to the student (Deluty and DeVitus, 1996).
Any decent teacher
knows that it is one of their greatest responsibilities to show a good
to their students. This is important in
the success of cognitive-behavioral treatment called “modeling”. Modeling is a teaching technique that is
naturally utilized by many teachers, hence, teaching by example. In the case of modeling as treatment for a
student with GAD, the teacher models non-fearful responses in fearful
situations. This is accomplished by
adaptive responses to stimuli that cause fear. Instead
of tensing up, freezing, worrying, or shying
away from an
experience that causes anxiety, find a way to cope with those feelings
the situation head on. Construction of
skills or references as to what to do in a certain situation will help
student to react more calmly to situations that otherwise would make
him or her
anxious. Appropriate behaviors are
eventually acquired, and fears are reduced (Deluty and DeVitus, 1996).
student with GAD sees that these situations occur for others,
teacher, and that others find ways to cope with these situations, this
ease the process of being able to cope. Adversely,
if the teacher demonstrates that when he
or she is put into a
stressful or fearful situation that the way to handle it is to tense up
away, what kind of example will this provide for the student? Not that the “do as I say, not as I do”
approach is ever appropriate for teaching, but especially in the case
student with GAD. This student needs
concrete evidence that if coping and problem-solving techniques are
reaction to a stressful situation, he or she will make it through that
situation with success.
treatment option coincides with imaginary and “in vivo” exposure. This technique exposes the student to his or
her fears. The student is placed in a
fear-inducing situation until he or she acclimatizes.
Fear-reduction occurs when the student can
discriminate between the stimuli that cause stress, and the stimuli
not. (Deluty and DeVitus, 1996) The student must face his or her fears in
order to overcome them. Through
modeling, the student can see that coping and problem-solving skills
can be used
to help dissolve these fears.
Anxiety Disorder is a disorder that can be
severely harmful to their academic and social
functioning of a child or adult. However,
many disorders, early
detection and treatment can
keep the symptoms under control. In
reference to GAD in the classroom, the
student with GAD can
be helped through a combination of professional
pedagogical treatments. The goal of the
treatments is to get the student in control. When
the student is out of control, academic,
dysfunction become highly probable. Intensive
behavioral treatments have been proven to
in the treatment of Generalized Anxiety Disorder.
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disorders: generalized anxiety disorder. http://www.nmha.org/infoctr/factsheets/31.cfm
Richards, T. A. 2004. What
is generalized anxiety disorder? http://www.anxietynetwork.com/gawhat.html
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