ADDRESSING ANXIETY IN

INDIVIDUALS WITH

DEVELOPMENTAL DISABILITIES

JULIE T. STECK, PH.D., HSPP

CRG/CHILDREN’S RESOURCE GROUP

WHAT IS YOUR PRIMARY ROLE IN

ATTENDING THIS WEBINAR?

As a result of attending this presentation,

attendees will:

Identify three common behaviors or symptoms of anxiety in those with DD

List three strategies for lessening anxiety in those with DD

Recognize approaches for treatment of anxiety in individuals with DD

WHAT IS ANXIETY?

Excessive worry

Irrational fear

Discomfort with others looking at us

Stomachaches and bowel problems

Other physical symptoms of stress

Perfectionism

Panic

Compulsive/repetitive behaviors

WHAT IS ANXIETY?

HOW COMMON ARE ANXIETY DISORDERS?

25% of adolescents between 13 and 18 will have

an anxiety disorder

5.9% of adolescents will have a server anxiety

disorder

30% of females versus 20% of males will have an

anxiety disorder during adolescence

About 18% of adults have anxiety in any given

year

DEVELOPMENTAL DISORDERS AND

ANXIETY: WHO IS AT RISK?

Autism Spectrum Disorders

Intellectual Disabilities

Blindness/Low Vision

Deafness/Hard of Hearing

Cerebral Palsy, Seizure Disorders and other Neurological Conditions

Learning Disorders

ADHD

WHAT IS RESEARCH TELLING US?

Those with DD are at higher risk for mental health disorders (including anxiety) than the normal population

Those with DD are likely to meet criteria for a mental health disorder for a longer period of time than the normal population

Those with DD are less likely to get treatment for mental health disorders than the normal population

HOW IS ANXIETY DEMONSTRATED IN

THOSE WITH DD THAT YOU KNOW?

WE USED TO THINK IN BOXES:

WHAT IS IT?

ASD (ASPERGER’S)

ANXIETY

ADHD

NOW WE THINK IN VENN DIAGRAMS

ASD

ANXIETYADHD

RELATIONSHIP BETWEEN SCHOOL,

FAMILY AND MENTAL HEALTH

FAMILY

SCHOOLMENTAL

HEALTH

RELATIONSHIP BETWEEN SCHOOL,

FAMILY AND MENTAL HEALTH

FAMILY

SCHOOLMENTAL

HEALTH

NORMAL CURVE FOR ANXIETY

NORMAL CURVE FOR THOSE WITH DD

CASE STUDY--BEN

7 year old male

Parents divorced, both very involved and he is

only child

Eligible for special education as student with SLD in

reading

Diagnosed with anxiety, depression, ADHD and

dyslexia (SLD)

Hates school and feels that teachers and other

students don’t like him

ANXIETY LOOKS LIKE

Talking to self in class

Withdrawn and distracted

Lost in school environment

Playing alone at recess

Difficulty getting started in the morning

Confused at end of day

Making little progress in reading

SMALL CHANGES MAKE A BIG DIFFERENCE

Ben would get confused and lost in morning routine—resource teacher assisted in making a checklist

Ben did not know who to play with at recess—teacher helped identify groups/friends

Ben worried about which parent would pick him up—a schedule was made by parents and used at school

CASE STUDY--ABBY12 year old female with ASD and low average ability

Abby has two siblings near her age

Parents are divorced and both are actively involved

in her care

Abby and her siblings spend equal time with each

parent changing homes every 3 to 4 days

Abby is fully included in general education but

struggles with completing work and following

classroom instruction

She has few friends and feels that others don’t like

her

WHAT DOES ANXIETY LOOK LIKE IN ABBY?

Pacing

Talking to herself

Feeling/stating that others are against her

Stomachaches during school day

Struggles with attention in class and completing

work

Doesn’t start work

Sits alone during recess

WHAT ARE SOME STRATEGIES THAT

MIGHT HELP DECREASE ABBY’S

ANXIETY?

DEVON—22 YEAR OLD MALE

Lives at home with parents and a high school sibling

Completed college with a great deal of family effort

Has few friends

Despite college diploma, has not been able to hold

a job

Recently diagnosed with ASD

Stays up late at night and sleeps late in morning

Does not readily shower, shave or change clothes

WHAT DOES ANXIETY LOOK LIKE IN DEVON?

Very stubborn about trying new things

Does not ask for help and resists advice

Prefers to do things on his computer to interact

with others

Blames others on things not working out

Avoids the social aspects of a situation

Does not initiate contact with others or make

calls, send e-mails

WHAT WOULD NOT BE HELPFUL TO

DEVON?

TREATMENT OF ANXIETY IN THOSE

WITH DDAppropriate diagnosis of primary and secondary

conditions

Parent/caregiver and teacher education about the conditions and related conditions

Adjustment of expectations and environment to meet the individual’s needs

TREATMENT OF ANXIETY IN THOSE WITH DD

Establishing realistic expectations

Individual and family therapy

Adapting the environments (school, home,

community) to meet the individual’s needs

Consideration of medication

ADULT/CAREGIVER ROLES

“Downshift” and keep emotions calm

Assume the role of “frontal lobe”

Problem solve

Implement solutions

IN GENERAL . . .

Decrease expectations

Decrease stimuli—including less talk

Increase support

Provide more clear visual input

Provide an option to let the individual get out of situation with dignity

TOO MUCH . . . TOO FAST

Allow more time for daily routines and

transitions

Talk less

Minimize transitions

Provide visual prompts and schedules

Decrease stimulation and stress

Find alternative ways to include but not to

over-stress

A DIFFERENT PERSPECTIVE

Recognize that the individual’s needs and perspectives are not the same as your own

Try to establish a routine that is fulfilling to the individual but not overstimulating

Make sure that the individual (as well as the caregiver) is getting enough sleep, nutrition and exercise

RECOMMENDED READINGS

Hallowell, E. (1999). When You Worry About the Child You Love:

Emotional and Learning Problems in Children. DIANE Publishing

Co.

Greene, R. The Explosive Child. Harper-Collins. 1998.

Koplewicz, H.S. It’s Nobody’s Fault: New Hope and Help for

Difficult Children.

Kutscher, M.L. Kids in the Syndrome Mix of ADHD, LD, Asperger’s,

Tourette’s, Bipolar and More! Jessica Kingsley Publishers, 2005.

RECOMMENDED READINGS

Ratey, J. (2002). A Users Guide to the Brain. Vintage Books.

Attwood, T. (2008). The Complete Guide to Asperger’s Disorder.

Jessica Kinglsey Publishers.

Boyd, B. (2003). Parenting a Child with Asperger Syndrome.

Jessica Kingsley Publishers.

Harpur, J., Lawlor, M., & Fitzgerald, M. (2004). Succeeding in

College with Asperger’s Syndrome. Jessica Kingsley Publishers.

Tsai, L. Taking the Mystery Out of Medications in Autism/Asperger

Syndromes. Future Horizons, 2001.

RECOMMENDED READINGS

Miles, B.S. & Southwick, J. Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums, Rage, and Meltdowns. Autism Asperger Publishing Co. (www.asperger.net), 2005.

Quinn, B. & Malone, A. (2000). Pervasive Developmental Disorder: An Altered Perspective. Jessica Kingsley Publishers.

Waltz, M. (1999). Pervasive Developmental Disorders: Finding a Diagnosis and Getting Help. O’Reilly.

Welton, J. (2004). Can I Tell You About Asperger Syndrome: A Guide for Friends and Family. Jessica Kingsley Publishers.

Siegel, B. The World of the Autistic Child. New York: Oxford Press.

RECOMMENDED READINGS

Diagnosing Learning Disorders: A Neuropsychological Framework. Bruce F. Pennington. Guilford Press. 2nd Edition, 2008.

Overcoming Dyslexia. Sally Shaywitz. Random House, 2003.

Nonverbal Learning Disabilities at School. Sue Thompson & Pamela Tanguay. Jessica Kingsley Publishers, 2002.

The Source for Nonverbal Learning Disorders. LinguiSystems. 1-800-776-4332. http://www.linguisystems.com

Straight Talk About Psychiatric Medications for Kids. Timothy Wilens. Guilford Press, 2008.

WEBSITES AND ARTICLES

Autism Society of America http://www.autismsociety.org/site/PageServer

American Psychological Association www.apa.org

The National Autism Center ‘s Evidence-Based Practice and Autism in

the Schools

http://www.nationalautismcenter.org/pdf/NAC%20Ed%20Manual_FINAL.

pdf

Evidence-Based Comprehensive Treatments for Early Autism. Rogers, S.J. & Vismara, L.A. J Clin Child Adolesc Psychol. 2008 January; 37(1): 8–

38.

http://www.ncb i.nlm.nih.gov/pmc/articles/PMC2943764/

WEBSITES AND ARTICLES

Children and Adults with Attention Deficit Hyperactivity Disorder www.chadd.org

Living in Fear: Anxiety in Adolescents with Autism Spectrum Disorder. Bellini, S. http://www.iidc.indiana.edu/index.php?pageId=481

Anxiety and Panic Struggles. Davis, K. http://www.iidc.indiana.edu/index.php?pageId=3553

What About the Mental Health of Kids with Intellectual Disability? http://m.medicalxpress.com/news/2014-11-mental-health-kids-intellectual-disability.html#&ui-state=dialog

THANK YOU FOR ATTENDING!!

Julie T. Steck, Ph.D., HSPP

CRG/Children’s Resource Group

9106 North Meridian St., Suite 100

Indianapolis, IN 46260

317-575-9111 fax 317-571-4470

www.childrensresourcegroup.com