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ADDRESSING ANXIETY IN
INDIVIDUALS WITH
DEVELOPMENTAL DISABILITIES
JULIE T. STECK, PH.D., HSPP
CRG/CHILDREN’S RESOURCE GROUP
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WHAT IS YOUR PRIMARY ROLE IN
ATTENDING THIS WEBINAR?
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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
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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
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WHAT IS ANXIETY?
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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
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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
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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
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HOW IS ANXIETY DEMONSTRATED IN
THOSE WITH DD THAT YOU KNOW?
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WE USED TO THINK IN BOXES:
WHAT IS IT?
ASD (ASPERGER’S)
ANXIETY
ADHD
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NOW WE THINK IN VENN DIAGRAMS
ASD
ANXIETYADHD
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RELATIONSHIP BETWEEN SCHOOL,
FAMILY AND MENTAL HEALTH
FAMILY
SCHOOLMENTAL
HEALTH
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RELATIONSHIP BETWEEN SCHOOL,
FAMILY AND MENTAL HEALTH
FAMILY
SCHOOLMENTAL
HEALTH
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NORMAL CURVE FOR ANXIETY
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NORMAL CURVE FOR THOSE WITH DD
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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
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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
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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
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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
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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
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WHAT ARE SOME STRATEGIES THAT
MIGHT HELP DECREASE ABBY’S
ANXIETY?
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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
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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
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WHAT WOULD NOT BE HELPFUL TO
DEVON?
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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
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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
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ADULT/CAREGIVER ROLES
“Downshift” and keep emotions calm
Assume the role of “frontal lobe”
Problem solve
Implement solutions
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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
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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
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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
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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.
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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.
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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.
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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.
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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.
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/
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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
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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