What is anxiety?



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Information Sheet – Anxiety


What is anxiety?
All students feel anxious at times. Many young students, for example, show great distress when separated from their parents. Young students are often frightened of strangers, thunderstorms, or the dark. These are normal and usually short-lived anxieties. But some students suffer from anxieties severe enough to interfere with the daily activities of childhood or adolescence.

Anxious students may lose friends and be left out of social activities. They often experience academic failure and low self-esteem. Because many students with this disorder are quiet and compliant, the signs are often missed. Teachers and parents should be aware of the signs of a possible anxiety disorder so that appropriate referrals can be made.

Signs of anxiety may present differently in children and adolescents than in adults. Common signs can include:


  • Excessive and persistent worry

  • Restlessness and irritability

  • Crying or losing temper easily or frequently

  • Avoidance and procrastination

  • Disruption to sleep and eating patterns

  • Decline in academic performance

  • Truancy and school refusal

  • Increased use of alcohol or other drugs

  • Withdrawal from social, class or school activities

  • Tiredness and fatigue

 

There are several types of anxiety disorders.  The list below describes those most common to children.



Generalized Anxiety Disorder —Children with generalized anxiety disorder (GAD) have recurring fears and worries that they find difficult to control.  They worry about almost everything—school, sports, being on time, even natural disasters.  They may be restless, irritable, tense, or easily tired, and they may have trouble concentrating or sleeping.  Students with GAD are usually eager to please others and may be “perfectionists”, dissatisfied with their own less-than-perfect performance.

Separation Anxiety Disorder —Students with separation anxiety disorder have intense anxiety about being away from home or caregivers that affects their ability to function socially and in school.  These students may have a great need to stay at home or be close to their parents.  Students with this disorder may worry excessively about their parents when they are apart from them.  When they are together, the student may cling to parents, refuse to go to school, or be afraid to sleep alone.  Repeated nightmares about separation and physical symptoms such as stomach-aches and headaches are also common in students with separation anxiety disorder.

Social Phobia —Social phobia usually emerges in the mid-teens and typically does not affect young students.  Adolescents with this disorder have a constant fear of social or performance situations such as speaking in class or eating in public.  This fear is often accompanied by physical symptoms such as sweating, blushing, heart palpitations, shortness of breath, or muscle tenseness.  Adolescents with this disorder typically respond to these feelings by avoiding the feared situation.  For example, they may stay home from school or avoid parties.  Young people with social phobia are often overly sensitive to criticism, have trouble being assertive, and suffer from low self-esteem.  Social phobia can be limited to specific situations, so the adolescent may fear dating and recreational events but be confident in academic and work situations.

Obsessive-compulsive Disorder —Obsessive-compulsive disorder (OCD) typically begins in early childhood or adolescence.  Children with OCD have frequent and uncontrollable thoughts (called “obsessions”) and may perform routines or rituals (called “compulsions”) in an attempt to eliminate the thoughts.  Those with the disorder often repeat behaviours to avoid some imagined consequence.  For example, a compulsion common to people with OCD is excessive hand washing due to a fear of germs.  Other common compulsions include counting, repeating words silently, and rechecking completed tasks.  In the case of OCD, these obsessions and compulsions take up so much time that they interfere with daily living and cause a young person a great deal of anxiety.

Please note that the purpose of the information above is NOT to classify children according to a particular disorder. Rather this section simply aims to provide background information on Anxiety.
Post Traumatic Stress Disorder
Post-Traumatic Stress Disorder (PTSD) refers to an ongoing reaction to trauma, and is commonly associated with reactions to experiences of war. However, PTSD is more common in children than frequently thought. The trauma may have occurred in an isolated event (e.g. the child being in a car accident) or through ongoing events (e.g. ongoing child abuse). 

Children and young people who are experiencing PTSD may be experiencing:



  • Intense fear, helplessness or horror

  • Agitation or disorganisation

  • Inability to complete age-appropriate tasks

  • Flashbacks (using any of the senses)

  • Avoidance of trauma-related objects or activities

  • Hyper-attentiveness, or an increase in alertness, with decreased attention-focusing ability

Students with PTSD are often confused with students with Attention Deficit Hyperactivity Disorder (ADHD) because of their difficulty concentrating and seemingly unpredictable behaviour.  It is important to note that the experiences of PTSD can occur immediately following trauma, or the child may have a delayed reaction, and not have these experiences until many months after the trauma, or even a year after. It often appears that children delay their reaction until their parents or other adults have regained their composure and appear strong enough to help the child cope with their own reaction.   

Educational Implications
Because students with anxiety disorders are easily frustrated, they may have difficulty completing their work. They may worry so much about getting everything right that they take much longer to finish than other students. Or they may simply refuse to begin out of fear that they won’t be able to do anything properly. Their fears of being embarrassed, humiliated, or failing may result in school avoidance. Getting behind in their work due to numerous absences often creates a cycle of fear of failure, increased anxiety, and avoidance, which leads to more absences.

Students experiencing PTSD may have difficulty concentrating on work, as they are focused on the traumatic event and ensuring that they can avoid it in the future. Students may also be distracted frequently by reminders of the trauma triggering ‘flashbacks’, leading to an inability to complete work. Students’ reactions may be out of context given the current situation as they react to their perception of events, or reminders of past events. Reminders may come from any of the senses, and may seem innocuous to others (e.g. a smell of a vehicle, the rustle of leaves, the touch of a friend, or the use of a certain word). Emotional reactions may take the form of fear, horror, anger or hopelessness, without an obvious trigger. 

Younger students are not likely to identify anxious feelings, which may make it difficult for educators to fully understand the reason behind poor school performance.

Tell tale signs may include:



  • Excessive absence, school refusal, truancy or illness related to the anxiety

  • Anxiety or fear about particular school activities (would vary according to the type and level of anxiety)

  • Difficulty keeping scheduled appointments (secondary students)

  • Difficulty beginning or completing activities or assessments

  • Inability to think and act (high anxiety can paralyse these functions)

  • Physical responses such as becoming ill or highly agitated

  • Physical responses that inhibit learning (material is not absorbed and/or the material is not recalled)

  • Responding to perceived stressful situations with either anger, aggression or withdrawal

  • Difficulty participating fully in curriculum activities due to fatigue from being hyper-aware of their surroundings. It is important to remember that emotional energy can be as draining as physical exertion. 



Possible Educational Adjustments
Educational adjustments are designed to meet individual student needs on a case-by-case basis. Possible adjustments include:

 

Adolescence



  • Preferential seating

  • Pre-arranged breaks

  • Exit plan - permitting students to leave the classroom if anxiety becomes unmanageable (with a pre-arranged safe place in the school, where they will be supervised by an adult)

  • Work with the parents/carers and the clinical care provider to understand how the disorder manifests for this student.

  • Clear behaviour management plans

  • Providing explicit guidelines for assignments

  • Identifying any changes to routine well in advance

  • Exemption or alternative arrangements (refer to QSA Policy on Special Consideration)

  • Recognising small achievements using positive reinforcement, communication strategies and feedback

  • Extended time for tests and exams

  • Use of memory aids during exams




  • Alternative evaluation/assessment procedures (e.g. substitute assessment- many students experience anxiety with oral presentations; provision of alternative formats to demonstrate knowledge e.g. narrative tape instead of written journal, oral presentation to the teacher and a few close friends rather than the whole class)

  • Reduced subject load

  • Negotiated attendance

  • Programs with strategies tailored to manage anxiety e.g. RAP - Resourceful Adolescent Program

  • Access to external agency support (Child and Youth Mental Health Services)

  • Regular access to a guidance officer or school based youth health nurse.

 

Early and Middle Childhood

  • Identifying high risk activities and times, and developing strategies accordingly e.g. handover or transition at the beginning of the day

  • Work with the parents/carers and the clinical care provider to understand how the disorder manifests for this student.

  • Develop strategies to reinforce attendance at school, e.g. providing preferred activities on arrival and a reward schedule

  • Desensitising strategies to focus on anxiety related behaviours e.g. remaining in class

  • Modifying curriculum where necessary by shortening task lengths, alternatives to oral presentations or other assessments which may cause anxiety

  • Recognising small achievements (initially may require recognising very small achievements, such as writing the date or a name at the top of the page, saying hello to someone on arrival at school, or even the fact that the student arrived at school in the first place.)

  • Scaffolding, setting limits of work, particularly around any subjects or topics that cause extreme anxiety

  • Conducting a Functional Behavioural Assessment (FBA) to identify triggers/antecedents, as well as maintaining consequences to anxiety and developing strategies to manage resulting behaviour (safe corner in room to go to, chill out space)

  • Exit plan (chill-out card)

  • Providing structured time-out

  • Assigning buddies to support unstructured time such as lunch breaks

  • Structured classroom routine with preferred activities on arrival

  • Reward schedules

  • Explicit teaching of stress management skills such as relaxation and problem solving skills

  • Programs with strategies tailored to manage anxiety e.g. FRIENDS Program

  • Access to external agency support (Child and Youth Mental Health Services)

  • Regular access to a guidance officer or school based youth health nurse


___________________________________________________________

Student Services, Department of Education, Training and the Arts


Material contained in this publication is of a general nature only and it is not, nor is it intended, to be opinion or advice on any specific medical condition.



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