Anxiety
Most Americans Don’t Know The True Danger Of Anxiety 9/1/15
Anxiety
Disorders Anxiety is a normal reaction to stress and can be beneficial in some situations. It can alert us to dangers and help us prepare and pay attention. Anxiety disorders differ from normal feelings of nervousness or anxiousness, and involve excessive fear or anxiety. Anxiety disorders are the most common of mental disorders and affect nearly 30% of adults at some point in their lives. But anxiety disorders are treatable and a number of effective treatments are available. Treatment helps most people lead normal productive lives. How Common Are Anxiety Disorders? In any given year the estimated percent of U.S. adults with various anxiety disorders are: 7-9%: Specific Phobia Women are more likely than men to experience anxiety disorders. Anxiety refers to anticipation of a future concern and is more associated with muscle tension and avoidance behavior. Fear is an emotional response to an immediate threat and is more associated with a fight or flight reaction – either staying to fight or leaving to escape danger. Anxiety disorders can cause people to try to avoid situations that trigger or worsen their symptoms. Job performance, school work and personal relationships can be affected. In general, for a person to be diagnosed with an anxiety disorder, the fear or anxiety must:
There are several types of anxiety disorders, including generalized anxiety disorder, panic disorder, specific phobias, agoraphobia, social anxiety disorder and separation anxiety disorder. Types of Anxiety Disorders
Risk Factors The causes of anxiety disorders are currently unknown but likely involve a combination of factors including genetic, environmental, psychological and developmental. Anxiety disorders can run in families, suggesting that a combination of genes and environmental stresses can produce the disorders. Diagnosis and Treatment The first step is to see your doctor to make sure there is no physical problem causing the symptoms. If an anxiety disorder is diagnosed, a mental health professional can work with you on the best treatment. Unfortunately, many people with anxiety disorders don’t seek help. They don’t realize that they have an illness that has effective treatments. Although each anxiety disorder has unique characteristics, most respond well to two types of treatment: psychotherapy, or “talk therapy,” and medications. These treatments can be given alone or in combination. Cognitive behavior therapy (CBT), a type of talk therapy, can help a person learn a different way of thinking, reacting and behaving to help feel less anxious. Medications will not cure anxiety disorders, but can give significant relief from symptoms. The most commonly used medications are anti-anxiety medications (generally prescribed only for a short period of time) and antidepressants. Beta-blockers, used for heart conditions, are sometimes used to control physical symptoms of anxiety. Self-Help, Coping, and Managing There are a number of things people do to help cope with symptoms of anxiety disorders and make treatment more effective. Stress management techniques and meditation can be helpful. Support groups (in-person or online) can provide an opportunity to share experiences and coping strategies. Learning more about the specifics of a disorder and helping family and friends to understand better can also be helpful. Avoid caffeine, which can worsen symptoms, and check with your doctor about any medications. Related Conditions
Source: projectsemicolon.com/anxiety-disorders
Seeking
The Best Treatment For Anxiety Without Medication -
Updated July 13, 2020 Therapy As Primary Form Of Treatment There are many forms of therapy that psychologists utilize to help patients through anxiety disorders. A common and successful way of treatment is Cognitive Behavior Therapy. This is a kind of therapy that teaches anxiety disorder patients how what they think makes an impact on their anxiety. The therapist’s aim is to help the individual change their way of thinking, thus decreasing anxiety and its symptoms. How does this happen? Many patients that have an anxiety disorder attend CBT sessions over a period of several months. Sessions are often catered to the needs and personal experiences of the patient. These sessions are commonly just an hour a week for less than a year. By the time Cognitive Behavior Therapy has been completed, individuals tend to feel far less anxious and prepared to handle the cause of their anxieties. If you are hesitant about seeking help from a mental health professional for CBT, it’s understandable. This is especially true if you feel anxious about leaving your home or if you must use public transportation to get to the psychologist’s office. However, studies have shown that CBT conducted over the telephone is feasible and successful. Without the need for medication, a mental health professional can treat anxiety over the phone, in an online chat, or even by email. Given the various anxiety disorders that exist, having the option to be treated from the comfort of your own home can be beneficial. With this particular kind of therapy, being home can be easier because it is more than talking freely about whatever is on your mind. Instead, CBT requires addressing the causes of anxiety and setting specific goals to move past them. It can be easier for patients to do so when they are in a familiar and comfortable environment. Because of the existence of such goals, a therapist will likely ask the patient how they feel in regard to the process. It’s imperative that the therapy work over the short time it lasts. Without the addition of medication, patients also often have tasks to complete outside of sessions. These tasks might be keeping a journal of specific times anxiety set in. It could also involve facing a cause of anxiety. Treating anxiety requires the patient to put in a lot of work, but making a real attempt at healing can change their life. Alternative Ways To Treat Anxiety When you want to avoid the use of medication to treat anxiety, there are a number of natural ways to do so. Aside from therapy or counseling, people that suffer from an anxiety disorder can find a way that might work best for them. While these natural treatment options have proven to be helpful, it is typically best to consult a mental health professional to ensure the best treatment is being utilized.
Choosing The Best Treatment Option For You With so many alternatives to medication for treating anxiety, it can be hard to decide which to choose. Ultimately, the decision is between you and your health care provider. With a generalized anxiety disorder, your therapist might recommend therapy in addition to a number of alternative suggestions. With minor anxiety, you might attempt to exercise more. Whatever you decide, it is essential that you truly put forth the effort to get through the anxiety. It can get worse if proper treatment is not sought out. In many cases, proper treatment starts with Cognitive Behavior Therapy. If you don’t have a therapist, finding an online mental health professional might be an excellent option to seek out. It can be faster than finding someone local to fit you in, more convenient, and more comfortable. Trusted online counselors and therapists are modern forms of treatment that have proven to be helpful with various mental health disorders. Seeking out help is brave. Perhaps the
idea itself gives you anxiety. However, if you feel as
though you require a bit of help to get through your
anxiety, please do not hesitate to reach out to a counselor
or medical professional for assistance. Taking the first
step is often the start of healing. You may find that your
anxiety can be decreased more than you ever thought
possible. The Definition Of
Anxiety For Various Types Of People - Updated July 07,
2020 While one individual might define anxiety as the inability to leave their home, another may avoid motor vehicles. Someone with anxiety might be terrified of enclosed spaces while someone else has panic attacks in an open space. Anxiety disorders do not always present in the same ways for everyone. Defining what anxiety might look like various types of people might help you to understand that you don’t have to dismiss your anxiety because it doesn’t match up to your neighbor’s. You can seek counseling and receive successful treatment for your anxiety disorder even when it doesn’t sound like someone else’s anxiety. Statistics And Demographics Of Anxiety Patients Forty million adults in the United States are affected by anxiety disorders each year. That’s more than 18% of the nation’s population. Unfortunately, less than half of those people get treatment. Of those 40 million adults, nearly 7 million suffer from generalized anxiety disorder, 6 million have panic disorder, and social anxiety disorder has numbers above 15 million. Phobias add another 19 million to the total, and OCD totals more than 2 million. If you’re a math person, you know that those numbers reach far more than 40 million – meaning that numerous people suffer from more than one kind of anxiety disorder. The demographics related to these numbers might surprise you. What’s the difference between women and men with anxiety disorders? Why do some children develop anxiety while others don’t experience it until adulthood? What jobs cause anxiety disorders? Understanding the answers to these questions and a variety of risk factors may help you to grasp how anxiety affects different people. Women And Men Women are more likely to develop an anxiety disorder than men. This statement is specific to the types of anxiety, but the majority of anxiety cases are women. For example, a woman is twice as likely to have a generalized anxiety disorder as a man. The same goes for panic disorder and phobias. Women are also more likely to develop PTSD, but in the case of rape, male victims are more likely than their female counterparts to develop the disorder. Several anxiety disorders are common among both men and women equally. Included in this group are social anxiety and obsessive-compulsive disorder. Other similarities between males and females with anxiety disorders are that both groups tend to have hospital and doctor visits than those without anxiety disorders. On the opposite side of things, women with anxiety tend to miss more work than men with the same conditions. Studies also show that women with anxiety have little relation to getting help with substance abuse – women without anxiety have the same numbers in this type of counseling. Men with anxiety, however, tend to go to substance abuse counseling for more than a man without anxiety. With this information, you may conclude that although women with anxiety are more prevalent, men also experience anxiety disorders. Some components are harder for men and some that are harder for women. Many of the differences can be explained with logic. For example, men traditionally feel the need to provide for their families. Despite their anxiety, men still force themselves to go to work so that they can continue to do that. Both men and women with anxiety may benefit from seeking help in the form of a counselor or therapist. There is treatment available for every type of person. Some may prefer an in-office, face to face visit. Others may prefer to do an online messaging kind of therapy. Treatment should not be avoided because it might be uncomfortable. Find the best option for you and try out a session, to begin with. Men and women alike may be surprised to find the type of treatment that works best for them. Teens And Children A quarter of teens from the age of 13 to 18 are affected by anxiety disorders. Perhaps the most commonly thought of anxiety disorder for children is separation anxiety. Many kids feel this as a toddler when mom or dad goes to work, when left at daycare, or when put in their room. This kind of separation anxiety is normal, and children tend to grow out of it. However, when older kids still feel this way, they may have a separation anxiety disorder. 4% of kids have this anxiety disorder. An anxiety disorder that is prevalent in teens is social anxiety. With the pressures of school and making friends, some teens develop social anxiety. This is a disorder in which the person is extremely fearful of being embarrassed or judged. The fear can be so much that the individual doesn’t want to attend school, make friends, or spend time in the presence of their peers. Social anxiety disorder is present in more than 9% of teens. Children and teens can also have GAD, panic disorder, OCD, phobias, selective mutism, and PTSD. Counseling is a common treatment for these concerns, but the sessions are typically altered to fit the age of the patient. For example, a 5-year-old may talk as they draw and may have the whole family present. Teens, on the other hand, would likely clam up if their whole family was sitting in the same room. Therapists and the sessions they use to treat children and teen patients are often adaptable to the situation at hand. Anxiety Disorders Caused By Profession All kinds of jobs have the power to cause anxiety disorders. Workplace stress is a huge problem when it comes to causing anxiety disorders. Think of highly stressful jobs: active duty military, police, firefighters, EMS, trauma doctors, ER nurses, pilots. These, among many, many others, are incredibly stressful jobs. With these particular jobs, stress is likely related to the idea of having the lives of others in your hands. Also, these professions are often those that witness terrible things. First responders see horrifying and gory events as a part of their day job. They experience another person’s worst day and often have to witness what becomes of it. These events can harm the mind. PTSD and other anxiety disorders are common among the people in these jobs. In fact, first responders are 20% more likely to commit suicide than the general population. For these people, anxiety disorders and depression are dark and scary things. Treatment options for them and all suffering from these disorders must be made known. Minority Groups It is estimated that approximately half of the LGBTQ+ population deals with anxiety disorders. Racial minorities often experience anxiety as a result of discrimination. African American individuals experience anxiety more than any other race. Additionally, low-income individuals and families tend to develop anxiety disorders more commonly than those of higher status. Anxiety Disorders And Risk Factors What causes anxiety? You now know that both men and women, teens, and children, people with stressful careers, and minorities can have to deal with anxiety disorders. This covers the entire population. You might assume that a black woman within the LGBTQ+ group working as a police officer would be far more likely to have an anxiety disorder than some other demographics. However, there are also other risk factors to consider.
Being aware of the risk factors can help you to monitor your own. Knowing that these factors may push you into anxiety can help you to better care for yourself with regular exercise, a healthy diet, meditation, avoiding drinking alcohol and doing drugs, and exposure to sunlight. There are various ways in which you can reduce your stress level. Try a few so that the controllable risk factors might not be part of the cause of an anxiety disorder. Does Everyone Receive The Same Treatment? Treatment varies from person to person but has the same idea for all people. As previously mentioned, children are often treated differently in therapy sessions. However, one individual might not be a great candidate for medication, and someone else might do well with it. It is up to you and your mental health professional to determine the best course of action for your treatment. Recovering From Anxiety Disorders Anxiety disorders do not have to control your life. With proper treatment and managing stress, you may find that your anxiety disorder has become a thing of the past. Recovering from an anxiety disorder can be hard work. It often requires months of one on one or group therapy. Counselors will often assign homework and fully expect you to do it. When you put in the work to get better, you can see an improvement in your mental health that allows you to live life again. If you feel that anxiety has control
over your life, seek help. Doing so can change your
future. Facts &
Statistics
Anxiety and Depression It's not uncommon for someone with an anxiety disorder to also suffer from depression or vice versa. Nearly one-half of those diagnosed with depression are also diagnosed with an anxiety disorder. Find out more about depression. Facts Generalized Anxiety Disorder (GAD) GAD affects 6.8 million adults, or 3.1% of the U.S. population, yet only 43.2% are receiving treatment. Women are twice as likely to be affected as men. GAD often co-occurs with major depression. Panic Disorder (PD) PD affects 6 million adults, or 2.7% of the U.S. population. Women are twice as likely to be affected as men. SAD affects 15 million adults, or 6.8% of the U.S. population. SAD is equally common among men and women andtypically begins around age 13. According to a 2007 ADAA survey, 36% of people with social anxiety disorder report experiencing symptoms for 10 or more years before seeking help. Specific phobias affect 19 million adults, or 8.7% of the U.S. population. Women are twice as likely to be affected as men. Symptoms typically begin in childhood; the average age-of-onset is 7 years old. Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are closely related to anxiety disorders, which some may experience at the same time, along with depression. Obsessive-Compulsive Disorder (OCD) OCD affects 2.2 million adults, or 1.0% of the U.S. population. OCD is equally common among men and women. The average age of onset is 19, with 25 percent of cases occurring by age 14. One-third of affected adults first experienced symptoms in childhood. Posttraumatic Stress Disorder (PTSD) PTSD affects 7.7 million adults, or 3.5% of the U.S. population. Women are more likely to be affected than men. Rape is the most likely trigger of PTSD: 65% of men and 45.9% of women who are raped will develop the disorder. Childhood sexual abuse is a strong predictor of lifetime likelihood for developing PTSD. The leading cause of disability in the U.S. for ages 15 to 44.3. MDD affects more than 16.1 million American adults, or about 6.7%of the U.S. population age 18 and older in a given year. While major depressive disorder can develop at any age, the median age at onset is 32.5 years old. More prevalent in women than in men. Persistent depressive disorder, or PDD, (formerly called dysthymia) is a form of depression that usually continues for at least two years. Affects approximately 1.5 percent of the U.S. population age 18 and older in a given year. (about 3.3 million American adults). Only 61.7% of adults with MDD are receiving treatment. The average age of onset is 31 years old. Source: National Institute of Mental Health Related Illnesses - Co-Occuring Disorders Many people with an anxiety disorder also have a co-occurring disorder or physical illness, which can make their symptoms worse and recovery more difficult. It’s essential to be treated for both disorders. Obsessive-compulsive disorder (OCD) and posttraumatic stress disorder (PTSD) are closely related to anxiety disorders, which some may experience at the same time, along with depression. Read on to learn more about the co-occurrence of anxiety and these disorders:
Anxiety disorders affect 25.1% of children between 13 and 18 years old. Research shows that untreated children with anxiety disorders are at higher risk to perform poorly in school, miss out on important social experiences, and engage in substance abuse.
Anxiety disorders also often co-occur with other disorders such as depression, eating disorders, and attention-deficit/hyperactivity disorder (ADHD).
Older Adults (page broken) Anxiety is as common among older adults as among the young. Generalized anxiety disorder (GAD) is the most common anxiety disorder among older adults, though anxiety disorders in this population are frequently associated with traumatic events such as a fall or acute illness. Read the best way to treat anxiety disorders in older adults. Worldwide Statistics Depression is the leading cause of disability worldwide. Almost 75% of people with mental disorders remain untreated in developing countries with almost 1 million people taking their lives each year. In addition, according to the World Health Organization (WHO), 1 in 13 globally suffers from anxiety. The WHO reports that anxiety disorders are the most common mental disorders worldwide with specific phobia, major depressive disorder and social phobia being the most common anxiety disorders.2 Anxiety disorders are treatable, and the vast majority of people with an anxiety disorder can be helped with professional care. Several standard approaches have proved effective: Source: Source: adaa.org/about-adaa/press-room/facts-statistics How Teens Deal
with Anxiety Some teenage anxiety is a normal natural response to events. For most teenagers, it is short-term, based on specific circumstances, and relatively benign. However, when that anxiety comes too often, out of proportion to events, and begins having a noticeable effect on daily life, it becomes a serious teen and mental health issue. Experts describe a “rising epidemic” of anxiety in children and teens.[1] According to the National Comorbidity Survey, 31.9 percent of adolescents aged 13-18 met the criteria for some form of anxiety disorder.[2] From the total sample of teens, 8.3 percent were suffering from severe anxiety disorders.[3] Anxiety disorders can hurt academic performance and contribute to substance abuse and other behavioral problems. The effects can last well past graduation. Anxiety was the most common complaint (50.6 percent) of college students seeking university counseling according to a 2015 survey.[4] Signs of Anxiety Some signs of anxiety in teenagers can be physical changes. Teens may feel consistently irritable and restless. Anxiety can disrupt teenagers’ sleep patterns. They may have trouble falling asleep, staying asleep, or waking up at appropriate times. Teens may complain of chronic fatigue, muscle tension, and headaches. Anxiety can also cause or exacerbate a range of gastrointestinal issues for teenagers. Abrupt changes in appetite and diet could signify a teenager is struggling with anxiety. Excessive and irrational worrying about such symptoms can be an indicator of anxiety as well. Anxiety can also manifest through changes in a teenager’s behavior. Parents may see their child’s schoolwork decline abruptly. Teens coping with anxiety struggle to concentrate, complete assignments, and remember deadlines. Anxiety can also have a major impact on lives outside of the classroom. Teenagers can withdraw from the world, avoiding social interactions and extracurricular activities they previously enjoyed. How to Manage Anxiety A first step for how to manage anxiety is removing the stigma surrounding mental health disorders and anxiety in particular. Even among those suffering, there can be a reluctance to acknowledge and, consequently, treat the problem. World Mental Health surveys showed that only 41.3 percent of the global population meeting the criteria for an anxiety disorder thought they needed care.[5] Just 27.6 percent of them received any treatment, and only 9.8 percent received “adequate treatment.”[6] Teens should understand that their anxiety is not a stain on their individual character or capability. Suffering from an anxiety disorder is not making excuses or a sign of weakness. It’s not a normal thing that everyone deals with. An anxiety disorder is a serious mental health issue, but one that can be resolved with treatment. Parents should also understand that their child’s anxiety may not be a product of his or her home life and upbringing. Mental health professionals can be a major help to teenagers suffering from anxiety disorders. They can provide teenagers with cognitive behavioral therapy. This therapy tries to instill positive thinking patterns and to provide teens with tools to help manage their stressors rationally and healthily. Mental health professionals can also prescribe medication to aid teenagers with more severe anxiety disorders. Selective serotonin reuptake inhibitors (SSRIs) are common antidepressants that can help reduce anxiety with minimal side effects. Teenagers can also help control their anxiety by focusing on their general physical health and wellness. Regular exercise and a consistent sleep schedule can help reduce anxiety. So can eating a better quality diet with nutrient-rich foods. Teens can try several different relaxation techniques, including yoga, meditation, and deep breathing. Merely setting aside a short 20-minute period each day to wind down and rest can be helpful. Even teens who remain glued to their smartphones can sample a myriad of different mindfulness apps. The Anxiety and Depression Association of America vetted many of them.[7] These offer short meditations and other techniques that may help teenagers mollify their stress and anxiety. Anxiety isn’t abnormal, per se. We all deal with it in some form or fashion but leaving signs of anxiety unanswered can lead to more severe issues. Talk to your teens and tweens about their feelings. One of the best ways to gain insight into how your teens and tweens are managing their own anxiety is to ask them. This is another benefit to working with a company like Pride Surveys. We have years of experience working with community coalitions and local leaders — in schools, churches, and other organizations — to get a better understanding of the challenges and stresses our teens and tweens face in today’s world. Please browse our selection of surveys to learn more about what we offer and why it’s important to gain these insights directly from our teens and tweens. [1]
“The Rising Epidemic of Anxiety in Children and
Teens” Retrieved 12 June 2019 at www.psychologytoday.com/us/blog/liking-the-child-you-love/201601/the-rising-epidemic-anxiety-in-children-and-teens
[2]
“Lifetime Prevalence of Mental Disorders in U.S.
Adolescents: Results from The National Comorbidity
Student-Adolescent Supplement (NCS-A)} Retrieved 11 June
2019 at www.ncbi.nlm.nih.gov/pmc/articles/PMC2946114/
[4]
“The Association for University and College Counseling
Center Directors Annual Survey” Retrieved 12 June 2019
at www.aucccd.org/assets/documents/aucccd%202016%20monograph%20-%20public.pdf
[5]
“Treatment gap for anxiety disorders is global: Results
of the World Mental Health Surveys in 21 Countries.”
Retrieved 12 June 2019 at www.ncbi.nlm.nih.gov/pubmed/29356216
[7]
“ADAA Reviewed Mental Health Apps.” Retrieved 13
June 2019 at adaa.org/finding-help/mobile-apps
Source: www.pridesurveys.com/index.php/blog/how-teens-deal-with-anxiety/
How
Anxiety Leads to Disruptive Behavior EN
ESPAÑOL A10-year-old boy named James has an outburst in school. Upset by something a classmate says to him, he pushes the other boy, and a shoving-match ensues. When the teacher steps in to break it up, James goes ballistic, throwing papers and books around the classroom and bolting out of the room and down the hall. He is finally contained in the vice principal’s office, where staff members try to calm him down. Instead, he kicks the vice principal in a frenzied effort to escape. The staff calls 911, and James ends up in the Emergency Room. To the uninitiated, James looks like a boy with serious anger issues. It’s not the first time he’s flown out of control. The school insists that his parents pick him up and take him home for lunch every day because he’s been banned from the cafeteria. Unrecognized anxiety But what’s really going on? “It turns out, after an evaluation, that he is off the charts for social anxiety,” reports Dr. Jerry Bubrick, a child psychologist at the Child Mind Institute. “He can’t tolerate any — even constructive — criticism. He just will shut down altogether. James is terrified of being embarrassed, so when a boy says something that makes him uncomfortable, he has no skills to deal with it, and he freaks out. Flight or fight.” may be reacting to anxiety he can’t articulate. James’s story illustrates something that parents and teachers may not realize — that disruptive behavior is often generated by unrecognized anxiety. A child who appears to be oppositional or aggressive may be reacting to anxiety—anxiety he may, depending on his age, not be able to articulate effectively, or not even fully recognize that he’s feeling. “Especially in younger kids with anxiety you might see freezing and clinging kind of behavior,” says Dr. Rachel Busman, a clinical psychologist at the Child Mind Institute, “but you can also see tantrums and complete meltdowns.” A great masquerader Anxiety manifests in a surprising variety of ways in part because it is based on a physiological response to a threat in the environment, a response that maximizes the body’s ability to either face danger or escape danger. So while some children exhibit anxiety by shrinking from situations or objects that trigger fears, some react with overwhelming need to break out of an uncomfortable situation. That behavior, which can be unmanageable, is often misread as anger or opposition. “Anxiety is one of those diagnoses that is a great masquerader,” explains Dr. Laura Prager, director of the Child Psychiatry Emergency Service at Massachusetts General Hospital. “It can look like a lot of things. Particularly with kids who may not have words to express their feelings, or because no one is listening to them, they might manifest their anxiety with behavioral dysregulation.” The more commonly recognized symptoms of anxiety in a child are things like trouble sleeping in his own room or separating from his parents, avoidance of certain activities, a behaviorally inhibited temperament. “Anyone would recognize those symptoms,” notes Dr. Prager, co-author of Suicide by Security Blanket, and Other Stories from the Child Psychiatry Emergency Service. But in other cases the anxiety can be hidden. “When the chief complaint is temper tantrums, or disruption in school, or throwing themselves on the floor while shopping at the mall, it’s hard to know what it means,” she explains. “But it’s not uncommon, when kids like that come in to the ER, for the diagnosis to end up being a pretty profound anxiety disorder.” To demonstrate the surprising range of ways young children express anxiety, Dr. Prager mentions a case she had just seen of a young child who presented with hallucinations, but whose diagnosis she predicted will end up being somewhere on the anxiety spectrum. “Little kids who say they’re hearing things or seeing things, for example, may or may not be doing that. These may not be the frank hallucinations we see in older patients who are schizophrenic, for example. They might be a manifestation of anxiety and this is the way the child expresses it.” Problems at school It’s not uncommon for children with serious undiagnosed anxiety to be disruptive at school, where demands and expectations put pressure on them that they can’t handle. And it can be very confusing to teachers and other staff members to “read” that behavior, which can seem to come out of nowhere. Dr. Nancy Rappaport, a Harvard Medical School professor who specializes in mental health care in school settings, sees anxiety as one of the causes of disruptive behavior that makes classroom teaching so challenging. “The trouble is that when kids who are anxious become disruptive they push away the very adults who they need to help them feel secure,” notes Dr. Rappaport. “And instead of learning to manage their anxiety, they end up spending half the day in the principal’s office.” Dr. Rappaport sees a lot of acting out in school as the result of trauma at home. “Kids who are struggling, not feeling safe at home,” she notes, “can act like terrorists at school, with fairly intimidating kinds of behavior.” Most at risk, she says, are kids with ADHD who’ve also experienced trauma. “They’re hyper-vigilant, they have no executive functioning, they misread cues and go into combat.” Giving kids tools to handle anxiety When a teacher is able to build a relationship with a child, to find out what’s really going on with him, what’s provoking the behavior, she can often give him tools to handle anxiety and prevent meltdowns. In her book, The Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students, Dr. Rappaport offers strategies kids can be taught to use to calm themselves down, from breathing exercises to techniques for distracting themselves. “When a teacher understands the anxiety underlying the opposition, rather than making the assumption that the child is actively trying to make her miserable, it changes her approach,” says Dr. Rappaport, “The teacher is able to join forces with the child himself and the school counselor, to come up with strategies for preventing these situations.” If it sounds labor-intensive for the teacher, it is, she notes, but so is dealing with the aftermath of the same child having a meltdown. Anxiety confused with ADHD Anxiety also drives a lot of symptoms in a school setting that are easily misconstrued as ADHD or defiant behavior. “I’ll see a child who’s having difficulty in school: not paying attention, getting up out of his seat all the time, asking a lot of questions, going to the bathroom a lot, getting in other kids’ spaces,” explains Dr. Busman. “His behavior is disrupting other kids, and is frustrating to the teacher, who’s wondering why she has to answer so many questions, and why he’s so wrapped up in what other kids are doing, whether they’re following the rules.” People tend to assume what’s happening with this child is ADHD inattentive type, but it’s commonly anxiety. Kids with OCD, mislabeled as inattentive, are actually not asking all those questions because they’re not listening, but rather because they need a lot of reassurance. How to identify anxiety “It probably occurs more than we think, either anxiety that looks disruptive or anxiety coexisting with disruptive behaviors,” Dr. Busman adds. “It all goes back to the fact that kids are complicated and symptoms can overlap diagnostic categories, which is why we need to have really comprehensive and good diagnostic assessment.” First of all, good assessment needs to gather data from multiple sources, not just parents. “We want to talk to teachers and other people involved with the kid’s life,” she adds, “because sometimes kids that we see are exactly the same at home and at school, sometimes they are like two different children.” And it needs to use rating scales on a full spectrum of behaviors, not just the area that looks the most obvious, to avoid missing things. Dr. Busman also notes that a child
with severe anxiety who’s struggling in school might
also have attentional or learning issues, but she might need
to be treated for the anxiety before she can really be
evaluated for those. She uses the example of a teenager with
OCD who is “doing terribly” in school.
“She’s ritualizing three to four hours a day, and
having constant intrusive thoughts — so we need to
treat that, to get the anxiety under control before we ask,
how is she learning?”
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