ADDRESSING ANXIETY IN INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES JULIE T. STECK, PH.D., HSPP CRG/CHILDREN S RESOURCE GROUP

Transcription

1 ADDRESSING ANXIETY IN INDIVIDUALS WITH DEVELOPMENTAL DISABILITIES JULIE T. STECK, PH.D., HSPP CRG/CHILDREN S RESOURCE GROUP

2 WHAT IS YOUR PRIMARY ROLE IN ATTENDING THIS WEBINAR?

3 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

4 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

5 WHAT IS ANXIETY?

6 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

7 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

8 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

9 HOW IS ANXIETY DEMONSTRATED IN THOSE WITH DD THAT YOU KNOW?

10 WE USED TO THINK IN BOXES: WHAT IS IT? ASD (ASPERGER S) ANXIETY ADHD

11 NOW WE THINK IN VENN DIAGRAMS ASD ADHD ANXIETY

12 RELATIONSHIP BETWEEN SCHOOL, FAMILY AND MENTAL HEALTH FAMILY MENTAL HEALTH SCHOOL

13 RELATIONSHIP BETWEEN SCHOOL, FAMILY AND MENTAL HEALTH FAMILY MENTAL HEALTH SCHOOL

14 NORMAL CURVE FOR ANXIETY

15 NORMAL CURVE FOR THOSE WITH DD

16 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

17 ANXIETY LOOKS LIKE Talking to self in class Withdrawn and distracted Lost in school environment Playing alone at recess Difficulty getting started in the morning Confused at end of day Making little progress in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

18 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

19 CASE STUDY--ABBY 12 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

20 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

21 WHAT ARE SOME STRATEGIES THAT MIGHT HELP DECREASE ABBY S ANXIETY?

22 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

23 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 s

24 WHAT WOULD NOT BE HELPFUL TO DEVON?

25 TREATMENT OF ANXIETY IN THOSE WITH DD Appropriate 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

26 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

27 ADULT/CAREGIVER ROLES Downshift and keep emotions calm Assume the role of frontal lobe Problem solve Implement solutions

28 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

29 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

30 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

31 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 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.

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

33 RECOMMENDED READINGS Miles, B.S. & Southwick, J. Asperger Syndrome and Difficult Moments: Practical Solutions for Tantrums, Rage, and Meltdowns. Autism Asperger Publishing Co. ( 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.

34 RECOMMENDED READINGS Diagnosing Learning Disorders: A Neuropsychological Framework. Bruce F. Pennington. Guilford Press. 2 nd Edition, Overcoming Dyslexia. Sally Shaywitz. Random House, Nonverbal Learning Disabilities at School. Sue Thompson & Pamela Tanguay. Jessica Kingsley Publishers, The Source for Nonverbal Learning Disorders. LinguiSystems Straight Talk About Psychiatric Medications for Kids. Timothy Wilens. Guilford Press, 2008.

35 WEBSITES AND ARTICLES Autism Society of America American Psychological Association The National Autism Center s Evidence-Based Practice and Autism in the Schools pdf Evidence-Based Comprehensive Treatments for Early Autism. Rogers, S.J. & Vismara, L.A. J Clin Child Adolesc Psychol January; 37(1): 8 38.

36 WEBSITES AND ARTICLES Children and Adults with Attention Deficit Hyperactivity Disorder Living in Fear: Anxiety in Adolescents with Autism Spectrum Disorder. Bellini, S. Anxiety and Panic Struggles. Davis, K. What About the Mental Health of Kids with Intellectual Disability?

37 THANK YOU FOR ATTENDING!! Julie T. Steck, Ph.D., HSPP CRG/Children s Resource Group 9106 North Meridian St., Suite 100 Indianapolis, IN fax