1 Anxiety in the Context of a Learning DisabilityJoseph Gumina, Ph.D. CPMC Kalmanovitz Child Development Center May 3, 2016 Archdiocese of San Francisco Resource Teachers’ Professional Development Day
2 Agenda/Objectives Introductions/Framing QuestionsBrief overview of anxiety disorders Brief overview of developmental learning problems Review of Assessment and Intervention Possibilities Anxiety, LD and the learning specialist/resource teacher Teacher Reflections/Questions/Sharing
3 Introductions WELCOME! WELCOME! WELCOME! Raise your hand if…You have 1-3 years teaching experience, 3-5, 5-10, 10+, 15+, 20+? You work with students from K-8, if you work with only younger or older students, groups/individual/push in service You are involved in the assessment of learning disabilities, if you have had ocassion to recommend to parents comprehensive testing or psychotherapy You became a specialist after starting as a classroom teacher You observe your students to experience low morale or worry associated with their learning challenges SHARE 1 THING YOU LOVE ABOUT YOUR POSITION AND 1 THING YOU FIND QUITE DIFFICULT ABOUT IT
4 Common Teacher Questions:How do I enter into a conversation with a parent about pursuing an evaluation or treatment, especially when the parent might not be receptive to this? How do I know if a hard behavior is related to anxiety or a learning problem, or if it is more strictly “oppositional,” or all of the above? Is it wrong to make an anxious student with LD “tow the line?” Are there general things that help all anxious or LD students that I can do proactively or regularly? How do I increase participation in the tutoring/resource/remediation sessions? The student needs it so badly and is not taking advantage/fully engaged.
5 Anxiety In Children Pediatric Anxiety Disorders are among the most common disorders of childhood (Separation Anxiety, Fears/Phobias, Social Anxiety, Generalized Anxiety, Obsessive-Compulsive Disorder, Traumatic Anxiety) NIMH, CDC and other research agencies suggest that many children (10- 25%) are affected at one time by an anxiety condition, and it is believed that up to 40% of children experience subclinical anxiety Anxiety in childhood can have an early onset, it fluctuates and may have chronic course, it can show up in middle childhood and adolescence as well, anxiety is hard wired and at times adaptive, types of anxiety frequently can be related to developmental tasks/stages Anxiety in childhood frequently co-occurs with Specific Learning Disabilities – in one study comorbidity was 28% (Margari et 2013)
6 Ways to Think About AnxietyBiopsychosocial Framework Genetic inheritance, somatic symptoms Thought patterns, learning experiences Environmental and Contextual Events Secondary Anxiety Commensurate with a developmental difficulty Adaptive Anxiety Evolutionary, needed for safety and thoughtful living The Function and Impact of Anxiety Frequency, Duration, Intensity, What Does it Interfere With Why avoidance and over-controlling behaviors are common, why they help and hurt
7 Learning DisabilitiesBetween 2-10% of school aged children have a learning disability Of the 13% of US Public School Students in Special Education, 35% of those are qualified for Specific Learning Disabilities Children with Learning Disability are at risk for developing mental health and behavioral problems
8 Learning DisabilitiesCAN YOU THINK OF A STUDENT WITH…??? Difficulties with reading, writing, math Difficulties with sustained attention, concentration, and mental impulse control, difficulties with organization and planning, task orientation Strength/coordination issues, sensory processing issues, language processing issues, social thinking issues
9 Types of Anxiety & Behaviors Often Associated with Learning Disability (Levine, 1994)Targeted Anxiety (highly specific to demand type or context or person) Test-Taking Anxiety (history of poor performance, memory difficulties, low processing speed) Anticipatory Anxiety (kids with specific mental health problems, kids who live in high stress circumstances, in context of projects, presentations and long term assignments) Generalized Anxiety (physically tense kids, somatic “complainers”, pervasively anxious kids) School Phobias (related to more profound LD and low morale – avoidance gets reinforced, kids who have medical issues, social problems or who experienced a discrete traumatic event at school) Perfectionism
10 Continued… Avoidance (low participation, never volunteering)Impulsivity/Hyperactivity (rushing, working without thinking or using skills, behavioral problems that are diversions or distractions) Poor Coping (very sensitive, will easily cry or get flustered, put head down or leave room) Defensiveness (lying in different forms, not asking for help) Depression (in a funk, low mood, low arousal, irritability, hard on self)
11 Attending to LD related anxiety (Levine, 1994)Give feedback tactfully, privately, encourage self- assessment/rating and review, ask for student feedback Attend to effort, set children with LD up to leverage and use their identified strengths (in front of classmates) Make the right accommodation (rate, volume, complexity, evaluation, introduce aids, prioritization, etc.) Start with and address upstream problem, the “chicken”
12 Collaborative Problem Solving (Greene, 2014)Make Rewards/Punishment an adjunctive method, not the main intervention Reduce learning disability issues to SOLVABLE PROBLEMS Understand Hard Behaviors from a different perspective (“Incompatibility Episodes”), consider SKILLS AVAILABLE & ENVIRONMENTAL DEMANDS Empathy Step (student concerns), Define the Problem Step (teacher concerns), Invitation Step (Brainstorm)
13 Motivational Interviewing (Miller & Rollnick, 2012)INVITATION: THINK MOTIVATION FIRST – REMEDIATION SECOND, students with LD are being asked to do something that is hard and therefore can give rise to strong emotions and compensatory behaviors Teacher Communication/Questioning Style OARS: open questions, affirmations, reflections/summaries DEARS: develop discrepancy, express empathy, amplify ambivalence, roll with resistance, suppose self-efficacy Teacher Listening Style DARNs: desire statements, ability statements, reason statements, need statements
14 Teacher Discussion and InputAsk a psychologist, ask a resource teacher… Share general reactions to the conveyed points. AND Share some hard won knowledge about something you have found works or does not work with students who have both LD and anxiety.
15 CONCLUSIONS & WISHES Take pleasure in how important and impactful you are and can be Make learning about student motivation a professional development focus point (classes, consultation groups, feedback from mentor teachers) Advocate for the time and resources you need from your schools Support and partner with the primary instructors of your students STAY WELL
16 [email protected] (415) 600-6200Thank you! (415)