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Saturday, March 16, 2013

Invisible Anxiety: Hiding in the Classroom

From Special-Ism.com

By Kimberly S. Williams, Psy.D.
March 11, 2013

One in eight children will be diagnosed with an anxiety disorder.

Separation Anxiety Disorder, Specific Phobia, and Obsessive Compulsive Disorder (OCD) are common in younger children, ages 6-9, while Generalized Anxiety Disorder (GAD), Social Anxiety Disorder (SAD), and Panic Disorder are more prevalent between 8 and 12 years; all of these disorders may continue through adolescence.

These anxious children, who spend up to eight hours a day in school, are frequently overlooked and denied educational supports and accommodations because their anxiety is invisible.

Why Invisible? Four Common Reasons

1. Children’s anxiety symptoms are not always overtly apparent to teachers. "Mrs. Smith, there is no problem. Your child is quiet, well-behaved, and an excellent student.”

2. Anxiety symptoms are confused with defiant or oppositional behaviors. “Mr. Brown, your son cries, whines, refuses to read aloud, or raise his hand.”

3. It’s often difficult to determine how anxiety symptoms interfere with learning. “Your child worries, but so does every student in this academically rigorous school.”

4. Schools often have few resources and may deem a child’s anxiety to be a private matter. “We see your child’s anxiety, but what can we do? This is emotional and should be dealt with at home, or by your doctor.”

Recognizable Effects on Behavior

Without obvious physical signs like sweating, tremors, or blushing, anxiety can be missed. More subtle signs include inflexibility, over-reactivity, intense emotion, and impulsivity. Anxiety is not always distinctive – sometimes, the only difference between oppositional and anxiety-related behavior is the underlying cause.

One of the most identified school fears is separation from parents. Other frequently reported worries include riding the bus, eating in the cafeteria, public restrooms, being called on in class, changing for gym and being bullied.

Furthermore, these invisible anxiety symptoms can greatly affect academic performance. Anxiety impacts working memory and processing speed, making it difficult to learn, retain, and recall information.

Teachers must be educated on the behavioral manifestations of anxiety in the classroom in order to make this invisible disability easier to detect and understand.

Anxiety-Related Behaviors to Look Out For:
  • Avoidance of interactions with classmates and teachers;
  • Speaking at low volume or only to select individuals;
  • Frequent requests to leave the classroom, to use the bathroom, see the nurse, or call a parent;
  • Complaints of feeling hot/cold; trouble breathing; aches, pains, itchiness;
  • Social isolation. No participation in after school groups;
  • Awkwardness in appearance and conversation with peers;
  • Task avoidance and defiance;
  • Sudden change in actions such as writing very small, excessive focus on certain ideas, need for order, repetitive behavior.

Getting Help For Your Child

When anxiety interferes with learning, it is considered a functionally impairing disability. Under the Americans with Disabilities Act and the IDEA Laws, students with disabilities are entitled to classroom accommodations and supports under section 504 and through Individualized Education Plans (IEP).

For many children, anxiety disorders fall under the classification of Other Health Impaired (OHI). If students with anxiety are to succeed in school, they need a behavioral intervention plan that addresses anxiety and teaches more appropriate responses.

Parents can make this happen:
  • Share evaluations and clinical information that explain your child’s anxiety in school.
  • Have the treatment provider present information about the disorder, your child, what educators might expect and suggested school recommendations.
  • Design supports to help lessen anxiety while encouraging normal routine; least restrictive supports should be considered first.
  • Encourage your child to share what is going on in school as well as his or her reactions to the school’s response.

Suggested School Accommodations for Anxiety

Every child is unique; each support plan is individualized. The goal of accommodations must be to lower the child’s anxiety while increasing self-esteem and encouraging independence, self-advocacy and developing new skills.

The following are some of the 504 and IEP interventions that may help to your child:
  • Always keep the child in school. Do not reinforce or increase anxiety symptoms by sending a child home unless absolutely necessary.
  • Provide positive reinforcement, like stickers, extended computer time or a special activity when a child tolerates a feared situation.
  • Present verbal encouragement and prompts in subtle, non-punitive ways.
  • Offer advance preparation for upcoming changes to routine or daily schedule, including field trips or fire drills and supervision during transitions between classes and activities.
  • Provide a consistent, predictable schedule; post in a visible place for the child’s reference.
  • Allow breaks as necessary and provide opportunities for action. For instance, pacing without disturbing others, running an errand, handing out papers, or using a soft squeeze ball.
  • Prompt in advance before calling on him to answer a question.
  • Avoid using jokes, sarcasm and bringing unwanted attention to student.
  • Modify assignments; have the child complete only odd numbered problems, allow him the use of a word processor, or give an oral exam instead of high pressure written exam.
  • Allow extra time on quizzes, exams, and in-class assignments.
  • Designate one teacher as the coordinator of this plan, to aid with implementation and review, as necessary.


Anxiety is the leading mental health disorder in children; thus, it is inevitable that educators will encounter students experiencing disabling symptoms in the classroom. It is imperative that teachers are educated about subtle, often invisible signs of anxiety among their students. Teachers must engage in supportive collaboration with parents and faculty to help generate an effective action plan.

Children with anxiety are entitled to specific support and accommodations, with a positive goal of enhancing learning potential and promoting positive behaviors.

About Kimberly S. Williams, Psy.D.

Dr. Kimberly Williams is a clinical psychologist and neuropsychologist who specializes in the assessment and treatment of children and adults with psychological disorders including anxiety, depression and disruptive behaviors, as well as learning disorders, developmental delays, executive functioning issues and social deficits.

When Dr. Williams isn't in her Great Neck and Brooklyn, N.Y. offices helping kids get ahead in their academic and social development, she is consulting and providing workshops and training in issues related to Autism, Asperger’s Disorder, Nonverbal Learning Disability, Special Education and Parent Advocacy. Visit her site at Dr. Kimberly Williams.

1 comment:

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