Transcript Anxiety-School Phobia

Emotional
Disabilities/Disorders
Arousal Level
Optimal performance
Optimal arousal
Stress zone
Bored zone
Underaroused (low)
CD ADHD
Overaroused (high)
Anxiety
Asperger’s Autism
4/9/2015
Anxiety
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Anxiety Definition
An unpleasant state involving:
1.
subjective apprehension and
2.
physiological arousal of a diffuse nature.
When is Anxiety a Disorder?
Duration--over 2 years
Intensity
(impairs academic or social
functioning)
Etiology or causes:
1. Nature (heredity)
sensitive personality
2. Nurture (learning)
a. Social observation of others (dog bite)
b. Own experiences (trauma, divorce)
C. Skill deficits (LD), physical problems)
ACAdemics
 1. Academics failure (4 times greater
high anxious )
Selective attention to:
Safety, Competence
Evaluator
 2. Depends on Task Complexity
 Simple good
 Complex poor
# of problems
Reading
Group-paced
Communication
Incidental learning
TYPES OF ED
ANXIETY DISORDERS
 Generalized anxiety/overanxious disorder
 Panic disorder
 OCD (Obsessions/Depressions)
 Posttraumatic stress disorder (PTSD)
 Specific
 Separation anxiety & school phobia
 Phobias specific ‘things’ like spiders, elevators
 Person Anxieties (social phobia, agoraphobia)
Post Traumatic Stress Disorder
Subtype: POSTTRAUMATIC STRESS DISORDER
Result of some devastating event--devastating events include
experiencing or witnessing assaults, natural catastrophes,
rape, suicide, life-threatening illness, war, etc.
Symptoms may be immediate or delayed--includes sense of reliving
the experience, illusions, flashbacks, etc.
In young children, recollections can be expressed through
repetitive play with themes of trauma
POSTTRAUMATIC STRESS DISORDER
Symptoms of avoidance:
(1)
avoid thoughts, feelings or conversations of the trauma,
(2)
avoid activities, places or people that arouse recollections of trauma,
(3) inability to recall important aspects of the trauma,
(4) markedly diminished interest or participation in activities,
(5) feeling of detachment or estrangement from others,
(6) restricted range of affect,
(7) sense of a foreshortened future (not expect to have career, marriage, kids),
Symptoms of arousal:
(1) difficulty falling or staying asleep, (2) irritability or outbursts of anger, (3) difficulty concentrating,
(4) hypervigilant, and (5) exaggerated startle response
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School Refusal broad category:
1. Separation Anxiety
2. School Phobia
3. Truancy
Two categories of school refusal
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1. Internalizing
 Seeks comfort of
home
School phobic child really
WANTS to go to school, just
unable to do so.
2. Externalizing
 Avoids home
 “Truancy”
What Possible Disorder?
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Functional Etiology: Why avoid school?
Avoid a negative
1. Loss of parent
2. Tests/evaluations
3. Social situations
4. Performing before a
group
Obtain a positive
1. Stay home with
parent and receive
attention
2. Watch TV or play
Experience Contributors
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1.
Life changing events
a)
b)
c)
d)
e)
2.
3.
4.
death in the family,
birth of a sibling,
move,
parent losing job,
unstable or divorced families
Failure oriented classroom -- child is punished for trying and failing
and punished for not trying
Transitions (start of kindergarten, junior or sr. high school).
School breaks, holidays, summer vacation -- symptoms worse on
Sunday evenings and Monday mornings, or after vacation
Family Contributors
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Mothers are more likely to
be diagnosed with anxiety
disorders
Parents have unrealistic
expectations of academic
success
SCHOOL PHOBIA: Matilda
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Matilda enjoyed school until her parents notified her that they
were having a baby.
Matilda missed at least 20 days every school year after her
younger sister was born.
Her parents divorced when she was in fourth grade. Her
attempts at absenteeism escalated.
She continued to try to stay home from school saying she had
stomachaches and headaches. She was a straight A student.
By the time Matilda reached high school, her mother was tired
of fighting her about school attendance and let Matilda stay
home whenever she wanted as her grades did not suffer.
Matilda’s outcomes
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Matilda graduated as valedictorian of her high school and
college classes. Her professors were understanding of her
frequent absences, as she was such a good student.
When Matilda graduated from college, she was unable to keep
a steady job.. Her employers were not as generous as her
teachers had been.
By the time Matilda was 31 years old she had had at least fifty
jobs. Most of those jobs she held for less than a month.
Long Term Outcomes
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If School Phobia is not treated:
 Family problems:
Parents may have to quit job; see school phobia as WORSE
than CD
 Siblings are affected as parents’ attention is focused on the
child with school phobia.
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Student outcomes:
leads to more generalized anxiety disorder, depression,
phobic disorders, such as agoraphobia.
 predicts occupational, social, and marital problems
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Accommodations-School Phobia
1. The school environment may be causing anxiety,
so investigate the child’s fears:
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reduce pressure;
a good relationship with the teacher can help the student
return to school;
2. Practice relaxation techniques in the classroom.
3. Sit the child by the door, so he/she can leave the
room when feeling anxious.
4. Give practice tests
5. Allow extra-curricular activities even when they miss
school.
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Interventions
Anxiety disorders have a high rate of
recovery if treated. School phobia should
be treated right away, as the child’s fear
will continue to build.
Interventions School Phobia
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Behavioral and cognitive treatments are 93% successful
while only 37% of the hospitalized group and 10% of the
home school/psychotherapy group were successful.
Treat the student in the fear provoking setting, using gradual
reintroduction into school .
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Focus on long-term goals, like the ability to attend school full
time, rather than on immediate academic concerns
Behavioral contracting--baby steps and reinforce attendance
Do not reinforce crying or complaints of physical symptoms. Be
firm but gentle.
SOCIAL PHOBIA
PERSON ANXIETY
involves social avoidance
1. Shy,
2. Social Phobic,
3. Agoraphobic
Two subtypes of Social Phobia
Fears that he or she may do something in a way that will be humiliating.
Specific (restroom, writing, speaking)
General (hallways, cafeteria)
Background on Robert
White, male, 17 years old, senior at West Side
School
LD in Lang. Art
Gifted in Math and Computers
Social Difficulties
Family Contributions
Recently moved
Family tragedy (Due to the death of his younger brother Robert’s
mother tends to shelter him and keeps him from social situations).
Weird behavior
Moans, mumbles, and
laughs
Doesn’t answer/ mute
Walks away
Selectively silent to avoid
fearful settings
SETTINGS THAT
TRIGGER
Being approached
Being asked a question
Being forced to interact
Being graded in class for
participation
Other Social Phobic Characteristics:
1. doesn’t have any interpersonal relationships.
2. seems depressed --says that he hates his life.
3. was asked to be a chairman of the Robotics team but
declined.
Classes
that lead
to
abnormal
behavior
Classes That Grade Particpation
10%
90%
1 Classes that don't grade participation
2 Classes that grade participation
Observable Consequences
1. Left alone
2. Doesn’t have to
produce
3. Teacher
attention
Payoff Data
Psychobiological Payoffs
15%
47%
38%
1
Avoid lack of control
2
Avoid failure
3
Get adult attention
DSM IV Definition of Social Phobia & Robert
A marked and persistent fear of one or
more social situation or performance
situations in the person is exposed to
unfamiliar people of scrutiny by others
1.
Marked fear in more than on social situation and is
worried about how other’s view him.
2.
Exposure to feared situation provokes a
panic attack
2.
Exposure to feared situation causes his moans,
mumbles, and weird laugh.
3.
Person recognizes that the fear is excessive
or unreasonable
3.
Robert does recognize that his fear is excessive and
unreasonable
4.
The fear situations are avoided or else
endured with great anxiety
4.
Robert avoids situations that might make him
uncomfortable (speeches, group projects, games, etc..)
1.
5.
The fear, avoidance, or anticipation
interferes with the person’s normal routine,
occupation, relationships, or situations that 5.
would otherwise not be effected by a
normal person
Robert’s avoidance at times interferes with his life
and most often interferes with his academic success.
6.
Individuals under 18 years old and duration 6.
longer that 6 months
Robert has had these characteristic since I first met
him last year.
7.
The fear is NOT due to another substance, 7.
medical condition of and is not better
accounted for by another mental disorder.
Robert does not have another medical condition that
could explain his behavior and his behavior cannot be
better accounted for under another mental condition.
8.
If a medical condition or other mental
disorder is present the fear experienced is is
unrelated to them.
Persistent refusal to
speak despite the
ability to speak and
comprehend spoken
language.
Types
Unduly shy in the company of
acquaintances or relatives
May be a symptom of social phobia rather
than a separate diagnostic category.
Contributors
Contributors
Family psychopathology
(mother depressed & overprotect)
and
father shy temperament
Temperament
(shy & anxious)
Presenting Problem
Developmental
Delay (elimination
problems)
Speech and Language LD
(20%)
Not Speaking in at least one
Social Situations
(usually classroom)
Versus
Experience of Trauma
Behavioral INTERVENTIONS
1.
Systematic desensitization-gradual and repeated
exposure to the fear-producing stimuli (either in
real life or in purposeful fantasy) and in an
activity that is incompatible with anxiety (relaxing
in a favorite chair, eating ice cream).
2.
Reconditioning through role play, reinforcement
for facing object of fear, matter-of-fact statements
that child will “go back to school” for instance,
removal of reinforcers for avoiding object of fear
(e.g., can’t watch TV if at home)
3.
Guided participation or practice--introduce other
persons as models with the feared stimulus (e.g.,
videotapes of person with a dog and then with a
dog under highly supervised conditions).
Other Interventions
1.
Flooding or implosion-- high frequency exposure to
feared objects
2.
Self-control training--may learn relaxation, selfreinforcement, self-punishment, self-instruction, visual
imagery, or problem solving strats. Children taught to
(1) recognize anxious feelings and physical reactions, (2)
modify cognitions and misperceptions that contribute to
anxiety, (3) Reinforce self for making change
3.
Pharmacology
4.
Expressive Therapies Art, Music, Drama, Dance,
bibliotherapy where books are used to provide models of
coping. (e.g.,. On divorce, going to the hospital)
Websites:
-www.drjplowman.co.uk
-www.phobics-society-org.uk
-www.openmind-rossendale.co.uk