1. Anxiety in the School / Classroom Environment
Kym Asam, LICSW
NFI Vermont

2. Objectives Define anxiety Identify manifestations of anxiety
Identify causes of anxiety
Be able to identify signs and symptoms of anxiety in children
Develop and discuss multi-tiered strategies for supporting students

3. Regulate to educate
“No matter how exciting and meaningful and supported the learning experience is designed to be, the child cannot reap the cognitive benefits from it unless she feels calm enough to be curious.”
McMahon, 2011
Prior to next slide, ask audience to identify some myths and stereotypes that are associated with anxiety.

4. Myths & Stereotypes
Students with mental health problems are just looking for attention.
It’s just typical childhood angst.
Why doesn’t she/he just shake it off?
He’s just using ______ as an excuse.
Popular kids don’t have mental health problems.
Discuss concept of reification and how it interferes with effective intervention strategies.

5. What is Anxiety? Disorder of the brain affecting: Thoughts Feelings
Behaviors
Physical Health
Excessive anxiety and worry occurring more days than not for at least 6 months, about a number of events or activities (like school!) present for most of each day, every day
The person finds it hard to control the worry
Can cause clinically significant distress or impairment in social, occupational or other important areas of functioning (peer relationships)
Every one gets worried about things, but clinical anxiety has a different quality, intensity, and duration
Experiential situations that cause anxiety – test, new school, first date, etc.
Situational vs. Pervasive. Students can at times appear to function well in some situations and not in others
Have audience call out experiential anxiety situations

6. Anxiety continued Fear, apprehension, worry, sense of dread
Distress or uneasiness of mind that is accompanied by physical sensations
Manifests in order to deal with threats
Might cause person to escape / avoid
Confirmatory bias
Ask Audience if they have ever been anxious? Write down lined piece of paper in your packet how anxiety manifests. Have audience members pick from basket and act it out.
How is anxiety helpful? Anxiety has a very important function to our survival! Emphasize. Examples: avoiding a car crash / passing a big test perhaps discuss ANS system, Fight, Flight, Flee and Flock
An anxious person might feel “keyed up,” but might also be “stopped up” or “twisted up!”
Anxiety is helpful to a point; when it is excessive, there is cause for concern and a mental health disorder may manifest. We have anxiety before a test, job interview, date, etc. Ask audience to imagine those feelings they have when they are anxious as being constant and never stopping even when the stimuli that causes anxiety is diminished or gone.
Ask participants what environmental stressors / risk factors can contribute to child and adolescent anxiety. Examples include academic stress, poverty, homelessness, family instability, substance abuse and/or mental illness in the family, significant life changes, peer issues, adult expectations, etc.
Helpful to a point….

7. Anxiety Signs and Symptoms
Feeling extreme tension
Constant and excessive worry / fear
Feeling the need to maintain control
Fear of being out of control
Difficulty relaxing
Avoidance of situations
Panic attacks
Obsessions and compulsions
Can’t vs. Won’t
Note the excessive worry / fear is often illogical; it may not be reality-based at all or it may be exaggerated. Perception is more important than reality.
Point out that needing to feel in control can manifest itself as non-compliance – Can’t vs. Won’t
These symptoms sometimes are paired with various anxiety disorders – there are lot, I.e., OCD, GAD, Panic attacks, etc. Do not need to be diagnostician but it is important to ask your school point person for information about your student so you can better understand how to support them.
PTSD is no longer categorized as an anxiety disorder but anxiety can be a result of PTSD
Break group into small groups (4 people per group)
Discuss students with whom you have worked who have shown these signs and symptoms
Read aloud the case scenario and underline the symptoms – talk about how you might help that kid in school
What were some of the signs and symptoms that you noticed?

8. Signs and Symptoms (continued)
Frequent self-criticism
Attempts at being “perfect”
Physical manifestations like racing heart, stomach aches, increased body temp.
Fidgety behaviors
Difficulty concentrating
Social withdrawal and isolation
Irritability / anger
Insomnia or restless sleep
Low self-esteem / self- efficacy
Increase risk in depression
Ask participants how these signs and symptoms manifest in the classroom. For example, an anxious student may overly criticize his/her work, fidget when feeling overwhelmed, or may isolate from peer groups.
Be aware signs and symptoms can vary among age groups. Refer to Anxiety Quick Fact Sheet.
Note that those on the right side of the slide are also signs of depression. It is not always important to know if it is depression or anxiety but rather be aware of the symptoms and provide appropriate interventions and accommodations to help the student be more successful in school.

9. Causes of Anxiety: Mutually Interacting Factors
Key points
anxiety is caused by a variety of factors which are linked and interactive
The mind and body are not separate entities, but rather connected and interdependent. What affects the body will often affect the mind and vice versa. Wellness or illness is not simply a matter of someone’s physical state, but is also influenced by a person’s psychological and social status as well.
For example – anxiety.
Biological = biochemical neurotransmitter functioning and some anxiety symptoms manifest themselves as physical (headaches, stomach aches, etc.).
Psychological = negative patterns of thinking, difficulty concentrating, obsessive thinking, on edge
Social = school phobia, avoidance of friends
The interplay makes it difficult to break the cycle – your biochemical make up makes you feel anxious and so you struggle with having positive social interactions. Your lack of positive social interactions also makes you feel lonely and more anxious about why you cannot have positive peer interactions. Because of your anxiety, you are more likely to worry which can impact your functioning across all settings and may cause physical symptoms, etc.
For students, mental health problems are exacerbated by a mismatch between a student’s vulnerabilities and his or her environment.
Another example: A child with an internal predisposition for anxiety may be asked to do a presentation in front of the rest of the class. While this student may be capable of understanding the assignment, the thought of presenting in front of an entire class is overwhelming and paralyzes the student preventing him/her from doing any of the project. The student is admonished by the teacher, etc. Exacerbates the symptoms

10. Anxiety’s Interference with Learning
Frequent interruptions in learning
Performance anxiety
High levels of self-criticism / perfectionism
Avoidance of what is anxiety-producing (class, school)
Intrusive worry thoughts
Sleep disruptions affect availability to learn
Lack of participation
Low self-esteem and self-efficacy
Difficulty concentrating
Working Memory
Revisit some of the signs and symptoms that appear in the classroom before moving on to interventions.
Emphasize that anxiety is an individual experience. Because anxiety is experienced differently, anxiety manifests differently among children and adolescents.
For example, students experiencing anxiety may not be able to participate in group work or during activities / assignments that involve public speaking. (performance anxiety / lack of participation)

11. General Strategies to Intervene
Healthy Attachment
Affect management
Attunement
Consistency
Competency
Avoid if, then…
Reduce sequential expectations
Hard to abstract to the future – more in the moment reinforcers

12. Adult Affect Management
Can the adult:
Express a range of affect?
Understand own triggers?
Manage own behaviors in face of child’s affect?
Maintain good boundaries?
Use own supports/resources?

13. Attunement
The ability to accurately and empathically understand and respond to children’s actions, communications, needs, and feelings.

14. Competency 3 Key Principles
Build student executive functioning skills
Target self-development and identity
Target additional key developmental tasks
The student develops an ability to evaluate situations, inhibit impulsive responses and actively make choices.
Overarching goal is to build the foundational skills needed for healthy ongoing development and resiliency
Doable tasks
Islands of competency
Sports
Music
Theatre
Yoga
Academics
Marshall arts
The child develops an ability to evaluate situations, inhibit impulsive responses and actively make choices.
Source = Margaret Blaustein and Margaret Kinniburg

15. Universal Strategies Relationship Reduction in visual noise
Environmental considerations
Frequent movement breaks
Visual schedules

16. Universal Strategies Multi-modal learning Pilate balls for sitting
Presentation alternatives
Multiple classroom stations
Model Coping Strategies
Psychoeducation – mind body: body mind

17. Targeted Strategies Schedule check-ins (CICO)
Change the environment to change behavior
Teacher Check, Connect and Expect (TCCE)
Small group learning opportunities
Social skills groups
Adjust homework load

18. Targeted Strategies Validation and empathy Stress balls/fidget items
High preference activities/jobs
Adult anchoring
Pair success with reward
Exposure/desensitization

19. Intensive Strategies Private signal for stress identification
Individual stress reduction work
Engage student in planning
Family involvement and input
Exposure/desensitization

20. Intensive Strategies Proactive intervention (attunement)
Specific and tailored educational plan
Adjusted homework load
Increased time to finish assignments
Grade attempts vs. whole assignments
Alternative assignments (audio recorded, video taped at home, audio voiceover of presentation)
Alternatives to recess, cafeteria, assembly, etc.

21. Questions