Feb 142021
 

(The Behavior List)

 

Hello again, everyone!  It’s nice to be back with our B-Lister group after such a long hiatus since our last gathering.  Remember that you can find those long-lost e-mail blasts at http://www.behavioradvisor.com/blog-3/ , what-to-do and how-to-do-it posts on kids who are labelled as having O.D.D., Conduct Disorder, Generalized Anxiety Disorder, PTSD, Autism Spectrum Disorder, and ADHD.  You’ll also find video case studies of kids who display a number of DSM-5 disorders.

But that’s the past.  Here’s the present…

Today I have the professional pleasure and privilege of bringing a special educational treat.  It’s a goodie for those of you who work with students who often-times display “reactionary” behaviors to what seems to us to be rather innocuous circumstances.  What causes a learner to “shut down” and withdraw into oneself, or “tense up” and strike out verbally or physically?  What’s going on behind the “function” (the cause, reason, or purpose) of the persistent response pattern that we’ve identified with our Functional Behavior Assessment (FBA) procedures?

 

I’m now joined by Simon Currigan, well-known purveyor of behavior management wisdom at the Beacon School Support website (beaconschoolsupport.co.uk).  His frequent postings provide sage advice on how to bolster your skills for reaching and teaching children and youth with mental health and behavioral challenges.

 

    

 

Tom: Good day, Simon!  Thank you kindly for visiting with us today.  On behalf of our BehaviorAdvisor.com “B-Listers” I’d like to chat with you about a cause of challenging classroom behaviour that is often overlooked; a topic that is receiving increasing attention in the professional research literature, but might not have made its way to classroom application quite yet.  But before we delve into that compelling subject matter, please introduce yourself to people who are unfamiliar with your full-of-advice website.  What’s your professional background, and how did you come to be a sought-after consultant who supports schools in their efforts to better serve students with behavior disorders?

 

Simon: Well, it wasn’t a career path I planned, exactly.  I studied Computer Science originally and worked as a programmer before taking the next natural step of training to become a school teacher!

Joking aside, those two careers are related in one sense:  I’ve always been interested in taking things apart and finding out how they work.  Computing is about understanding how systems work in the real world and modelling them in software.  Education is understanding how systems in the mind work.

 

Tom: When did you move from the inclusive classroom to special education with troubled and troubling kids?

 

Simon: After about 8 years in mainstream, a colleague of mine mentioned I had strong behaviour management skills, and related well with “difficult kids”.  He recommended I apply for a position in a pupil referral unit.

 

Tom: I’m unfamiliar with that term, Simon.

 

Simon: In the UK, these are small schools where students are sent when their severe behaviors result in them being permanently excluded from their mainstream school.  The kids all bring significant challenges in terms of mental health issues, behaviour, aggression, and their emotional well-being.  While designed to provide needed services and supports, when a large group of children and youth with these issues are placed together, educators need to possess a certain type of demeanor and set of skills in order to prevent the lighting of the fuse to an emotional powder keg! 

At this point in my career, I started learning a lot more about the deeper causes of behaviour, and finding ways to place that psychology and behavioural science into practical use in the classroom.

 

Tom: Yes, we have a strong and constantly increasing knowledge base, but those ideas don’t  always work  with the same degree of effectiveness as stated in the textbooks… especially with young people who possess severe emotional and behavioral challenges.

 

Simon: That’s the truth! Then after about six years of working in the classroom, I made the jump to running the unit, and from there to supporting schools back in mainstream, with the hope of preventing pupils getting kicked out of mainstream schools to the referral units in the first place.

 

Tom: You’ve got the credibility, Simon.  You mentioned earlier the application of psychology and behavioral science to classroom teaching with learners who display errant reaction patterns.  So, that’s the area of interest that we’re going to look at today?  What’s this often-overlooked cause of over-reactive classroom behavior?

 

Simon: The impact of stress on human behaviour.  Full credit to Dr. Stuart Shanker   here – his work in this field has had a huge impact on me.

 

Tom: We certainly read and hear a great deal about stress, but how does its presence apply to students who display inappropriate… inappropriate in the classroom…response patterns?  And what do you mean by stress, exactly?

 

Simon: I mean stress in the biological sense – any pressure, internal or external, that causes our bodies to start producing stress chemicals like adrenalin, noradrenalin and cortisol – and make us burn more calories.  These changes are important because they affect how our brains operate – and limit the kinds of behaviour choices our brains have available.

It kind of boils down to this:  When kids feel calm, happy and confident in the classroom, learning happens naturally.  Even for the most challenging of pupils.

But when those same students are under stress, all that changes.  And I don’t think that we – as adults – appreciate how stressed some of our young people in our classrooms are.

 

Tom: What are the sources of that stress – in the classroom?

 

Simon: Well, that depends on the individual student.  We’re all different.

For some kids, that stress might be related to sensory needs.  When our senses are unbalanced, our bodies spend a lot of energy trying to compensate, which results in additional stress.

For others, attachment issues may mean they feel unsafe, are constantly on-guard for threats to their psychological and/or physical safety, and prepared to immediately fend for themselves if they perceive potential peril – and that’s made worse in large group situations.  Some pupils may maintain high stress levels due to anxiety, or have difficulty understanding social interaction – and schools are full of complex social interactions – which results in…

 

Tom: Stress?

 

Simon: Okay. So I’m getting predictable!

 

Tom: Why does this building up of stress matter to us as educators?

 

Simon: Well, stress changes the way humans think and act.  In our day-to-day lives – and I’m putting survival situations to one side here – our brains have access to three types of behaviour; logical, emotional and automatic.  And those are all driven by different parts of the brain.

But the more stressed we get, the less influence our prefrontal cortex has on our behaviour and decision making.  And I’m sure your students know about the role of the prefrontal cortex.

 

Tom: Mine do, but for others who haven’t studied this material, it deals with rational thinking, executive functioning, logic, inhibition, planning, prioritizing, thinking about long-term goals…

 

Simon: Exactly.  So, if we want kids to use those skills, we need them to be emotionally calm.

Let’s take an example student.  We’ll call him Gavin.  Gavin has sensory needs, difficulties with receptive language and issues around perfectionism.  His mentor has given him a strategy to follow when there are misunderstandings, he makes a mistake, or sensory input causes him distress: Go to a time out area, do some deep breathing, and clear the mind.

Here’s the impact of stress…  On Day One he walks into a classroom where he feels like the teacher doesn’t like him.  The sunlight streaming through the window shines directly on him and the teacher reads out the test instructions quickly.  Gavin immediately feels under pressure and he’s scared he’s going to make a mistake.

Each of these factors are going to increase Gavin’s stress levels.  The sunlight, the poor relationship with the adult, the test, processing the instructions.  Biologically, his stress goes sky high.

So he loses access to the prefrontal cortex; all those executive and self-control skills.  All he’s left with are the emotional or automatic behaviour options.

Tom: So then you might witness an emotionally-charged behavior, like an outburst.     

Simon: Absolutely – because that might be a strategy that’s been successful for Gavin previously.  Or he might display an automatic behaviour that’s been successful for him in the past, like refusing the test or ripping it up, and he just replays that.

And I don’t mean successful in terms of academic success, or following strategies suggested by the adults.  This is success from his body’s perspective, which wants to escape the current stressful situation he’s trapped in.  His biological state will focus him very much on the ‘now’; survival in the moment.

 

Tom: So the stress or a perception of a threat to his psychological safety might result in a fight or flight response, like walking out of class, or…

 

Simon: That’s right.  Or being aggressive towards the teacher – or the other kids.  Or whatever.

 

Tom: In educational psychology those actions are said to be maladaptive.  A short-term survival strategy that works against you in the long-term.

 

Simon: In this high-stress state, he can’t access that type of long-term, logical thinking.  So when the adults give him reminders about his targets or strategies – or which consequence will be administered down the line if the behaviour continues – it won’t have much effect in that moment.

 

Tom: So what can we do when we’re in a situation with an emotionally-charged student whose rational-thinking pre-frontal lobe has shut down?

 

Simon: Let’s take another example. 

It’s Day Two. Gavin walks into the same classroom, but it’s a different teacher – one he has a good relationship with.  The sun is still bright, but his teacher pulls down one of the shades or tells Gavin he can move out of the direct sunlight if he wants to.

The teacher still hands out an unexpected test, but this time, puts a photocopy of the instructions on Gavin’s desk so he can read and process them in his own time.

 

Tom: Each of these actions is either preventing or reducing Gavin’s stress levels.

 

Simon: It’s like a see-saw.  Gavin’s stress levels will still go up, because of the test.  But his teacher is also taking stress out of the system, wherever possible, to compensate, lowering the see-saw down in the opposite direction.  And a big protector here is going to be Gavin’s relationship with the teacher.

 

Tom: In my mind, building and maintaining positive student-teacher trust bonds is THE crucial component to working productively with intervention-resistant kids.  We’ll see more progress with kids like Gavin when they feel like the we’re on their side, keeping their welfare in our hearts and minds.

 

Simon: And that’s going to make him feel more relaxed – even protected.  Lower stress means Gavin can still engage in emotional, automatic AND logical behaviours.  I think this is why good relationships are the cornerstone of classroom management.

 

Tom: The kids feel like you’re acting in their best interests, keeping them safe.  Okay – what about automatic behaviors?  In the first example, Gavin’s automatic behaviors for the test were all negative… maladaptive.  What approaches have you seen work to replace those behavioral errors?

 

Simon: Well, I think it’s a big mistake – and I see this often – to give your student a strategy, talk it over once and twice, and walk away as if it’s a case of job done.  There’s a big gap between knowing what to do – and actually doing it.  The world’s full of overweight people who know what’s good for them – they should eat less and exercise more – they just don’t do it.  No judgement here – I’m one of them!

Truth is, if we want a behaviour to become automatic, we have to do more than that.  We have to help our kids rehearse the behaviour, over and over; experience being in that stressful situation and then act in a positive way. 

So we expose them to the trigger – the thing that’s causing them stress – but then we practise the positive behaviour in response to that trigger.

 

Tom: Spot on, Simon.  Teaching is more than telling.  If kids are going to display a replacement behavior under pressure, they need to practice it in progressively more realistic hypothetical situations.  That role-playing desensitizes them to the stressors and provides a new response that adequately addresses the stressful situations.  I’m guessing that positive reinforcers for effort and progress are included too.  Yes?

 

Simon: Tom – you’re one step ahead of me!  We follow up with a reward, to encourage that response in the future. That reinforcer doesn’t have to be anything big – it could be praise, a high-five, a sticker on a chart.  My mantra is: Whatever works for the child.  They’re all individuals.

And then – as they say in the gym – it’s doing reps and sets.  This is the bit that gets missed in busy classrooms and schools.  Repeating and practising that trigger and response multiple times daily with the pupil, until it becomes automatic.  Coaching them through.  It doesn’t have to take long, you might be able to practise the trigger and response 5 times in a five-minute session.  Then it’s a case of scheduling that five-minute session every day, or twice a day, or whatever’s needed.

 

Tom: So, when our learners get stressed, they’ve got a newly ingrained automatic behavior they can use to better resolve the situations – instead of resorting to the old, maladaptive one.

 

Simon: Absolutely.  We’re hitting the problem from both sides – we’re reducing the factors that cause the stress in the first place, but then replacing the old automatic behaviours with positive ones. Now our student can cope positively and prosocially when those stressful situations come up.  We rehearse that new behaviour until it becomes second-nature.

It’s interesting because, we know from research that the power of the prefrontal cortex to use self-restraint and logic decreases when under pressure – but under that exact same pressure, automatic behaviours actually become more powerful.

 

Tom: In your experience, how long does this training process take? How long before the student is able to display the new automatic behavior when the situation calls for it?

 

Simon: There’s no simple answer to that question.  Depends on the child, depends on the behaviour.  It also depends on how complex the new behaviour is – if it’s simple, it makes it easier to learn. If it’s complex and involves lots of steps, it’s more difficult to make it stick.

And it also depends on the willingness of the student you’re working with.  If they actively don’t want to change, then no amount of persuasion or repetition is going to work.  It’s like your motto, if you want to…

 

Tom: …teach them, you gotta reach them.  We can use an “evidence-based” intervention with fidelity, but if the student isn’t willing to engage in that process with us, it’s not going to work like it did in the research studies.  I believe that takes us back to an earlier essential point.

 

Simon: Exactly.  We’re back to relationships.  You can’t help someone change if they don’t want to change.  Fortunately, most kids – especially younger ones – are willing to accept the help and see the benefits.

 

Tom: And our older learners with severe acting-out behavior patterns, the ones who are sent to deeper and more intensive levels of special services, almost without exception bring with them a history of myriad bad experiences with educators. Even though our intent is to “expel them to better places”, they’re initially quite suspicious of our motives, especially in anxiety-producing situations.  Simon, I’m not telling you anything you don’t already know when I say that we need to prove ourselves as being different than their expectations for us.  We get to that trustworthy point by using “symptom separation”… working diligently to dissolve and replace the aberrant actions, all the while unswervingly supporting those learners; expressing our belief in their ability to make better behavior choices, and strengthening their faith in the student-teacher trust bonds we’re striving to build with them.  Quite simply; They gotta like the messenger if they’re going to listen to the message.

That brings us back to your vital messages today, Simon. You’ve given us a lot of food for thought regarding the impact and addressing of the stress that our kids with disruptive behavior disorders are experiencing.  How can our readers find out more about these ideas and other knowledge points and skill sets that bring success with our students with behavior challenges?

 

Simon: Well, we’ve got lots of free resources and articles on our website beaconschoolsupport.co.uk – where we always try to join the dots between theory and classroom practice.  Just click on the free resources tab to access them.  And if you’re particularly interested in the impact of stress, I’d also recommend you look at the books and training Stuart Shanker produced around self-regulation.  They’re super-clear and actionable.

 

Tom: I’ve viewed all those freebie materials on your site and read your information-packed e-mail blasts.  Great stuff. For folks reading the transcription of our conversation, let me mention to you fine folks that Simon’s materials are full of what-to-do and how-to-do-it behavior management tips. 

Thanks, my cyber-colleague, for accepting the invitation to talk a bit about how stress impacts our young learners’ ability to focus, calm themselves, and self-manage their actions.  Thanks too for the tips regarding how we can best serve these young people.

Simon, it’s been a pleasure chatting with you.  One last time; Thank you for joining us today!

 

Simon: Good to speak to you too, Tom!

 

 

 

The ONLY book written FOR kids with Disruptive Behavior Disorders!

Great for your classroom library or SEL/Social Skills groups.

Available at https://www.freespirit.com/gifted-and-special-education/survival-guide-for-kids-with-behavior-challenges-thomas-mcintyre/

 

 

 

 

 

 

 

 

 

 

Sep 082018
 

We have nothing to fear, but fear itself!

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Certainly the inspirational phrase from Franklin Delano Roosevelt was intended for a different reason (to comfort and inspire the homefront during WWII), but it seems somewhat appropriate for this week’s write-up and video.  This week we’ll become informed regarding GAD (eGADs & GADzooks!); Generalized Anxiety Disorder.  It’s the first in a series on the anxiety disorders that include the five major types (as per the U.S. Department of Health and Human Services, quoted here):

Generalized Anxiety Disorder

  • Generalized Anxiety Disorder, GAD, is an anxiety disorder characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing to provoke it.
  • Obsessive-Compulsive Disorder (OCD)
    Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as hand washing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called “rituals,” however, provides only temporary relief, and not performing them markedly increases anxiety.
  • Panic Disorder
    Panic disorder is an anxiety disorder and is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.
  • Post-Traumatic Stress Disorder (PTSD)
    Post-Traumatic Stress Disorder, PTSD, is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.
  • Social Phobia (or Social Anxiety Disorder)
    Social Phobia, or Social Anxiety Disorder, is an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. Social phobia can be limited to only one type of situation – such as a fear of speaking in formal or informal situations, or eating or drinking in front of others – or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people.”

We’ll also look at other anxiety disorders such as “Selective Mutism” and other phobias (specific fears).

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Now don’t get nervous!  We’ll take it slow and guide you gently this week.

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Let’s start at the beginning (Yes, I too remember Mary Poppins singing this sentence).  Let’s look first at that general anxiety category.

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Anxiety in Our Lives

We all experience nervousness and concern about life events.  Anxiety is a normal and expected emotion in humans all over our blue-green orb.  We often feel tense before taking a test, and worry about problems at work or home.  Important impending decisions make us bite our lips and nails.

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However, anxiety disorders move beyond everyday stress to longterm distress that interferes significantly with a person’s ability to lead a normal life.  Its causation is more complicated than being of “weak” constitution.  Overcoming it requires more than simply “toughing it out” and “sucking it up”.  An anxiety disorder is a serious mental illness that is socially and emotionally overwhelming… Indeed, it is psychologically crippling.  For people who struggle with anxiety disorders, extreme worry and fear are constant companions.

 

 

As with adults, anxiety in children and youth is a normal part of childhood.  Every child goes through phases… crying as an infant or toddler when separated from the caretaker, fear of the boogie man and other assorted monsters in the closet or under the bed, nervousness about one’s performance before “the big game”, and sweating over the entrance exam for that prestigious high school.  However, these events and phases are temporary and usually emotionally harmless.  Youngsters who suffer from an anxiety disorder experience incapacitating fear, nervousness, and shyness on a persistent long-term basis.  Due to it, they avoid certain places and activities.

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When Nervousness is Magnified

It is estimated that about 1 in 8 children possess an anxiety disorder. Left untreated, this condition places children at high risk for missing out on important social experiences, performing poorly in school, and engaging in alcohol and/or drug abuse to numb the fears and concerns.  With treatment and support, these youngsters can successfully manage the symptoms and engage in normal childhood activities and pursuits.

 

Anxiety is often “co-morbid” (Yeah, I don’t like that term either… it means “can occur at the same time”) with other disorders such as ADHD, depression, and eating disorders.  Given their insecurities, concerns about being judged by others, and striving for perfection, our anxious youngsters may persistently seek reassurance and approval from others.  Children with anxiety disorders are often quite hard and critical on themselves, psychologically self-flagellating for not being “normal” … beating themselves up, emotionally speaking.

 

Whereas, generalized anxiety disorder (GAD) reveals a pattern of overly strong and constant worry and negative stress pertaining to a wide variety of different events and issues, other variations are more finely tuned.

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So… WHAT IS GENERALIZED ANXIETY DISORDER?

Everyone gets anxious and concerned, but it the frequency, duration and intensity of that fearfulness of what might transpire that takes a common human condition and turns it into to a disability

Here are the identifiers:

  • Persistent, exaggerated, excessive unrealistic worrying about everyday things with no obvious reason for doing so.
  • Multiple non-specific worries.  Worries about multiple possible happening/negative outcomes.  Difficulty focusing on one concern without bringing others to mind.

It is the most common anxiety disorder (and perhaps the most common mental health condition).

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DSM-5 Diagnostic Criteria (paraphrased)

Must occur for at least 6 months and occur more days than not.

The child/youth finds it difficult to manage the worry.

The child/youth displays one of the following: restlessnes or a feeling of being “one edge”, becoming easily fatiqued, having difficulty concentrating, irritability, muscle tension, or sleep disturbance. (Adults must show 3 symptoms.)

The disturbance is not due to medications, a medical condition, or another mental health disorder.

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Here’s the GAD video, courtesy of one of the revered grad students in my teacher training program in the area of mental health an behavior disorders.  It describes a youngster before comparing his characteristics with the diagnostic criteria for GAD.  Strategies are presented at the end. – https://www.youtube.com/watch?v=g_lZvBtpkys

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Interventions

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Early and intensive provision of emotional support services is mandatory.  Support from parents, school, and peers is essential.  These supporters will most likely need to be trained so that they can be truly therapeutic in their assistance, and avoid inadvertantly heightening the after-effects of the trauma.Most importantly, the supporters of this youngster must work as a team to establish feelings of being safe and protected in the aftermath of happenings that have created doubt of that safety and security. Therapy sessions by well-trained individuals should allow the youngster to play, draw, write or talk freely about the event.  Reflective listening strategies help the youngster to continue addressing the emotional challenge in a supportive environment. 

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Other sometimes-indicated interventions include behavior modification techniques that promote “desensitization” (engaging in progressive goals that reduce the frequency and intensity of the negative recollections), and cognitive behavioral therapy that teaches the child to reframe the events in a manner that helps to reduce fears and worries.
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Medication can also contribute to a lessening of anxiety, and ability to benefit from counseling as the youngster deals with the emotional after-effects of the trauma.  Some of the common prescription meds are: SSRIs (selective serotonin reuptake inhibitors that stop recycling thoughts), antidepressants, and Bensodiazepines (anti-anxiety/sedatives).Bibliotherapy and play therapy are often utilized.

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During and after the school day, teachers also need to find mental calm; whatever gives one inner peace and strength.  There are many ways to do so; listen to music, exercise, engage in a hobby, spend time with special people, visit the dispensing machine in the teachers’ lounge…

It’s important to ensure that one does not seek calm with too much of this method.

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To assist with that goal, Dr. Donia Fahim, a former colleague of mine in our Department of Special Education at Hunter College, created an audio relaxation tape.

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Knowing that her teachers needed to decompress after their work day, “Dr. Donia”, a former colleague of mine in our Department of Special Education at Hunter College would start and end her evening graduate classes with a short relaxation session.  I asked her to make an audio recording for me.  She was kind to do so.  To listen to this free 11 minute audio,  CLICK HERE Click for more options or here ( https://youtu.be/2Mbg9BXNweQ ).  Call it up, close your eyes, and float away..

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Dr. Mac

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Tom McIntyre, Ph.D. (Dr. Mac)

Professor of Special Education and Coordinator of the Graduate Program in Behavior Disorders

Hunter College of the City University of New York

DoctorMac@BehaviorAdvisor.com

Buy Dr. Mac a Cup of Coffee! Dr Mac - CupOfCoffee (Click on the cup for info) (or go to paypal to say “Thanks”.)

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Sep 082018
 

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But that’s just my free-floating general anxiety in life. 

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HELLO FELLOW B-LISTERS!!  This week, as we continue with our write-ups and (free) videos regarding DSM-5 diagnoses that are found in the records of our students labeled “emotionally disturbed” (Oh, how I hate that term… How about “emotionally challenged” or “emotionally readjusting”?) or “other health impaired” (U.S. terms).  Given the 3-day weekend in the U.S. (celebrating our labor force), let’s give you the remainder of the anxiety videos.  If you’re reading this B-List blast from out side the states, you’ll have to cram it all in during your shorter weekend.

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Before you binge watch these videos related to anxiety disorders, do be aware that you can find the previous weeks’ blasts (Murphy’s Law as applied to behaviour, ODD, ADHD, and Generalized Anxiety Disorder) at: http://www.behavioradvisor.com/blog-3/   You’ll need to scroll down through the listing to find the one you’d like to read. (My tech help went off to college, so we’re stuck with this set-up until I find another teen tech wiz.)

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OVERVIEW: All anxiety disorders have the same derivation: An irrational (to others) fear of something; a perception of a threat to their physical or psychological comfort/safety.

This week, I’ll let the videos do the talking. (Too late?)  Each will provide you with the case study of a hypothetical youngster.  Then the characteristics of that learner will be compared to the diagnostic criteria of the DSM-5 diagnostic manual structure for that disorder.  That part is then followed by suggestions for intervention.

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These videos (made by my wonderful graduate students in my teacher training program in the area of mental health and behavior disabilities) would serve well for short staff professional development sessions.  Professors could make use of them in classes.  Parents of children/youth with these conditions would become more informed.  Spread the informational  wealth!

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So, without further ado, this week’s videos can be found at the following links:

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Agoraphobia (with panic attacks) – (2 parts based on the criteria of DSM-IVtr, an  earlier version of DSM)

                Part 1 – https://www.youtube.com/watch?v=FphWF2yTX3E

                Part 2 – https://www.youtube.com/watch?v=dDZVuz8aAGA

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Generalized Anxiety Disorder (last week’s video) – https://www.youtube.com/watch?v=g_lZvBtpkys

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Obsessive Compulsive Disorder (OCD) – https://www.youtube.com/watch?v=J1Uia0UOGkE

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Selective Mutism – https://www.youtube.com/watch?v=A29zj0LdauM

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Separation Anxiety – https://www.youtube.com/watch?v=ldJ7ocs0gE0

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Social Anxiety Disorder (SAD) – https://www.youtube.com/watch?v=cwEh0rh94XQ

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Social Phobia (the Social Anxiety Disorder diagnosis when it had a different name & slightly different criteria under the previous DSM manual)

                Part 1 – https://www.youtube.com/watch?v=zHiEKwGNoVI

                Part 2 –  https://www.youtube.com/watch?v=rdmjXMuJnSM

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PTSD (Post Tramatic Stress Disorder in children) – Let’s save this one for next week’s mailing. 

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Interventions

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Early and intensive provision of emotional support services is mandatory.  Support from parents, school, and peers is essential.  These supporters will most likely need to be trained so that they can be truly therapeutic in their assistance, and avoid inadvertantly heightening the after-effects of the trauma.Most importantly, the supporters of this youngster must work as a team to establish feelings of being safe and protected in the aftermath of happenings that have created doubt of that safety and security. Therapy sessions by well-trained individuals should allow the youngster to play, draw, write or talk freely about the event.  Reflective listening strategies help the youngster to continue addressing the emotional challenge in a supportive environment. 
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How we phrase things when talking with anxiety-impacted kids can heighten or lower the perception of a threat.
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When the tides of life turn against you… And the waves upset your boat… 
Don’t think of the way things might have been… Just lay on your back and float!
Art Carney (famous comedic actor talking to Jackie Gleason on the old “Honeymooners” TV show)

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Other sometimes-indicated interventions include behavior modification techniques that promote “desensitization” (engaging in progressive goals that reduce the frequency and intensity of the negative recollections), and cognitive behavioral therapy that teaches the child to reframe the events in a manner that helps to reduce fears and worries.
 
 
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Medication can also contribute to a lessening of anxiety, and ability to benefit from counseling as the youngster deals with the emotional after-effects of the trauma.  Some of the common prescription meds are: SSRIs (selective serotonin reuptake inhibitors that stop recycling thoughts), antidepressants, and Bensodiazepines (anti-anxiety/sedatives).Bibliotherapy and play therapy are often utilized.

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How to talk with kids in a manner that reduces anxiety & builds positive relationships

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Freebie for you and your kids with anxiety: Knowing that her teachers needed to decompress after their work day, Dr. Donia Fahim (“Dr. Donia”), a former colleague of mine in our Department of Special Education at Hunter College would start and end her evening graduate classes with a short relaxation session.  I asked her to make an audio recording for me.  She was kind to do so.  To listen to this free 11 minute audio,  here’s the link https://youtu.be/2Mbg9BXNweQ.  Call it up, close your eyes, and fl oat away.

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 GLOSSARY

  • Generalized Anxiety Disorder, GAD, is an anxiety disorder characterized by chronic anxiety, exaggerated worry and tension, even when there is little or nothing apparent to provoke it.
  • Obsessive-Compulsive Disorder (OCD)
    Obsessive-Compulsive Disorder, OCD, is an anxiety disorder and is characterized by recurrent, unwanted thoughts (obsessions) and/or repetitive behaviors (compulsions). Repetitive behaviors such as hand washing, counting, checking, or cleaning are often performed with the hope of preventing obsessive thoughts or making them go away. Performing these so-called “rituals,” however, provides only temporary relief, and not performing them markedly increases anxiety.
  • Panic Disorder
    Panic disorder is an anxiety disorder and is characterized by unexpected and repeated episodes of intense fear accompanied by physical symptoms that may include chest pain, heart palpitations, shortness of breath, dizziness, or abdominal distress.
  • Post-Traumatic Stress Disorder (PTSD)
    Post-Traumatic Stress Disorder, PTSD, is an anxiety disorder that can develop after exposure to a terrifying event or ordeal in which grave physical harm occurred or was threatened. Traumatic events that may trigger PTSD include violent personal assaults, natural or human-caused disasters, accidents, or military combat.
  • Social Phobia (or Social Anxiety Disorder)
    Social Phobia, or Social Anxiety Disorder, is an anxiety disorder characterized by overwhelming anxiety and excessive self-consciousness in everyday social situations. Social phobia can be limited to only one type of situation – such as a fear of speaking in formal or informal situations, or eating or drinking in front of others – or, in its most severe form, may be so broad that a person experiences symptoms almost anytime they are around other people.”

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Dr. Mac

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Tom McIntyre, Ph.D. (Dr. Mac)

Professor of Special Education and Coordinator of the Graduate Program in Behavior Disorders

Hunter College of the City University of New York

DoctorMac@BehaviorAdvisor.com

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