Students With Anxiety in the Classroom: Educational Accommodations and

Interventions
Author(s): Kim Killu, R. Marc and A. Crundwell
Source: Beyond Behavior , August 2016, Vol. 25, No. 2 (August 2016), pp. 30-40
Published by: Sage Publications, Inc.

Stable URL: https://www.jstor.org/stable/26381826

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 Anxiety in the Classroom

Students With Anxiety in the Classroom: Educational Accommodations

and Interventions

Kim Killu University of Michigan-Dearborn

R. Marc A. Crundwell Greater Essex County District School Board, Windsor, Ontario

What Is Anxiety? What Causes Anxiety Disorders?

neurobiological condition
Anxiety disorders, a
common in youth, typically From time to time, all individuals Research into the causal factors of

emerge during early childhood or experience varying degrees of anxiety anxiety disorders has identified a
early adolescence (Kessler et al., 2005) fears, and worries. Anxiety is a normal number of potential sources, including
and are noted as the most prevalent experience that typically reflects genetic, temperamental, psychosocial,
mental health disorder in the child anticipation about events that might and parental factors. Ongoing
and adolescent population. Not have a negative outcome, such as investigations continue to examine the
surprisingly anxiety disorders are theworries about losing a loved one, or origins of anxiety and to assist in
earliest of all forms of apprehension of having to speak in understanding the nature and
developmental trajectory of anxiety
psychopathology to emerge (Beesdo, front of many people. The experience
disorders in children and adolescents.
Knappe, & Pine, 2009). Approximately of anxiety can be the result of a
10% to 20% of children and perceived threat that may be physical
Genetic Factors
adolescents in the general population(e.g., a tornado is approaching), social
and in primary care settings report (e.g., meeting new people), or The role of genetics in anxiety
performance related (e.g., failing an disorders has been studied extensively
distressing levels of anxiety (Costello,
in the last decade and the general
Mustillo, Keeler, & Angold, 2004). Atexamination). Anxiety can be
considered as an adaptive state of findings have been that genes play a
any given time, 6% to 10% of school
arousal if it results in an individual significant role in the transmission of a
age children meet the diagnostic
risk for anxiety that accounts for about
criteria for an anxiety disorder taking some action to deal with or
one-third of the variance in the risk
(Briggs-Gown, Horwitz, Schwab avoid the perceived threat (Beesdo
factors (Chorpita, Albano, & Barlow,
Stone, Levennthal, & Leaf, 2000). Left et al., 2009). If anxiety becomes so
1998). There appears to be a tendency
untreated, anxiety disorders are severe and persistent that the
for general anxiety to exist within
known to persist over months or individual is always in a negative families that is transmitted across
years, impacting the functioning of state of worry or avoids situations to
generations, thereby predisposing
children and adolescents in the school the point that it becomes self
children to the development of a
setting (Kendall, Aschenbrand, & defeating, the anxiety is no longer
specific anxiety disorder. For example,
Hudson, 2003; VanAmeringen, adaptive. Rather, it negatively impactsyouth who experience test anxiety
Mancini, & Farvolden, 2003; the daily functioning of the individualhave a biological predisposition to
Woodward & Fergusson, 2001). in his environment. Under these
high levels of anxiety when they are in
Anxiety disorders in children and conditions, this pattern of responding situations where they perceive they
adolescents are associated with high falls within the classification of an
are being evaluated (Huberty, 2009).
rates of school refusal (Kearney, 2003), anxiety disorder (Pliszka, 2009).
poor academic performance (Ma, Anxiety disorders are a heterogeneous Temperamental Factors
1999), impaired school functioning group of disorders, ranging from Temperament has also been
(Mychailyszyn, Mendez, & Kendall, simple specific phobias, generalized linked to the development of anxiety
2010), and higher school dropout rates anxiety, separation fears, and social disorders in children and adolescents.
(VanAmeringen et al., 2003). Further, phobia, to panic attacks and Temperament is most often referred to
anxiety disorders have long-term obsessive-compulsive disorder. The as an early inherent personality style
negative implications as they have Diagnostic and Statistical Manual of which includes emotionality and
been shown to be associated with later Mental Disorders (5th ed.) (DSM-5; behavioral styles. Research in this area
depressive disorders, suicide attempts American Psychiatric Association, has indicated that some children
and suicidal ideation, and substance 2013) provides a full description of the exhibit a pattern of behavioral
abuse (Benjamin, Harrison, Settipani, diagnostic criteria for anxiety and inhibition, resulting in their
Brodman, & Kendall, 2013). related disorders. withdrawal from situations and peers.

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 Anxiety in the Classroom

These children are noted as less social Cummings, 2012). Although everyone difficulties in performance, the
than their peers and they avoid a worries occasionally, excessive worry anxious student's response is to
variety of social situations. They also can impair social, personal, and experience even greater levels of
present with qualitatively distinct academic functioning and contribute anxiety and concern regarding his
emotional and behavioral patterns to feelings of loss of control (Huberty, performance. This increased anxiety
from their peers. These children are 2009). The characteristics or further interferes with the ability to
described as extremely shy, putting symptoms of anxiety manifest across concentrate and perform. As a result
them at greater risk for developing three domains: cognition, behavior, of this negative cycle, many students
anxiety disorders (Prior, Smart, and physiology (Lawyer & with anxiety-based disorders develop
Sanson, & Oberklaid, 2000). Smitherman, 2004). Often the a sense of learned helplessness that
symptoms are apparent in all three results in avoidance of tasks they
Psychosocial Factors areas, such as a student who presents judge to be difficult. Subsequently, this
Psychosocial variables, such as the with worry (cognition), increased results in low levels of persistence, a
collective experiences of children and activity (behavior), and flushing of thetendency to give up quickly, and
the role of those experiences in the skin (physiology). Of the behaviors withdrawal from tasks where failure
development of anxiety, have been exhibited by anxious children and is perceived to be likely. As this
explored. Children who perceive a adolescents, most reflect an attemptpattern escalates, anxious children
lack of control in their environment by the student to control the anxiety often engage in self-blame and self
are more likely to develop anxiety and minimize its effects (Minihan &deprecation, and worry and ruminate
problems (Chorpita, 2001). Early Rappaport, 2013). about their own competence (Huberty,
childhood experiences have also been Within the classroom and school 2008). Over time, decreases in
linked to anxiety-based problems if setting, each domain may present asmotivation and effort within the
those experiences involve the child's specific characteristics or behaviors classroom are very likely to occur,
perceptions of limited control or if the that can be noticed by the classroomimpacting both academic achievement
experiences create persistent patterns teacher and other school personnel. In and overall academic skill
of anxious emotions. In terms of the the cognitive domain, classroom development.
development of anxiety, isolated behaviors may include concentration
events have less direct effects over and memory problems, attention What Are the Effects of Anxiety on
time; instead, it is the cumulative problems, oversensitivity, difficulties Social Development?
effect of multiple events that leads to with problem solving, and worry. In
the development of cognitive the behavioral domain, characteristics
Anxiety can also impact the social
affective patterns of anxiety or behaviors in the classroom may interactions and social development of
(Huberty, 2008). include motor restlessness, fidgeting,children within the school setting.
task avoidance, rapid speech, Children who experience anxiety are
Environmental Factors irritability, erratic behavior, more likely to have difficulties
Finally, parents can also play a withdrawal, lack of participation, participating in various social-based
role in the development of anxiety perfectionism,
in and a failure to class activities, initiating social
complete tasks. Finally, in the
children. Parents who have high levels interactions with other students,
of anxiety tend to have children withphysiological domain, characteristicsfitting in with same-age peer groups,
anxiety. This outcome is likely the may include tics, rapid heart rate, and making and sustaining
result of the modeling, prompting,flushing of the skin, perspiration, friendships (Scharfstein, Alfano,
and parental reinforcement of anxietyheadaches, muscle tension, nausea,
Beidel, & Wong, 2011). Students with
and related behaviors (Chorpita et al.,
vomiting, and enuresis. anxiety are far more likely to avoid
1998). As a result, children raised by social interactions because they worry
anxious parents tend to view What Are the Effects of Anxiety on that others may reject them; they
situations as being more threatening. Academic Performance? prefer to withdraw and cope with
their anxiety rather than risk rejection.
What Does Anxiety Look Like in the High levels of anxiety negatively In these students, anxiety results in
Classroom? impact academic performance as the subjective distress, cognitive
anxiety adversely influences impairments, and behavioral
While many different responses concentration,
or memory, attention,avoidance (Weissman, Antinoro, &
symptoms have been ascribed to organization of work, and Chu, 2009) resulting in poor social
childhood and adolescent anxieties performance on tests and other networks (VanAmeringen et al., 2003).
and fears, the central characteristic evaluative tasks. As high levels ofSome students may become very
symptom of anxiety-based disorders anxiety impact these areas and the socially withdrawn and attempt to
is worry (Kendall, Settipani, & student experiences increased avoid the majority of situations within

Vol. 25, Iss. 02, 2016 31

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 Anxiety in the Classroom

thoughts and beliefs. Cognitive

the school setting that would require practices for students with mental
them to interact with their peers. Bybehavioral therapy interventions oftenhealth needs have been slow to filter
avoiding social interactions with their
ensure that parents are involved in thefrom research settings to school
peers, social skill development is treatment to facilitate behavioral settings. Wehby, Lane, and Falk (2003)
inhibited and social skill deficits may
practice and help generalize skills to suggested that the limited focus on
become so pronounced that they home and school life. academics for students with emotional
subsequently impact their ability to Studies of CBT for childhood and behavioral issues is due to the
interact with others, particularly in anxiety disorder have supported its limited research on academic
regard to eliciting positive social utility and it can be considered an instruction for this population.
support from others. Students whoefficacious treatment (Silverman, Pina, Standard practice would dictate that
develop patterns of social withdrawal & Viswesvaran, 2008). Chiu et al. interventions are targeted based upon
tend to persist within this pattern (2013) have investigated the use of the unique presentation of symptoms
(Rubin, Coplan, & Bowker, 2009). In CBT within a school setting where a followed by an assessment, with the
this regard, students who have shown treatment protocol was individualized intervention individualized to meet
a pattern of social withdrawal by age to meet the specific needs of each the student's needs and educational
student. Chiu and colleagues (2013) program. The following discussion
seven continue to struggle in this area,
and by age 14, describe themselvesindicated
as that using an outlines accommodations available to
being lonely and having low social individualized, flexible protocol, address the cognitive, socioemotional,
competence and self-worth (Rubin,delivered within a school setting, was behavioral, and physiological needs of
Chen, McDougall, Bowker, & effective for the treatment of
students with anxiety in the
McKinnon, 1995). childhood anxiety disorder. classroom. Many of these
Expanding upon the use of CBT accommodations are based upon a
Addressing Anxiety in the treatment protocols in school settings,practical approach to addressing a
Classroom Lowry-Webster, Barrett, and Dadds student's needs and serve as common
(2001) developed the FRIENDS interventions in classroom settings,
Creating safe and successful protocol that utilized teachers as though they may not have been
facilitators
classrooms for students with anxiety to run group sessions as a
examined in the existing literature
routine
often involves the use of cognitive component of the class within the context of interventions

behavioral therapy and various curriculum for students with anxiety. for anxiety.
practical accommodations. The success of this program is Cognitive accommodations. Anxiety
significant because it suggests that does not impact a student's academic
Cognitive Behavioral Therapy interventions for anxiety can be ability, but instead, the student's
Cognitive behavioral therapy brought into the classroom and academic performance. For students
(CBT) is one intervention for the facilitated by teachers. Integrating with an anxiety disorder the
treatment of anxiety disorders in such procedures into a classroom completion of assignments and
children and adolescents. It is based routine can potentially decrease the examinations is negatively affected as
on the assumption that both cognitive stigma associated with psychologicalthe anxiety impacts concentration,
and behavioral processes can cause treatment and may enhance the memory, attention, organization of
and maintain anxiety (Brewin, 1996).sustainability of the intervention. work, and performance on tests and
There are variations in the form CBT Teacher-facilitated clinical techniquesother evaluative tasks. Directly
takes depending on the specific may lead to greater school-wide addressing academic skill deficits has
disorder to be treated (e.g., separationimplementation of such programs and
been the most effective intervention
anxiety disorder, social anxiety an increased use of empirically for preventing student failure and
disorder, and generalized anxiety supported techniques and strategies in
remediating these deficits (Kauffman
disorder). According to Albano and mainstream classroom management & Landrum, 2013). Educators can
Kendall (2002), CBT for childhood and instruction (Weissman
work with parents to address patterns
anxiety disorders has five et al, 2009).
of difficulty with academic
components: psychoeducational, performance and develop
somatic management skills training, Classroom Accommodations accommodations and interventions to
cognitive restructuring, exposure There are a limited number of address the anxiety itself, and the
methods, and relapse prevention research-based interventions that academic deficiencies resulting from
plans. Protocols aim to teach the childaddress the academic needs of it. Table 1 outlines cognitive
or adolescent new approach students with anxiety. Schaffer et al. characteristics of anxiety, classroom
behaviors, concrete problem-solving (2005) noted that, although schools aremanifestations of those characteristics,
skills, and strategies for challenging uniquely poised to address the mentaland classroom accommodations to
maladaptive or unrealistic anxious health needs of youth, research-basedaddress the characteristics and

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 Anxiety in the Classroom

Ac ommodations

Usea"prbudy"tohelpt sudentsayontaskndprovidepromting(Merc, Mercer, & Pulen, 201 ) Providethsudentwihapotcpyofthe ac r'soanthersudnt'soe(Lwis& Doorlag, 20 6) Providetxboksontape(Boyle tal.,203) Have xamsreadoraly,dictaed,andscribed Alowthesudntosiawyfromactivendrambunctioslamtesodcreas distracionsadincreas focus(Merc etal.,201) Ase tudnperfomancefrquntly,rahetanjust mider/final(Ker&Nlson,201) Provideth studentwihreminderso visualces Usegraphicorganizers(Lwis&Dorlag,206;Merc etal.,201) Adminster xamsinquiet,proctredsetings Postdirections theboard(Lewis&Dorlag,206) Useaignlwhengiv drections(e.g,flashover adlights,ringbel,caphnds)toge students'a entio rtoavidsurpise (Fister&Kemp,195) Providethestudentareducedworkload Provideth sudentwihtme stimaesforw kcompletion Alowfrextnde timeonasignmetsandexams(Merc tal.,201) Providean uditoryandvisual ignalwhengivngdirectons Avoidlengthy,emoti naldiscus ions Discu anyisue tha riseoutsideofclas time Decraseth numberofchoiesprovide to hestudent Alternativeformsofexaminatonadse ment Asithesudntidevlopingalterniversponethandlig ferntsiuaons (Kendal,Chu,Pimentl,&Choudh ry,20 ) Useviuals/pictures/diagrmsduring struciontasi wth eproblmsovingproces (Lewis&Dorlag,20 6;Merc etal.,201 ) Alowthesudntobservothersudntcomplet askbeforatempingaewtsk (Mercer et al., 201 ) Notifyhestudniadvnce,ifposble,ofanyupcomingcha es(Lwi&Dorlag,206) Clarifyguidelnsandexpctaions(Merc etal.,201) Usebilotherapytoadresfarsndprovidecopingstraegis(Forgan,20 ) Useviualstohelpt sudentma genxitesovrtimerlatdisue(.g,Time r®; Mercer et al., 201 ) Asithesudnti devlopingtherp sectivsoniuesofcner (Baret& Short , 20 3) Posthedailycs heduland otifyhestudni advnceofanych ges(Mrce et al., 2011)

Clas ro m Manifesta ions

concepts, forgets as ignments window,roamsthero m,placesheadon desk,has ocialconversationswithpers, an oyspers,ap earslesalert,displays lack of inter st, boredom directionstoberpeatd,completstask incorectly,failstopaycloseatentionto details,makescarels mistakes easily ir tabilty,withdrawl,givngupeasily, refuse tointia e/complet ask , dif icultiesorganizngconcepts persverations,daydreaming,excsive preoc upations, fears
Of taskbehavior,do les,roamstherom Dif cultyap lyingpreviously earned Frequntly oksaroundtheromor ut he Doesnotcmplet work,frequntlyask for Sensitvetocritcsm,senitvetofailure,cries Expres frustraionthroughs ort emper, Task-ir elvantwor ies,rumination,

problems deficits problem solving

Characteristics Concentration Memory Easily distracted Attention Oversensitivity Dif iculties with Exces ive wor y
Table1CognitveCharcteis ,ClasromManifeston,adAcom dationsfrAxietyDsorde

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 Anxiety in the Classroom

manifestation of the disorder in order Lourea-Waddell, & Kendall, 2008). and adjusting to some of the routines of
to assist students with academic task The physiological impact of anxietythe classroom. This original anxiety
completion, task engagement, and can be debilitating for students with
seemed to get better during kindergarten.
increased performance. anxiety and that may be exacerbated She integrated well into first grade, began
Socioemotional accommodations. by the fear and embarrassment maknig friends, and was succeeding
While disordered behavior has induced by an anxiety attack. Table academically.
4 The parents believed that all
implications for academic outlines the physiological was well with Abbey.
achievement, underachievement characteristics of anxiety the Within the past year, however, Abbey
produces social consequences that manifestation of those characteristics,
has complained several times of severe
may foster inappropriate behavior and classroom accommodations to abdominal pain that was worst in the
(Kauffman & Landrum, 2013). This address the characteristics and morning and never present at night. A
inappropriate behavior impedes the manifestations of the disorder in order review of her attendance records indicated
student's productivity, initiative, to alleviate the physical discomfort that she had missed about 20 days from
engagement and performance in the and the impact of that discomfort on the previous school year to the present
classroom across multiple domains the student's sustained presence in because of these reports of pain. The
(e.g., academic, social, the classroom.
parents had pursued these concerns with
communication), resulting in limited their pediatrician, and fortunately all tests
social growth and emotional Case Study: Abbey came back negative for any type of medical
development. Table 2 outlines the Abbey is a 12-year-old girl currently issues that may be causing the pain.
socioemotional characteristics of Abbey has been expressing some general
in the seventh grade at Crestview
anxiety, classroom manifestations of Academy. Over the last year her teachers concerns and anxieties about attending
those characteristics, and classroom(especially the homeroom teacher, Mrs. school in the morning, but has never been
accommodations to address the Girard) and the school administration specific with any reasons why. This year
characteristics and manifestation of
have become increasingly concerned aboutshe avoided a school field trip, staying
the disorder in order to promote socialher. They note that Abbey has a number ofhome with a relative, because she feared
interactions, appropriate behavior, worries and concerns, to the degree that itthe bus might crash with her class
and emotional development in the has started to impact her ability to onboard. Her parents reported that she has
classroom setting. complete assignments and interact with had some increased difficulty falling
Behavioral accommodations.
her peers in the classroom. In private asleep; she frequently asks her paretitsfor
Children and adolescents with anxiety conversations with her teacher, Abbey their reassurance that everything zvill be
disorders often have difficulties
reports that she worries about many issuesalright during the night and into the
behaving appropriately at school, in that do not seem to concern her peers. Hermorning. This report supports the
the classroom, and with peers. While classroom teacher notes that she is classroom teacher's observation that
some students with anxiety may increasingly restless in the classroom andAbbey often appears more tired in the
benefit from medication to assist them
has more difficulties concentrating. Abbeyclassroom, and that she is more easily
in controlling their behavior, studentsreports that often when working on an fatigued as the day goes on.
can also benefit from classroom fust recently Abbey had been
assignment or listening to her teacher
accommodation and modifications to
present, her mind suddenly seems to go extremely concerned that she and
assist them with functional and
blank. At times Abbey appears a little members of her family might be injured in
appropriate behavior. Table 3 outlines more irritable, and she reports to her some form of accident. In the past month
the behavioral characteristics of
teacher that she finds it difficult to controlshe has been unable to sleep the nights
anxiety, classroom manifestation of the worries that she has. Her grades have before she has an exam at school. She has
those characteristics, and classroom fallen since she is not completing her workbecome more insecure at home and
accommodations to address the
like before. She often gives up more easilyrequires more constant reassurance.
characteristics and manifestation of on tasks ivhen she becomes frustrated, andAbbey's teacher also reports that within
the disorder in order to assist these she is not interacting with her peers as the classroom, Abbey is more insecure
students with managing behavior thatmuch as she did in previous grades, about her ability to complete work and
impedes engagement in the academic including her close friends. assignments than before, and she is more
environment.
Because of these concerns, the frequently at the teacher's desk asking
Physiological accommodations. classroom teacher approached Abbey's questions about what she needed to do,
Children with anxiety disorders report
parents, who communicated their belief and asking for reassurance that she is
more somatic complaints than that Abbey has always been a little more performing up to the teacher's
children without anxiety, and the anxious than their other children, almost expectations. If the teacher does not
greater the frequency of these from birth. Parents describe her as a shy, provide reassurance, Abbey typically
complaints, the poorer the student'sreserved young girl in preschool who hadbecomes anxious and cannot complete the
academic performance (Hughes, some initial worries about going to schooltask or assignment. Abbey has also

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 Anxiety in the Classroom

Ac ommodations

atendigscholfrenti day;Bret&Short,203;Kendalet .,20 ) Providepra ngedbrakstomangestr and xiety(Baret&Short,203;Kendal et al., 2000) Devlopindvualizedcom dations metsudent'suiqends(e.g,panict ks incrowds,walkingthrough alwaysalone) Alowfrasignmet odifcatonsuchastpingaresntaiovs.delirngitoheclas (Mercer et al., 201 ) Provideavncednoticeofexamsand signmets Changeth formatofexamstomultipechoiet decrasenxiety Workwith estudntoidentfyrigestoheanxity(Kazdin,20 ) Divdexamsintoegmntsadpreaoutheadminstraionvermultipes ion Modelapro iatersponefrthesudntisuationshatelic anxety(.g,whena pencilbreaks,getanewone,sharpenit;Kazdin,20 ) Teachpositveslf-talkstraegis(Kazdin,20 ) Alowthesudntobrieflyconta fmily embrsoatrusedprsonatcholt "check in" Speakquietlyandcalmywith estudent Bridgesocalgpsbycreating sructional dsocialexprincesformalgroupsftudens Asigntudenstogrups,ather anlowingstudenstoelctgroupings(Merc et al., 2011) Providestu nswithapstousetolavetharewhn ecsary Askthe udntforhis erpfencswithclasprticaon dprovieportunies forthesudent oparticpaeinwaystha remostcmfortable Alowthesudntoselcthisowneaticrowde rlageroupactives(.g,asemblis)
•Systemaicdesnitzaonthrug olepayingor vioexpsurtoaversi tmuli(e.g,

Clas ro m Manifesta ions

Characteristics impendigdom/withdrawl,avoidngiteractions im ine tdeath,withpers,maint ingclose tensio ,shynes,physicalproximty oadults, timdity,bashfulnes refusaltoparticpate
Tero,panic,felingofFleingtherom,hidng,
Table2Socimtonai.Chrcteis ,ClasromManifestonadAcom dationsfrAxietyDsorde

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 Anxiety in the Classroom

Ac ommodations

(Mercer et al., 201 ) interactionswithpers;Baret &Short,203) (Mercer et al., 201 ) teacher,deliveringanitemto heof ice) activities knowledge and confidence get ing al of the material
•Provide xtend timetocmplet asignments •Alowformovemnt hroughout heclasrom •Alowfruseofmanipultvesortheinstrucional dstoprmte ovment •Shapendreifocesu iveaproximatons(e.g,lntheingscholday, •Providethsudentireconsi wrtingadreviwdaly(Merc tal.,201) •Acknowledgethestudent'sanxiety •Askthe udntoslwdonadrepatheinformatinoesur nderstandig •Teachtesudentsre mangemntskil (Kazdin,20 ) •Acom odatelate rivalstoschol/cas •Giveth student xratimefortansitons •Duringtasion,givethsudenta sktocmplet(.g,caryinga temforthe •Provideprefrentialseatinginlarge roups •Detrminethsudent'scomfrtlev withclasromparticpaon •Providesignalsforindvi ualprticpation •Arangeop rtuniesformalgroupinteracionsdurigstucredanustrcued •Alowthesudntoshareinfomatinotpicsnwhic eorsh athemost •Alowthesudent ouseatpercoder,o nte akr •Providethsudentwihacopyfthe ac r'slecturnoestdcreasthpresu of •Provideth studentwihawritencopy fdirectons •Reducethestudent'sworkload •Clarifyguidelnsandexpctaionsforthestudent

Clas ro m Manifesta ions

consta motin,taps encils,tapsfet,drum ing fingers,manipulatingobjectsinhands,wring hands procastinates,requires xcesiveprompting pres ured spe ch to eachrsandclasmates,withdrawl,emotinal, argumenta ive, asilyir ta edbype rs im obilzed,felingsofbeingoverwhelmd isolates self clarifcation rfo aditonalfedback,wil not intiaetask percivedasto dif cult stopsworkingontask whenfrustraed
Frequntlyout fseat,roamstherom,fidgeting,in Refus tocmplet ask,delaydintaion ftask, Sluringwords, if cult ounderstandspech, Socialwithdrawl,nocmpliance,yls/talksback Atempts oleav the nvironment,crying, Requires xcesiveprompting,refus toparticpate, Self-deprcatingcom ents,conti uoslyaskingfor Submits ncomplet work,unwil ngtoacepthelp,

restles nes complete tasks

Characteristics Motor Task avoidance Rapid spe ch Irritability Er atic behavior Withdrawal Perfectionism Failure to
Table3BhaviorlChacteris ,ClasromManifestonadAcom dationsfrAxietyDsorde

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 Anxiety in the Classroom BevondBehovior
Heyonflft

Ac ommodations

take10depbraths;Paine,Radich,Roselin,Deutchman,&Darch,1983) emerge (Kazdin, 20 0)

•Alternatesresfulactiv eswithcalmingactiv es •Providethsudentwihpermisontquietly avethromifnecsary •Provideaquietplacetoretreat •Teachstres mangemntskils(Kazdin,20 ) •Providenivdualizedacom dationstdecrasetrs •Devlopa ntode-scaltewhnsymptosincreas(.g,reta o "safeplc, •Establiharoutineorasit udenti postivepractieofarutine •Providethsudentwihanlteraivstmulstofcusonwhesomaticrespon

Clas ro m Manifesta ions

perspiration,headches,muscletnsion, hypervntila on, ause/vomitng,enuresi, frequnturinaton,bodyaches,chestpains, dif cultyspeaking,diz nes,exageratdstarle response,muscletwiching,hotflashe,chils

Ticks,rapidheart ate,flushingoftheskin,

responses
Characteristics Somatic
Table4PhysiolgcaChrcteis ,ClasromManifestonadAcom dationsfrAxietyDsorde

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 Anxiety in the Classroom

Table 5 Anxiety-Related Resources

Organization Web Address

American Academy of Child and Adolescent Psychiatry http://www.aacap.org

American Psychiatric Association http://www.psychiatry.org/
American Psychological Association http:/ / www.apa.org
Anxiety and Depression Association of America http://www.adaa.org/
Association for Positive Behavior Support http://www.apbs.org
Council for Exceptional Children, Council for Children with
Behavior Disorders http: / / www.ccbd .net
Mayo Clinic http://www.mayoclinic.com
Merck Manuals http://www.merckmanuals.com/professional/index.html
National Alliance on Mental Illness http://www.nami.org/
National Association of School Psychologists http://www.nasponline.org
National Association of Special Education Teachers http://www.naset.org
National Institute of Mental Health http://www.nimh.nih.gov/

decreased her participation in group and what still needs to be completed, so assignments so that she has clear
activities and has appeared more sensitiveexpectations and time lines remain clear instructions to review at any time.
to negative feedback or comments aboutfor all ongoing assignments and tasks. Further, after providing any instructions
her ideas when working in a group, thus During the last period of every day, to the class, each teacher provides Abbey
reducing her willingness to express her Mrs. Girard reviews the day's events with with a quick oral and written review of
ideas. Abbey. Mrs. Girard focuses on reducing these same instructions to ensure her
The school administrator contacted negative self-talk, generating positive self understanding and to reduce her anxiety
the school psychologist and social worker statements, and creating a coping plan for about the task requirements. When
to discuss these classroom concerns. They situations that Abbey found to be most appropriate, they also provide Abbey with
arranged a meeting with Abbey's parents anxiety provoking. She also assists Abbey a rubric of the assignment to assist her in
and teachers to develop an assessment with coordinating her course work for the knowing exactly what is expected within a
plan and subsequent individualized day and developing a checklist to facilitate completed assignment. On a task-by-task
intervention plan to assist Abbey and her self-management of her classroom basis, Abbey's teachers break down tasks
teachers within the classroom that assignments, projects, and homework. into smaller component parts and provide
iticluded a number of accommodations to During this meeting, Mrs. Girard also feedback at the end of each part before
help improve her academic, social, and gives Abbey copies of the day's classroom directing her to initiate the next section of
behavioral functioning. The notes to ensure she has accurate and up the assignment. If necessary, the number
accommodations were viewed as an to-date class folders. They also work on of questions for her to complete are
important step to address Abbey's needs, developing her skills in using an agenda/ reduced. This is most frequently done if
and all team members also agreed to day planner to keep track of all of the Abbey appears more anxious and stressed.
continued collaboration, monitoring, and upcoming school events. A behavior Her teachers also provide her with short
evaluation of Abbey's performance in intervention plan based on reinforcing breaks if she appears anxious, nervous, or
these targeted areas. Abbey's organization of her files and the frustrated with the task. In addition,
Mrs. Girard volunteered to serve as use of her agenda/day planner was under these circumstances, Abbey's
her unofficial case manager and act as the implemented and monitored. The teachers assisted her to recognize these
liaison between all of the teachers that development of this behavior plan focused emotions when they noticed an outward
work with Abbey. Mrs. Girard meets with on the use of positive consequences to physiological manifestation, thereby
Abbey at the beginning of each week to shape and develop her skills in these areas. providing Abbey with an understanding
assist her in developing, reviewing, and These procedures are important as of the physiological, cognitive and
evaluating specific goals for her academic, students with anxiety often have behavioral components of anxiety. The
social, and behavioral functioning. difficulties with organization, planning, teachers also use proximity control with
Together, they zvork to rehearse responses and task completion. Abbey during classroom activities to
to common situations Abbey encountered Across her different classes, all of ensure that they subtly redirect her back to
and to utilize problem-solving strategies Abbey's teachers agreed to follow a task without drawing attention to her off
to address those situations. She works consistent routine with her so that her task behavior in front of her peers.
zvith Abbey to revieiv any assignments day-to-day expectations are predictable. For tests, Abbey's teachers provide
and projects she has so that they could Each teacher provides Abbey with written her ivith study notes and review those
determine how much has been completed, directions for each day's tasks and study notes with her prior to each test.

38 Beyond Behavior

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 Anxiety in the Classroom BeyondBehavior
fcMMlBenavior

implementing
Students with anxiety disorders interventions to assist
often with mild disabilities. Learning
have performance anxietythem
andwith educational programming. Disabilities Quarterly, 20, 203-214.
worry
excessively about what will
Tablebe onresources
5 lists the test
and supports forBrewin, C. R. (1996). Theoretical
and what they need to study, teachers, and caregivers with foundations of cognitive-behavioral
parents,negatively
impacting their studying and subsequent
information on anxiety. Educators therapy for anxiety and depression.
performance. Study notesplay
fora significant
a test reducerole in the Annual Review of Psychology, 47, 33-57.
the anxiety as they provide the exact
identification and assessment of Briggs-Gown, M. J., Horwitz, S. M.,
material that will be on the test, reducing Schwab-Stone, M. E., Levennthal,
anxiety, as well as in developing and
the worry about which content to study. J. M„ & Leaf, P. J. (2000). Mental
implementing interventions. The
Abbey's classroom teachers also provide health in pediatric settings:
accommodations provided to these
her with opportunities for intermittent Distribution of disorders and factors
students are imperative for providing
breaks during the test, and allow her to related to service use. Journal of the
them with an appropriate education
take a short walk around the school and American Academy of Child and
and maintaining their academic
implement behavioral relaxation Adolescent Psychiatry, 39, 841-849.
functioning. The impact of anxiety is
techniques. These techniques included Chiu, A. W., Langer, D. A., McLeod, B. D.,
pervasive and requires a
breathing exercises, visual imagery, and Har, K., Drahota, A., Galla, B. Mv ...
comprehensive and individualized
listening to her favorite music for an Wood, J. J. (2013). Effectiveness of
approach to best meet each student's
agreed upon amount of time before modular CBT for child anxiety in
needs.
returning to complete the test. elementary schools. School Psychology
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