Online degree, online education, part 24. Anxiety Disorders.

Anxiety Disorders in Children and Adolescents in School
Many children and adolescents who either have been diagnosed with an anxiety disorder or have high levels of anxiety experience difficulty in the school setting. Students with anxiety disorders or high levels of anxiety have more difficulty learning new material, receive poorer grades, and do not perform as well on standardized and classroom tests. These students may struggle in core courses such as reading and math. They are also more likely to repeat a grade and drop out of school.
Besides experiencing academic difficulties, children and adolescents with anxiety disorders experience poor peer relationships. Because of cognitive distortions or maladaptive thinking patterns, these children and adolescents view their relationships with others more negatively. These negative perceptions of their relationships with others reduce the likelihood of interactions with peers. These individuals may feel socially isolated and experience depression and feelings of hopelessness.
Symptoms of anxiety can significantly interfere with children or adolescents' social-emotional and academic functioning. In light of these concerns, children and adolescents with an anxiety disorder may be eligible for special education and related services under the Individuals with Disabilities Education Improvement Act of 2004 (IDEA). Specifically, anxiety disorders are categorized under the emotional disturbance (ED) category of disabilities. To meet the criteria for an emotional disturbance, a student must exhibit one or more of the following conditions, and the condition(s) must have occurred over a long period of time and to a marked degree and must adversely affect the individual's educational performance:
1.An inability to learn that cannot be explained by intellectual, sensory, or health factors
2.An inability to build or maintain satisfactory interpersonal relationships with peers and teachers
3.Inappropriate types of behavior or feelings under normal circumstances
4.A general pervasive mood of unhappiness or depression
5.A tendency to develop physical symptoms or fears associated with personal or school problems

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Assessment of individuals With an Anxiety Disorder
To detect an anxiety disorder or high levels of anxiety in individuals of different ages, a multimethod approach to the assessment of anxiety is recommended. A multi-method approach involves the use of different types of measures completed by multiple informants across multiple settings to detect anxiety and comorbid conditions. A variety of assessment techniques, including clinical interviews, rating scales, direct observations, self-report, and psychophysiological measures, are available to assess anxiety in individuals of different ages. Many of these measures are completed by multiple informants (self, parent, spouse, and/or teacher) across multiple settings (home, school, and/or work).
Treatment of Anxiety
Once an assessment or evaluation is completed and high levels of anxiety are detected or an anxiety disorder is diagnosed, assessment results are linked to interventions to ameliorate anxiety and its negative effects. Different treatment strategies are available to address anxiety, including pharmacotherapy, behavioral strategies, and cognitive-behavioral interventions. Additional strategies may also be used to address comorbid issues. Thus, a multimodal approach, consisting of two or more interventions, is often used to alleviate an individual's anxiety and its negative effects.
Pharmacological treatment is one means of alleviating anxiety in individuals. Medications that have been used to treat anxiety include benzodiazepines, selective serotonin reuptake inhibitors, tricyclic antidepressants, and buspirone. Medication is often used in combina-tion with other treatments such as cognitive-behavior therapy because although the medication may reduce anxiety symptoms, it does not help individuals learn to cope effectively with their anxiety.
Behavioral interventions are another means of reducing anxiety in individuals. Relaxation training, systematic desensitization (graduated exposure), and modeling are some of the behavioral strategies used to treat anxiety. These strategies have been shown to be effective. Relaxation training may include deep breathing exercises or progressive muscle relaxation. Progressive muscle relaxation involves individuals learning to relax and tense different muscle groups in order to become more relaxed. Relaxation training may also be found in systematic desensitization. In systematic desensitization, a fear hierarchy is created, consisting typically of 10 to 15 steps evenly spaced. For example, if an individual had a fear of large dogs, the first step in the fear hierarchy may consist of a discussion about dogs. The second step may involve looking at a picture of dogs. The third step of the fear hierarchy may involve driving past a pet shop and so on until the last step, when the individual pets a real-life dog. The purpose of creating a fear hierarchy is to gradually expose the individual, step by step, to the feared stimulus. The graduated exposure can be conducted using imagery or real-life experiences. Relaxation or another incompatible response to anxiety is induced along the way to calm the individual as graduated exposure of the feared stimulus occurs. Modeling is another behavioral strategy used to reduce fears and anxieties. Modeling is based on social learning theory in which an individual observes, either live or on film, a person who interacts successfully with the feared stimulus or situation. The model is typically of the same age and gender as the individual. After watching the model interact successfully with the feared stimulus or situation, the individual is more likely to perform the same behavior, and the fear and anxiety associated with the feared stimulus or situation are reduced.
Cognitive-behavioral strategies, such as self-instruction, self-control training, and rational-emotive therapy, have also been used to alleviate individuals' anxieties. Self-instruction involves the use of positive self-talk to handle anxiety-provoking situations. In self-control training, individuals learn to modify and restructure maladaptive thoughts, resulting in less anxiety in the presence of anxiety-provoking stimuli or situations. Less anxiety experienced then leads to positive changes in behavior because these individuals are more likely to approach the feared stimuli or situations. Replacement of false, irrational beliefs that underlie an anxiety problem with rational beliefs is the focus of rational-emotive therapy.

Prevention of Anxiety
Because anxiety is a common mental health concern facing many Americans today, efforts should be directed toward the prevention of anxiety disorders. The emotional, social, and economic costs associated with anxiety disorders are astronomical. Economic costs alone are estimated to be more than $40 billion per year. Yet, few prevention programs exist. Although prevention programs are costly up front, universal (primary), selective (secondary), and indicated (advanced) prevention programs are needed. Future efforts should be directed toward the development and implementation of these programs, as there will never be enough mental health professionals to provide adequate treatment of anxiety and other disorders.

Patricia A. Lowe and Jennifer M. Raad

EDITOR Neil J. Salkind
Copyright © 2008 by SAGE Publications, Inc.