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.

Online Education And Degree. Part 23. Common Features of Anxiety Disorders

Although different types of anxiety disorders exist, according to Michael Telch, Jasper Smits, Matt Brown, and Victoria Beckner, there are some common features across these different disorders. Common features include escape and avoidance behaviors, chronic worry, attentional hypervigilance, faulty threat perception, and sympathetic activation. Individuals with an anxiety disorder try to avoid or escape from stimuli or situations that make them anxious, and they constantly worry about current and future events. These individuals attend excessively to cues that they perceive as threatening. The excessive attention given to these cues is referred to as attentional hypervigilance. Faulty threat perception is another common feature found among individuals with an anxiety disorder. These individuals erroneously perceive situations as threatening. Sympathetic activation is also a core feature found among individuals with an anxiety disorder. Activation of the sympathetic nervous system producing physiological changes in the body occurs in individuals with an anxiety disorder when there is no real or potential threat. Physiological changes experienced by these individuals in the absence of a real or potential threat may include accelerated heart rate, muscle tension, and increased perspiration and respiration.
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Types of Anxiety Disorders
The Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) (DSM-IV-TR) has identified 15 types of anxiety disorders, including generalized anxiety disorder, separation anxiety disorder, specific phobia, social anxiety disorder, obsessive-compulsive disorder, posttraumatic stress disorder, acute stress disorder, panic attack, panic disorder with and without agoraphobia, agoraphobia without a history of panic disorder, anxiety disorder not otherwise specified, anxiety disorder due to a general medical condition, and substance-induced anxiety disorder. Generalized anxiety disorders, phobias, obsessive-compulsive disorders, panic disorders, and posttraumatic stress disorders are the most common types of anxiety disorders.
Although there are several types of anxiety disorders, each involves an excessive degree of worry or fear about certain stimuli, situations, or events, which significantly interferes with an individual's normal state of functioning. Generalized anxiety disorder is characterized by a chronic, excessive, and uncontrollable degree of worry about a variety of events or situations, such as friends, family, school, work, or the future. Symptoms of generalized anxiety disorder include fatigue, irritability, restlessness, muscle tension, and difficulties with concentration and sleep. Another common anxiety disorder, specific phobia, is characterized by an extreme and irrational fear in response to a specific stimulus, such as animals or insects (e.g., dogs), aspects of the natural environment (e.g., storms), blood (e.g., viewing blood or receiving an injection), situations (e.g., being in small spaces), or other stimuli (e.g., loud sounds or costumed characters). This worry must be present for at least 6 months and may lead to symptoms in children such as crying, clinging, tantrumming, dizziness, shortness of breath, and fainting.
Like a specific phobia, social phobia is associated with particular circumstances and must involve symptoms present for at least 6 months. An individual with a social phobia experiences extreme worry regarding social situations. The individual may worry over or fear the possibility of ridicule, humiliation, or embarrassment in social situations, such as speaking in class or conversing with peers. Individuals with a social anxiety disorder may attempt to avoid or escape social behaviors, and they often have poor social skills. These individuals may also experience symptoms such as trembling hands or voice, perspiration, muscle tension, and blushing.
Obsessive-compulsive disorder involves obsessions (recurrent or persistent thoughts or worries that intrude on, and interfere with, an individual's normal functioning) and compulsions (repetitive behaviors, rituals, or practices in which the individual engages to provide relief from, or comply with, the obsessive thoughts or worries). Common obsessions and compulsions in children include contamination (hand washing), safety (checking), preoccupations with orderliness and symmetry (ordering, aligning), and counting or touching rituals. Individuals with an obsessive-compulsive disorder may feel embarrassed by their compulsions and may experience difficulties related to concentration, preoccupations, and perfectionist tendencies.
Posttraumatic stress disorder refers to stress or worry experienced by an individual following a traumatic event (such as a serious injury, death, or catastrophic event). The individual reexperiences the event (via flashbacks, nightmares, or images), as well as the accompanying physiological arousal, and may attempt to avoid stimuli associated with the event. Following the event, the individual may feel helpless, fearful, agitated, or disorganized and may experience hypervigilance, irritability, and difficulties with concentration or sleep. These symptoms must be present for at least 1 month following the traumatic event. If symptoms are present for less than 1 month, then an acute stress disorder may be present. Similar to posttraumatic stress disorder, acute stress disorder also results from witnessing or experiencing a traumatic event. Symptoms include reexperiencing the event and the accompanying physiological arousal; however, these symptoms are present for no more than 1 month.
A panic disorder refers to recurrent and unexpected panic attacks that are followed for at least 1 month by concern about, or consequences of, having another attack and/or a change of behavior related to the attack. Panic attacks develop abruptly, often last for approximately 10 minutes, and involve symptoms such as heart palpitations, sweating, chest pain, dizziness, fear of dying, feelings of detaching from one's body, and feelings of losing control. If the attacks become more frequent, the individual may come to fear experiencing a panic attack in public places, and develop agoraphobia (fear of public places) as well. However, agoraphobia may also develop in the absence of, and without resulting from, a panic disorder. In these cases, individuals may avoid public situations, such as being in a crowd or traveling in a train, and may experience symptoms of panic in these situations.
Separation anxiety disorder is an anxiety disorder commonly found in children. Separation anxiety disorder refers to excessive and unrealistic worry in response to separation from home or a caregiver. Children with separation anxiety disorder may experience nightmares with separation themes, headaches, stomachaches, or nausea. These symptoms must be present for at least 4 weeks. Separation anxiety disorders tend to decrease with an increase in age. That is, this type of anxiety disorder is common during the childhood years but declines during the adolescent and adulthood years.
Anxiety disorders may also result from external factors, such as a general medical condition or substance use. Finally, for individuals who experience symptoms of anxiety, but whose symptoms, duration, or impairment do not meet the criteria for a specific disorder, a diagnosis of anxiety disorder not otherwise specified (NOS) may be appropriate.
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EDITOR Neil J. Salkind
Copyright © 2008 by SAGE Publications, Inc.

Online degree, part 22. Prevalence of Anxiety and Comorbid Conditions.

Prevalence rates of anxiety in community samples are difficult to estimate, especially given the fact that internalizing disorders, such as anxiety, are often difficult to observe and identify. Prevalence estimates for clinical levels of anxiety in children, young and middle-age adults, and older adults range from 5% to 19%, 6% to 8%, and 9% to 11%, respectively. In general, the prevalence of anxiety disorders has been found to increase with age in the child and adolescent population, decline during the young and middle-age adult years, and slightly increase in the older adult years. Gender differences have also been found in the literature. Specifically, females typically report more anxiety symptoms than do males. However, it remains unknown at the present time whether this gender difference is due to females actually experiencing more anxiety symptoms than males or whether females are simply better able to recognize and report their symptoms of anxiety than are males. On the other hand, overall, more females than males are believed to suffer from an anxiety disorder. However, the gender ratios differ based on the type of anxiety disorder diagnosed and the age of the individual. Despite this variability and the need for further research with regard to prevalence rates among different ages and genders, it is clear that anxiety continues to be a major problem for individuals of all ages and one that can potentially lead to significant difficulties within multiple domains of functioning.
Anxiety disorders have high rates of comorbidity with other disorders. The rate of comorbidity between anxiety and depressive disorders may be as high as 55% to 65%. Speculation as to why these rates are so high is that both anxiety and depression share a similar trait known as negative affectivity, or emotional distress. Negative affectivity includes such affective states as worry, self-dissatisfaction, and sadness. High comorbidity rates may also be due to a sequential link between anxiety and depression, with anxiety serving as an early precursor to a depressive disorder. Comorbidity rates are also high between different types of anxiety disorders. It is not uncommon for an individual who has one anxiety disorder to be diagnosed with another anxiety disorder. Other common comorbid conditions include substance use disorders and disruptive behavior disorders, such as attention deficit hyperactivity disorder, oppositional defiant disorder, and conduct disorder.

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From a trait model perspective, anxiety is viewed as a stable personality characteristic. Without treatment, anxiety disorders may persist. Approximately 45% to 65% of individuals diagnosed with an anxiety disorder do not show remission of symptoms. However, approximately 35% to 55% of individuals do show remission, but many who show remission develop other disorders, especially other anxiety disorders. Anxiety disorders interfere with the social and emotional well-being of individuals. If individuals are still in school, academic development may be impaired. For adults, work productivity may decline and unemployment may increase.
Developmental Precursors or Etiological Factors
Different theories exist about the development of an anxiety disorder. The three most popular models used to explain the development of an anxiety disorder are the biological, behavioral, and cognitive models. Biological explanations of anxiety focus on genetics, neurotransmitters, differences in structural regions of the brain, abnormalities in the immune system, and behavioral inhibition. Genetics is believed to play a role in the development of an anxiety disorder. Genetic influences account for approximately 30% to 35% of the variance in anxiety in most cases, suggesting that anxiety is moderately inheritable. The neuro-transmitter gamma aminobutyric acid (GABA) has received some attention as a possible risk factor in the-development of an anxiety disorder. GABA may increase excitatory responses to real or perceived threats, or it may fail to send messages to inhibit these responses. Perturbations in the hypothalamic-pituitary-adrenal axis indicate structural brain differences in individuals with an anxiety disorder. Behavioral inhibition may be another possible etiological factor. Behavioral inhibition characterizes a child's temperament. Children with this type of temperament are shy and exhibit inhibited behaviors in response to novel stimuli. These individuals are also highly physiologically reactive to such stimuli.

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Behavioral explanations for the development of an anxiety disorder focus on learned behaviors. According to behaviorists, anxiety is a learned behavior that is acquired and maintained through a combination of classical and operant conditioning, operant conditioning alone, or modeling. From a classical and operant conditioning perspective, anxiety problems result when a neutral stimulus, such as a large dog, is paired repeatedly with an aversive stimulus (i.e., an unconditioned stimulus), such as a loud noise, to produce an unconditioned response, such as a startled reaction. Through repeated pairings with the unconditioned stimulus, the neutral stimulus becomes a conditioned stimulus, and this conditioned stimulus will produce a conditioned response. In other words, the presence of a large dog will result in a startled response without the loud noise being present on a regular basis. The conditioned stimulus (i.e., a large dog) will then be avoided, and by avoiding the conditioned stimulus, an individual's anxiety is reduced. The avoidance behavior demonstrated by the individual in response to the large dog is an example of operant conditioning. In operant conditioning, the stimulus, task, or situation feared is maintained by a negative reinforcement con-tingency. The feared stimulus, task, or situation is avoided, and the avoidant behavior is maintained because it reduces the individual's anxiety. In modeling, the individual observes the behavior of significant others in response to aversive stimuli, tasks, or situations. When significant others exhibit avoidance behavior and anxiety in response to aversive stimuli, the individual learns to model these behaviors. Exposure to similar aversive stimuli, tasks, or situations will produce similar behaviors.
The cognitive approach to anxiety disorders assumes that distorted cognitions are responsible for symptom manifestation. According to cognitive psychologists, individuals who have an anxiety disorder or experience high levels of anxiety exhibit threat-related attentional and interpretative biases. These individuals attend to threat-related stimuli, and they interpret ambiguous or neutral stimuli as threatening.

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

Online Education, College Degree, Part 21. ANXIETY.

Anxiety is a common mental health concern facing many Americans today. In 1997 Thomas Huberty defined anxiety as a unique emotional state characterized by feelings of distress and tension about real or anticipated threats that may manifest in cognitive, behavioral, or physiological patterns. Anxiety can have devastating effects on individuals, as it can interfere with their learning and social and emotional development. In this entry, general information about anxiety is presented. Common features found among the anxiety disorders, types of anxiety disorders, and etiologi-cal factors underlying anxiety disorders are discussed. Prevention and intervention strategies are covered.
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Components of Anxiety
Anxiety is a complex emotional state and may involve and influence multiple domains of an individual's functioning. Specifically, an individual may experience cognitive, behavioral, and physiological effects. Common cognitive symptoms of anxiety include excessive worries, concentration difficulties, and memory and attention problems. Anxiety may also be manifested through such behavioral symptoms as motor restlessness, difficulty sitting still, and attempts to escape or avoid anxiety-provoking stimuli or situations. Finally, anxiety also includes physiological symptoms, such as muscle tension, increased perspiration, rapid heartbeat, headaches, and stomachaches.
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Anxiety as a Unique Emotion
Anxiety is a unique emotion as it can be viewed in both a positive or negative light. A slight amount of anxiety can be helpful and facilitate an individual's performance, whereas too much anxiety can be debilitating and hinder one's performance. In small amounts, anxiety can serve as a motivator and lead to optimal performance in school, work, sports, or other areas in an individual's life. For example, a student can become slightly anxious before a major exam. The slight anxiety felt can motivate the student to study for the exam and do better because of the time spent preparing for the exam. In contrast, high levels of anxiety may interfere with the student's ability to concentrate, process information, or retrieve information from long-term memory. Under these circumstances, the student is less likely to perform his or her best on the exam.
Anxiety can also alert an individual to a potential danger. The fight-or-flight response, also referred to as the acute stress response, involves the activation of the sympathetic nervous system in an emergency situation. The individual will respond to a threatening or dangerous situation by fighting or fleeing. Thus, many believe that anxiety serves as a survival mechanism and protects the individual from harm.
Besides its positive and negative aspects, anxiety can be viewed as a normal indicator of development. During the normal course of development, individuals experience fears and anxieties, but the specific fears and anxieties experienced vary as a function of age. Moreover, there is some evidence to suggest that the number of specific fears and anxieties decrease with age, whereas others suggest that the number of specific fears and anxieties remain the same across the life span. Sources of anxiety for infants include loud noises, strangers, and novel stimuli, and for toddlers, separation from major attachment figures and imaginary creatures. Children fear large animals, darkness, and natural events, and adolescents fear social alienation. Sources of anxiety for adults include natural events, injury, and financial issues. Most individuals experience these age-specific anxieties and fears, which are mild and transient in nature.
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EDITOR Neil J. Salkind
Copyright © 2008 by SAGE Publications, Inc.

Online Education And Degree. Part 20. ANDROGYNY.

Androgyny is a term derived from the Greek andras (avSpaq—man) and gyne {yovx\—woman) referring to either the absence of any distinguishing masculine or feminine traits, as in the Hijras of India, or the combination of both masculine and feminine characteristics, whether spiritual, psychological, or physiological.
Most Western cultures presume a binary opposition between male and female. In the 1950s, June Singer revived a mystical interest in androgyny, reconciling the "masculine" and "feminine" aspects of a single human, restoring the balance between what Jung called animus and anima. Like Mircea Eliade and Carl Jung, Singer treated androgyny as archetypal, in which the divided self yearned for the complete reunion of male and female. This understanding of androgyny as a metaphysical ideal was implicit in shamans or deities like Buddha, Shiva, Kuan Yin, and Elohim. Even so, Singer believed that the sexes were naturally differentiated: that males are generally aggressive, dominant, hard, and logical, and women are passive, compliant, soft, and intuitive.
In 1974, Sandra Bern published the Bern Sex Role Inventory (BSRI), a self-test listing 20 socially desirable female traits, 20 socially desirable male traits, and 20 considered to be neutral. Male traits included "forceful," "analytical," and "self-sufficient"; female traits included "sympathetic," "loyal," and "compas-sionate"; and neutral items included "truthful," "sincere," and "friendly." Scores revealed the respondent's self-reported possession of socially desirable, stereotypically masculine and feminine personality characteristics. An individual who received high scores for both female and male traits was defined as androgynous, whereas one with low scores in both was described as undifferentiated. Gender traits had little correlation with the ascribed sex of participants. Like Singer and Jung, Bern believed that people who had androgynous psychological traits were the most effective and well-functioning individuals in society.
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At this time, Constructivism claimed that gender was socially constructed and could therefore be changed at will. Resistance to gender binaries and heterosexuality took the form of transvestitism, or performances as drag queens or drag kings. Kate Bornstein, having performed as a cross-dressing performance artist and encouraged the self-construction of "who you are," used surgery to change herself in 1998 to a "male-to-female lesbian transsexual" but has now settled into being neither male nor female, a gender outlaw.
To describe a born male as "lesbian" indicates some of the conceptual change required by this new gender fluidity, but it did not necessarily accommodate androgyny. A medical category, gender identity disorder, was created to describe those who felt incompatibility between their felt identity and their anatomy. Improvements in surgical processes made it possible to normalize anatomies as normalized male or female, and medical research sought to explain sex "transgres-sions" (gender identity disorder, cross-dressing, or homosexuality) physiologically in order to remove blame and effect a "cure." A few transsexuals, like female-to-male Jamison Green, rejected such normalizing "cures" and accepted their androgynous status to the extent of having hormone treatment but not requiring a surgically constructed penis or denying their past.
Despite a relatively low level of sexual dimor-phism in humans, Charles Darwin had naturalized the sex binary in The Descent of Man by referring to naturally selected sex differences between male and female in gonads, sex organs, body mass, amount and placement of body hair, intelligence, psychological traits such as aggression, and child-rearing practices. But he tended to overlook the high amount of androgyny in the natural world, for instance, in worms and snails. About 30% of the fish species on a coral reef start out as males and end as females, or vice versa, or are both male and female at the same time. Could humans be naturally androgynous?
In 1993 in Bodies That Matter, Judith Butler argued that even though we construct gender, our material bodies sometimes prevent us from conforming to social norms. Earlier in Gender Trouble, she claimed that drag queens in their "queer performativ-ity" demonstrate resistance to being required to "perform" normal dichotomous roles of male or female which they do not feel. The existence of physically androgynous humans challenges those dichotomies at an even more profound level.
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Anne Fausto-Sterling estimates conservatively that 1 in 1,000 persons is born with androgynous physiological features. Previously called hermaphrodites, they are now medically defined as intersex, a term, like androgyny, applied to any person with characteristics determined as neither exclusively male nor female, or combining features of both. The most common cause of so-called sexual ambiguity is congenital adrenal hyperplasia, an endocrine condition in which the adrenal glands produce unusually high levels of virilizing hormones. In genetic females, this leads to an appearance that may be slightly masculinized (large clitoris) to quite masculine. Another form of intersex is andro-gen insensitivity syndrome, in which people born with masculinizing Y chromosomes do not develop male morphology. Other physiological androgynes show chromosome variations such as 47XXY, 45XO, or mosaics. Far from being revered as complete or ideal persons, such anatomical androgynes are usually classified as male or female sex at birth and surgically or hormonally transformed into either male or female in childhood, with remaining variations of the male-female binary seen as transgressive.
Bern and Fausto-Sterling argue that the danger of perpetuating the male-female binary lies in the fact that cultural roles and norms remain dictated by males and highly polarized male values. The placement of the androgyne at the center of our understanding of physical and cultural humanness and our acceptance of complex combinations of male and female defuse current hegemonies.

Felicity Ann Haynes







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

American Indians and Alaska Natives 2.

The 21 st Century
Today, the U.S. Census Bureau reports that the First Nations are a young population as compared with other ethnicities, with just less than half living on a reservation or federal trust land and a little more than half living in urban areas. First Nations persons are overrepresented within the numbers of negative social and economic indicators of disparity. Though rates vary widely between tribes and geographic regions, the First Nations find themselves with many of the most disparaging statistical measures of societal success. Economically, they lag behind other ethnic populations, having high poverty and unemployment rates and disproportionately low educational opportunities and graduation rates at all levels. Physical health disparities include high rates of diabetes and heart disease. Mental and behavioral health disparities include depression, posttraumatic stress disorder, and alcohol abuse for the First Nations as a whole.
First Nations children and youth receive disproportionately low levels of prenatal care as compared with other populations. They are exposed to alcohol in utero at higher rates and thus suffer rates of fetal alcohol syndrome disproportionately. As a group, First Nations youth endure disproportionate rates of diabetes, obesity, inner ear infection, cancer, and toxin exposure. The lack of accessible culturally competent health care compounds the negative impact on First Nations health. Suicide and homicide are among the top 10 causes of death for First Nations youth ages 5 through 14 years, and loss and grief follow this young population as a whole, given the historical and persistent struggles with which it is faced. Emerging public health issues for the First Nations include high rates of pregnancy for young women and girls who have insufficient access to prenatal care, escalating rates of sexually transmitted disease (including HIV/AIDS), and an explosion of gang involvement, even in reservation areas.
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Health, Resiliency, and the Balance way
The disparities and impacts of coloniztion with which many First Nations struggle is best conceptualized through an Indigenous worldview. The situation then becomes historically bound and has been framed by First Nations elders and tradition keepers as transcending time in a spatial fashion and experienced both individually and collectively. Thus, historical events are experienced in real time by individuals and their communities. Healing occurs through communal support and recognition of suffering and ritual interventions. In this way, suffering is acknowledged by the individual and his or her support system, and assessment, diagnosis, and treatment occur via a vehicle that emphasizes both individual and group strategies. First Nations scholars and clinicians advocate for an intervention framework that recognizes the inter- and multigenera-tional nature of the loss, stress, and trauma to which American Indians and Alaska Natives are exposed. Such a framework is congruent with the First Nations concept of time and healing and draws upon the use of traditional concepts and strategies.
Assessment, Diagnosis, and Treatment: First Nations Values and Ancient Knowledge
Despite the breath of diversity within the First Nations population, pan-cultural values and worldview perspectives exist. One commonly held view is that of time as cyclical and spatial versus linear, as conceived by the mainstream. Emphasis is on process rather than product. Contextual space or environment is often closely tied with experience and thus with healing. The First Nations see all as connected, whether celestial, elemental, mineral, fauna, animal, or human. Relationships are not compartmentalized along blood lines but rather viewed as broad connections that invoke relational roles. For example, siblings and cousins may be seen as equivalent relationships for an individual, and both will be referred to as brothers or sisters. In this spatial worldview, conceptions of wellness and ill health, life and death are grounded in the idea of keeping balance internally and with the world around one's self, and moving from one time-space domain to the next, respectively. Traditional healers utilize place (e.g., sacred locations) and integrate the help of other elements (e.g., plants, animals) to aid in helping the indi-vidual rebalance. Given the value placed on process and the cyclical nature of existence, all human experiences are held as important. Events such as dreams, visions, and premonitions are integrated into the healing process and not pathologized in the vein of mainstream psychology. Traditionally, there is a broad acceptance of difference and individual diversity, and thus a strategy of relative noninterference exists. Persons are supported through change individually with a healer and/or communally, and they are encouraged to find their own path to meaning and balance, utilizing their own gifts and strengths in doing so. This idea of individual difference and noninterference is quite divergent from mainstream thinking and is particularly evident in mainstream socially constructed concepts, such as that of gender or sexual orientation/preference. Pan-culturally, First Nations persons traditionally view gender as discrete from sexual orientation, identity, and preference.
Given the historical context within which the fields of psychology and education have developed and the current statistics the First Nations face, it is clear that pervasive cultural competence is lacking in assessment, diagnosis, and treatment of this population. Stereotyping, stigma, and discrimination pervade the intervention process with the First Nations and are highly correlated with low rates of contact and retention within the helping professions. Clinicians must consider the possibility of institutional distrust on the part of First Nations clients. Accommodation must be made for cultural differences present between the client and the clinician as well as between the client and the system of service. Language can pose a particular roadblock to intervention, regardless of whether the client speaks English as a second or a first language. Previous generations pass down the cultural worldview housed in Indigenous languages. First Nations languages are relational and descriptive in nature and do not accommodate compartmentalization as English does. Most Indigenous languages provide an understanding of the world as either animate or inanimate, not living or dead. Gendered language too is relatively nonexistent in the fashion of Western-mainstream languages. A close examination of popular standardized assessment and diagnostic tools quickly reveals their inability to competently accommodate First Nations clients. The vast majority of such tools, including the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition, Text Revision) (DSM-W-TR), have been developed through a linear, White mainstream worldview, and few have been standardized or explored in relationship to their use with the First Nations.
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Learning: indigenous Science and Knowledge Acquisition
American Indians and Alaska Natives have had sophisticated systems of hypothesis testing and knowledge acquisition for thousands of years. This knowledge has persisted in oral, written, pictorial, and ritual traditions. Unfortunately, systemic racism, discrimination, and ignorance have all played a role in the perpetuation of the stereotype of First Nations science as a proto-knowledge, a less sophisticated form of Western-mainstream constructs. It is in this atmosphere that First Nations persons are educated by mainstream institutions of learning. Acculturation and assimilation pressures are significant for First Nations children in educational settings and persist through higher education.
Preschoolers may encounter difficulties adjusting to their new setting and its demands. Traditionally, First Nations youth are raised with close attention to attachment building and may share a bed with their primary caretaker(s), may be breastfed until they are 3 or 4 years old, and may enjoy the attention of multiple caretakers regardless of blood ties. Children entering ele-mentary school are often encountering mainstream culture for the first time and can be shaken by the shift in worldviews within which they must function. Boys may be ridiculed for keeping their hair traditionally long, and all youth are subject to defending themselves against the onslaught of holidays and practices celebrated in school systems that may be Christian-focused or U.S. nationalist. Language issues can be a particular challenge, and children may be required to shift from an experientially based traditional educational focus at home to a more linear, prescribed learning style in the educational setting. By middle and high school, First Nations youth often confront the full force of stereotyping and discrimination, as well as the aforementioned risk factors. They may encounter existential crises, struggling to integrate traditional spiritual beliefs with mainstream culture. The risk for internalized oppression is great, as teens strive for identity and self-preservation. A traditional adolescent may attend a school that promotes stereotyping and demeans the spiritual worldview of First Nations persons via Indian mascots or the promotion of, and forced participation in, Christian-based activities. This pressure mounts as those First Nations youth who do graduate from high school attempt to make their way to college. College students may have to travel great distances from their tribal communities and lands, deepening existential struggles. In higher education they find few First Nations mentors, little funding, and can struggle greatly to resolve the rift between their traditional worldview and that of the Western mainstream.
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Indigenizing the Mainstream
Best practices with American Indians and Alaska Natives mandate the integration of traditional knowledge, practices, community, and tradition keepers. Successful strategies and programs are individualized and recognize the potential for divergent worldviews and diversity within this group. Legitimate ways of knowing and healing are held within the First Nations culture and have been utilized for thousands of years to educate and heal this group. The educational psychologist will find a wealth of helpers within the commu-nity's natural supportive structure. Elders, traditional healers and mentors, extended family, and many others can be of assistance for case conceptualization and treatment. Traditional knowledge and values can be found in a group's original instructions (creation story) and provide a useful framework for conceptualizing a client's struggle, as well as his or her ethnic identity. Finally, policies that support the integration of understanding between the mainstream and First Nations may be supported by educational psychology as socially just objectives that promote healing and understanding for both groups.
Leah M. Rouse Arndt




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

American Indians and Alaska Natives

AMERICAN INDIANS AND ALASKA NATIVES
American Indians and Alaska Natives (AI/AN) are persons descended from the original inhabitants of North, Central, and South America and the Caribbean. Those who occupy what is now the State of Alaska are referred to as Alaska Natives. The colonization experience of Alaska Natives is originally seeded in Russian occupation, but their experience mirrors that of the tribes in the lower 48 states. As a group, tribal peoples of the Continental United States are referred to herein as First Nations persons. In the United States, there are more than 560 federally recognized nations and an untold number of non-federally recognized groups. These First Nations are culturally distinct and include populations speaking more than 300 discrete languages. The 2000 U.S. Census Bureau reported First Nations persons of full or partial decent comprise roughly 1.5% of the total U.S. population, accounting for slightly more than 4 million persons. In 1987, Russell Thornton estimated the population had exceeded 72 million in 1492. By 1800, according to Thornton, the number had been reduced by roughly 95% as a result of disease, warfare, and oppression. Systemically, the fields of education, mental and behavioral health, and medicine are products of this historical context. A conscious endeavor to comprehend the First Nations experience is essential to any professional working with this population. Sadly, this process is generally not undertaken during academic pro-fessional training. Following is a discussion of the historical implications for First Nations persons in relation to their inter- and multigenerational experience. Cultural resiliencies and treatment implications are considered, as well as best-practice frameworks.
Historical Context
It is widely recognized that Columbus was not the first European to make contact with the Americas. Regardless, this discovery myth persists and permeates presumptions about the First Nations in many fields, including educational psychology. The consequences of Columbus's contact, however, have been significant. One of the earliest outcomes of his arrival was the enslavement of Indigenous inhabitants. European-modeled slavery directly contributed to the mass disruption of many tribes' gender role structures and systems of government. Tribes were impacted differently by slavery depending upon the era in which they interacted with the newcomers; however, contact generally magnified intertribal disputes and fostered a divide-and-conquer stance toward the First Nations. Perhaps at the height of irony, some First Nations even adopted a pseudo-European model of slavery after years of intermingling with those of European and African descent. When slavery was abolished in the United States, all but one slave-holding tribe extended full tribal citizenship to newly freed slaves. This entitled former African slaves the right to acquire land, tribal representation, and protection under tribal laws, therefore requiring the U.S. government to deal with such persons as African Indians. Slavery historically correlates with the introduction of blood quantum as a measure of ethnic identity and belongingness for First Nations persons, a concept formalized within the federal reservation system. The impact of European-modeled slavery in the Americas is complex and ongoing, and its understanding changes the completion of what has traditionally been perceived as a Black and White element of American history.
More devastating than slavery to the First Nations and their ways of living was the impact of disease post-1492. Of the many diseases brought to the Americas by Europeans, the greatest killer was smallpox. This disease followed trade and warfare routes and struck in repeated waves of pandemic, decimating the vulnerable immune systems of the First Nations. Thornton has identified scores of other diseases introduced by Europeans, including measles, the bubonic plague, cholera, several variations of venereal disease, and rare forms of influenza and respiratory disease. Likewise, the introduction of African slaves to the Americas saw the presentation of diseases such as malaria and yellow fever. Thus, the clear conqueror of the First Nations was the repeated exposure to dis-eases by which they were decimated at a horrific and incomprehensible rate.
As the First Nations population decreased and the number of Europeans increased, the competition for land and resources became a focal point for conflict. Warring European groups, such as the French and English, capitalized on traditional rivalries between some First Nations tribes and forged alliances with opposing tribes. Most alliances were relatively short lived and dissipated once the First Nations were no longer of benefit to their White allies. Tensions soared between Europeans and the First Nations as the United States of America declared its independence. With the cultural integration of European tools of war such as the horse and firearms, conflicts between the two groups became more intense and lethal. The United States adopted a strategy of treaty making and entered into agreements with First Nations tribes, promising to cease hostilities in return for land concessions on the part of First Nations persons. Between the years of 1775 and 1890, hundreds of treaties were signed between the First Nations and the United States, though few were honored by the United States for any meaningful length of time in their original form. Tribes continued to be encroached upon, and armed conflict flourished. The U.S. Bureau of the Census indicated in 1894 that more than 53,500 American Indians were killed in wars between the United States and First Nations tribes. This number is likely in the hundreds of thousands if one includes the numbers who died as a result of Indian against Indian warfare as an outcropping of some tribes' alliances with the U.S. government. Acts of genocide add to First Nations casualties. Genocide includes acts intended to destroy (partly or wholly) a national, ethnic, racial, or religious group, including killing or causing serious bodily or mental harm, instituting living conditions highly correlated with death, preventing births to the group, and/or forcibly transferring children of one group to another. Both the U.S. government and its citizens committed acts of genocide. Often cited are incidents of germ warfare via infected blankets given to some First Nations; however, it is difficult to determine how many deaths may have occurred in this fashion, if any. Clear examples of genocide against the First Nations are found in incidents such as the hunting down and murder of First Nations persons during raids in the California and Texas territories, where American Indians were commonly viewed as less than human. In addition, scores have died as a result of harsh governmental policies that fostered little chance for sustenance and survival. It is difficult to discern where acts of warfare end and genocide begins. Many of the incidents of the Indian Wars once described as battles, such as those at Sand Creek and Wounded Knee, have now come to be known as massacres of First Nations persons instead.
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Though resistance continued on a relatively small scale after 1890, that year is generally recognized as the end of the Indian Wars. As the First Nations fell under the control of the United States, relocation and removal were increasingly used to deal with "the Indian problem." Removals persisted for decades following 1890, and nearly every First Nations group was affected by relocation as the United States strove to accommodate its encroaching settlers. These forced moves separated individuals from their families, communities, and traditional lands upon which entire ways of life and worldview systems resided. During marches, tribes often endured harsh treatment and conditions, cutting to the core of the human capacity to make meaning of what was being endured. High rates of mortality were recorded, and historical writings reveal the emergence of modern-day disorders such as refugee syndrome and concentration camp syndrome, conditions currently recognized as manifestations of posttraumatic symptoms. The First Nations were faced with repeated and persistent stress, trauma, loss, and grief to which they were forced to respond. A core source of resilience and coping was found in the pan-Indigenous value system and worldview. The First Nations turned to their spiritual leaders for guidance and hope. As the U.S. government sought continually to manage its Indian problem, it resorted to an apartheid approach of diplomacy—the reservation system. Tribes were generally removed from traditional lands and given dominion over a smaller tract. The life on reservations was often appalling, with starvation, violence, and death all too frequent. The changes First Nations persons faced were pervasive and affected their mental, behavioral, and physical health. The impact of this paternalistic treatment by the United States persists, and First Nations persons continue to struggle with the implications.
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As American Indians and Alaska Natives fell under the increased control of Whites, acculturation and assimilation pressures mounted. This is particularly true in respect to the education of First Nations youth. The boarding school era is recognized by First Nations scholars and professionals as the most destructive period in U.S. Indian policy. During the 1800s and 1900s, First Nations children were removed from their homes, as early as age 5, and sent to Christian mission and Bureau of Indian Affairs schools for European-oriented education with a focus on assimilation into White culture. Probably the most famous school was Carlisle Indian School in Pennsylvania, the first off-reservation government-sponsored boarding school. The school was established in 1879 by Henry Pratt, a veteran of the American Civil War and the Indian Wars, whose goal was the complete assimilation of the First Nations. Pratt's motto was "Kill the Indian and save the man." This stance toward Indian education continued well into the 1900s, and First Nations youth were trained in domestic and labor tasks via the school's outing system that prepared them for their place in White society. Children were not allowed to practice traditional culture and were prevented from speaking traditional languages and wearing traditional hairstyles and clothing. First Nations youth were forced to practice Christianity and forbidden, often in the face of physical threat, to practice their traditional religions. Children were subjected to harsh punishment in the military fashion of the schools' educational philosophy, and many children endured emotional, physical, and sexual abuse. This era saw generations torn from their traditional, holistic ways of learning and knowledge acquisition and reared instead in a militaristic, institutional setting virtually devoid of the caretaker bonds now recognized as fostering healthy attachment and relationships. The full effect of the boarding school era continues to be examined in respect to both the costs to and the resiliencies drawn upon by First Nations persons.
As failed Indian policies became apparent to the mainstream citizenry, the political tide turned from paternalism to that of fostering self-determination. One failed attempt at this goal was that of Termination. Termination policy was instituted in the early to mid-1900s to defederalize tribes, dissolving their political status as sovereign nations within the United States and thus their trust relationship with the government. The naive intention was to end governmental paternalism, but what was actually instituted was another form of forced assimilation. First Nations persons were subjected to state laws, and tribal lands were converted to private ownership by former tribal members. First Nations persons were forced to own land individually versus communally and were often forced to utilize it for farming, though virtually no provisions were made for helping tribes obtain the needed capital for such an endeavor. Much of the land made its way to White owners when the Indigenous owners were forced to sell it to support themselves and their families. Virtually overnight, First Nations persons in as many as 100 reservations, bands, and rancherias became not Indian as defined by mainstream law. Termination policy has resulted in significant identity struggles for many American Indians and Alaska Natives, as one's ethnicity is defined by another, seemingly at whim and on a continuous basis. An additional outcome of Termination was the mass removal of First Nations persons from reservation areas to urban areas with the promise of employment, education, medical care, and improved quality of life. Unfortunately, what many First Nations families found was poverty and an increased sense of marginalization, as they were now separated from their tribal communities.
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The 1960s marshaled in an era of societal and political change in the United States. Self-determination for the First Nations emerged as a priority, and the coming decades saw increased emphasis on fostering sovereignty. The Indian Civil Rights Act of 1968 was passed, prohibiting states from assuming jurisdiction over federally recognized tribal peoples and their lands under Public Law 280. The Indian Education Act of 1972 was an initial effort to require specialized training for educators in an effort to produce and fund cultural competency and to stimulate local attention to First Nations issues. The Indian Self-Determination and Education Assistance Act of 1975 encouraged tribes to assume control over federally funded program provided additional funding. The Indian Child Welfare Act of 1978 was a response to the massive removal and institutionalization of First Nations children via foster care, adoption, and detention in juvenile facilities. First Nations children were to be preferentially placed with First Nations families under the jurisdiction of tribal courts. The American Indian Religious Freedom Act of 1978 recognized the right of First Nations persons to practice their religions and required federal entities to adopt policies of noninterference. In 1988 the Indian Gaming Regulatory Act further defined tribal sovereignty. Also in 1988, Section 5203 of the Tribally Controlled Schools Act added to the intent of the Indian Civil Rights Act and fully repudiated Termination policy. The Native American Graves Protection and Repatriation Act of 1990 acknowledged the profound impact that centuries of objectiflcation have wrought upon the First Nations. The remains of First Nations persons and their burial sites were recognized as sacred, and scores of the deceased were released from museums around the world and returned for proper rites among their peoples. Finally, the Indian Arts and Crafts Act of 1990 furthered the de-objectification of First Nations peoples and helped turn the tide of cultural acquisition.


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