Children who cope with the daily frustrations and embarrassments of a learning disability (LD) may become excessively worried or anxious. A "vicious cycle" can develop, as the anxiety begins to make already difficult challenges with school and friendships even worse. What can parents do to prevent anxiety overload in their kids with LD? When anxiety begins to interfere with a child's enjoyment of life, what can parents do to help?
To address these questions, we asked three clinical psychologists, with specialized background in counseling children with learning difficulties, to share their insights and advice with parents. Drs. Roberta Goldberg, Ken Herman, and Bruce Hirsch provide counseling for children and parents at the Frostig Center in Pasadena, CA. The center conducts research, provides professional development, and operates a day school for children in first through 12th grades with learning and attention problems.
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders™, text revision, (DSM-IV-TR) devotes more than 50 pages to various kinds of anxiety disorders. For the purposes of this interview, we adopted a working definition of anxiety as: Excessive worry that is interfering with a child's daily activities and/or his enjoyment of life. In this article, practical descriptions of excessive worry in children are provided as examples only, not as a means to diagnose an anxiety disorder in your child.
This is the second of two articles on the topic of anxiety among children with learning problems. In the first article, the three psychologists discussed some causes and symptoms of anxiety in children.
Bruce Hirsch: The first thing I do, especially with an anxious child, is to go very slowly. Because if you immediately focus on their anxiety, you're going to make the child more anxious. I try to create a very non-threatening environment. If they don't want to talk much, that's okay. They may want to do a little drawing instead, or play a game. Then I usually test the waters because all kids are different. I might say, "Gee, Mom and Dad said that you have a lot of trouble falling asleep at night, what do you think about that?" If the child withdraws at that point, I don't push. Other kids may be relieved that someone's finally addressing the anxiety so that they can talk about what's going on.
When I work with kids, I always do the first appointment with Mom and Dad alone, so they can tell me things that might make the child embarrassed or uncomfortable if he or she were sitting there. So I've gotten a whole lot of information from the parents before I ever see the child - unless it's a teenager, especially past 13 or 14, who would get suspicious if I met with Mom and Dad without them. Typically, when I talk to the child, I'm not gathering facts as much as I'm trying to get a sense of this child's experience, what the world is like through his eyes.
Ken Herman: Counseling with children and adolescents is not always a "front door" process. When a child is really anxious, we want to decrease the expectations around him, to support him, to help him feel confident in the resources that he brings to the table, and to help him work on self-soothing statements.
For one teenage boy, the counseling initially involved revisiting his psychoeducational assessment and then making reasonable expectations and accommodations for him. The family and I decided family therapy would be the best approach to help this adolescent with his anxiety symptoms. He was involved in the decision and he indicated he might feel too vulnerable and "strange" in individual counseling. It seemed he was feeling anxious and intimidated about the counseling and sought his parent's protection and support if he was going to discuss his learning and attention problems. This brought his emotions into the room and was a great discussion point later in the therapy. We recalled later how anxious he was at the start of counseling, and we worked to enhance his coping skills and decrease stress in a number of ways. We increased his awareness of his own internal resources, increased his social support network, enrolled him in a karate class, helped him maintain perspective and not catastrophize situations, increase compartmentalization skills, improved time management and organization skills, and worked toward independence in a many different ways to help him feel competent and in control of his life.
Roberta Goldberg: One of the things parents need to do, especially in the 2nd to 6th grade period, is take care of themselves. They've got to have respite. This is a good time to get some counseling for parents and children, to help them navigate this time, so that they can respond to their children's frustrations, struggle through a couple of hours of homework, yet still have the strength to get dinner on the table.
It's important to introduce "strengths and weaknesses" into the family vocabulary-the idea that everybody in this family has some things they're very good at and things they aren't so good at. So, the youngster who's got learning disabilities-who's got, say, serious weaknesses in reading comprehension-also has some strengths in soccer or piano playing or packing the car for the camping trip. With this approach, this child doesn't stick out as the only one in the family who doesn't do well.
Bruce Hirsch: Most importantly, parents can do something that I never do with clients and that is to hug and cuddle their kids. I think physical touch is extremely important for soothing anxiety. One of the first questions I talk about with parents is how their child accepts physical touch. We do have some kids who, for whatever reason, shy away from too much physical touch, but that's really a minority. I think as touch gets internalized, it feeds into self-soothing, which is such an important part of dealing with anxiety.
Roberta Goldberg: When kids with learning disabilities start middle school, I think we need to scaffold them. A lot of parents think, "They're in middle school; they ought to be able to take care of all this." Well, often they aren't taking care of all of this and they're failing. So I help parents to realize that, although they wish their youngster was an independent learner, they are not yet. And if we don't provide them with some of the scaffolding - like helping them plan and organize - we're deluding ourselves.
I am not opposed to parents typing for children, with the teacher's knowledge. But they have to type exactly what the child has written. It has to be thought of as an accommodation. This is a controversial opinion, but I think the parents' job at this stage is to do everything they can to help children develop the compensatory skills required to show what they know.
Parents should also keep a keen eye on a young adolescent's social interactions. One of the primary anxieties reported to us in our longitudinal study for middle school was social anxiety. And that is the fear that their learning disability will be discovered by their friends and that they will not be considered cool. Parents need to shift the balance more toward "private," clandestine remediation, and away from noticeable, or "public," remediation.
Ken Herman: If you're being the disciplinarian or if you're too invested in the homework getting done, then you lose the most important role for a parent to play. Ultimately, the child needs you as their parent, not as their tutor. They need you to love them no matter what. They need to cry and have you hold them and pat their head and say, "It's okay, honey; I know it's hard." Even if they fail a test, even if they can't do a single problem on that "stupid page," they need you to love them. They need to know it's okay, that you believe that they've made their best effort. And that tomorrow's another day, and we'll get up and try it again.
Bruce Hirsch: Avoiding catastrophic thinking is a big one, especially because we're often dealing with parents who are very anxious themselves. The thing I see repeatedly - and parents don't necessarily like me to address this issue, but I do - is kids getting a couple of poor grades in a highly pressured academic environment, and the parents saying, "If you fail this class, you will never get into a decent college and you will never get a decent job." And I think, whoa! I know it would be better if you passed this class, but one failure or even being retained, these are never the absolute end of the world. So I really try to put that kind of catastrophic thinking back into perspective.
If parents have found particular things that are helpful to them in dealing with anxiety - whether it's yoga, meditation, deep breathing, visualization - I think it's great for them to teach those to their kids, and to do them together. Exercise is really important in both anxiety and depression control. Families can go out bicycling or jogging together.
Ken Herman: There's way too much pressure on children. We expect them to go to college and become professionals - doctors and lawyers and such. It's not that a child with learning disabilities can't do that. But parents have to allow for a variety of post high school options.
Each child is an individual, and it's okay not to go to college. It's okay to go into employment or go to a trade school or do something else. It's also okay to go to college when you're 30 or whenever you have better self-discipline and are better organized. Unfortunately, even if the family adjusts its expectations, children go to school and they get the pressure from their peers, especially in high school: "What's your GPA?" "Where are you going to college?"
Bruce Hirsch: Teachers are actually very good at figuring this out because veteran teachers typically see lots of kids over many years. So, they have lots of points of comparison. I sometimes consult with teachers at The Frostig Center to get a better sense of how anxious a kid is. Parents have a much harder time of it, even if they're very sophisticated, because typically today's parents are having one, two, maybe three kids. So there's not a lot of comparison. Sometimes a parent's point of comparison is the self. And anxiety, like many psychological characteristics has a large inherited component to it. So, often parents will say: "This child reminds me of myself at this age. But I struggled alone with this, and I'd like my child to have some help."
Roberta Goldberg: Kindergarten teachers are great communicators. They usually send home information. Even if you think that your youngster is not doing too well in pre-reading and pre-math areas, for example, if you get the sad face when they're telling you what they learned about numbers and letters, I wouldn't jump to any conclusions until January of kindergarten year. I would resist any reaction or response that would give the child an indication that you're nervous that they're not getting it, or that you don't have confidence that they are going to get it. We really have to rely on the kindergarten teacher's wisdom and experience with seeing lots of young children starting down this path of learning to read.
Ken Herman: We know that learning difficulties are a lifelong issue. Coping with them is a marathon; if you start sprinting, you're not going to make it. For example, the daily grind of the homework and the daily fights about it do not have to happen. Children with learning disabilities are of at least average intelligence; they are going to learn. What I encourage a lot of parents to do is - every night when their child starts decompensating around the homework - to draw the line and write a note to the teacher that says, "We did what we could do; done." Because the child's' psychological and emotional well-being is the number one objective, and we can't lose sight of that. While I firmly believe that students with learning disabilities and attention disorders need to learn perseverance in the face of challenge, I also know that this lesson is learned over years and that we can only persist to the extent of our daily attentional and emotional capacity. Pushing beyond our limits only leads to anxiety and school burnout, among other problems.