Research shows that children and adolescents with learning disabilities (LD) may experience increased levels of anxiety compared to young people without LD. To date, research findings on this topic are not conclusive because there haven't yet been enough data collected from comparable studies.
Clearly, not every child with LD will automatically experience anxiety. However, common sense would tell us that children who may face daily frustrations, failures, and embarrassment at school would be more likely to worry excessively about academic performance, social status, and prospects for future success than would peers without LD.
What types of situations are likely to evoke anxiety in children with learning difficulties? What kinds of symptoms might signal a parent to seek a professional assessment of a child who is anxious? In this interview three clinical psychologists from the Frostig Center in Pasadena, CA: Drs. Roberta Goldberg, Ken Herman, and Bruce Hirsch, explain these issues. The Frostig Center conducts research, provides professional development, and operates a day school for children from first through 12th grades with learning and attention problems. Among them, these three psychologists have more than 60 years of clinical experience assessing and counseling children 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 first of two articles on this topic. The second article focuses on approaches parents can use to help their children with LD who are experiencing anxiety.
Roberta Goldberg: I think all kindergartners and their parents start the school year happy and confident, expecting to be capable and successful. But for children growing up with learning disabilities, that attitude is short-lived, as the first reading readiness activities are introduced into the curriculum. In my intake interviews at the Frostig Center, in my private practice, and certainly in our longitudinal study of children growing up with learning disabilities,1 we note that this is the time that the first signs of anxiety emerge for youngsters with a learning disability. I think I'd call it "the anxiety of not being able to keep up."
As these children enter later elementary grades, the anxiety of not being able to keep up just worsens because the skill gaps widen. The teacher notices, the parents notice, the siblings notice, and of course the child himself starts to notice. This is usually the period of identification of the learning disability, and I think the anxiety of this period is "the anxiety of feeling different." Our study participants reported feeling "stupid," "retarded," or like "damaged goods" about this time.
Ken Herman: Up until a child starts school, he is certainly "the sparkle in his parents' eyes." Then he gets into school and he starts comparing himself with others and, all of a sudden, he starts to realize he's struggling. Early in the elementary years the stress really rises for children with learning disabilities. And developmentally they don't have a whole lot of coping skills, so they have very limited means of dealing with the stress. Typically, parents don't suspect a learning disability yet, so they think the child just isn't trying hard enough.
The children themselves can't tolerate the fact that they can't do something that they think they should be able to do. They know they saw it done in class that day where it was discussed at length. If they're older they maybe took a note or two, but they can't read their notes very well. They can't take the information from school to home and duplicate it. As soon as the external structure of the teacher's words leave, the child can't retain that structure, and it just crumbles.
Bruce Hirsch: For many of the kids I see, anxiety is probably part of their temperament, part of what they were born with. The anxiety may wax and wane some, but these kids tend to be anxious by nature. When you have a kid who has always been anxious, if he has been coping with that and he's used to that, I would probably wait longer before bringing him in for treatment. But, where anxiety comes on suddenly and unexpectedly, I would want to know what's going on here, what's causing this?
Roberta Goldberg: Unfortunately, a mystery often surrounds the early stages of this identification period, which can confuse the child terribly. Parents think they're discussing the child's learning in private, but the child is probably overhearing some discussions and picking up on the parents' anxiety. There are trips to the doctor - many of them. I talked to a nine-year-old boy with learning disabilities who was so relieved that he didn't have "head cancer." His grandpa had cancer, and because the boy was going to the doctor a lot, and the adults were talking about his head and learning, he thought he had head cancer. Frequently, the last one to know what's going on, or to get a good explanation of what's going on, is the child.
On top of that, parents are anxious. They're sometimes short tempered. Spouses frequently disagree about what should happen, and so naturally harsh words slip out. Siblings get caught in the crossfire and they often get the short end of the attention stick at this time. When the whole family dynamic is oriented around the difficulties of one member, other important issues can get ignored.
Ken Herman: When the psychoeducational evaluation is completed and the diagnosis of a learning disability is made, a couple of things happen. There is initial relief all the way around because now we know what the problem is, and what it is not. The child is still bright, but now it is confirmed that he has a learning disability. They become anxious as they try to figure out what this means. There is also a grieving process for both the parents and child when they realize the child is not perfect, that he has a relative weakness they really need to work on. So, it's a turning point in their lives when the diagnosis is made, and there is still much emotional and academic work to be done.
Bruce Hirsch: I see a lot of overlap in symptoms among age groups. For example, typically, we would think of something like nightmares as more of a young child's expression of anxiety, but I see nightmares in older kids. In fact, in younger kids I sometimes think it's just normal; I would be more concerned about nightmares in an older child. Another symptom might be school phobia, where a child is so frightened they can't leave the house, can't leave mom and dad's side, what we officially diagnose as separation anxiety disorder. I see that in all ages. Again, when you see that symptom in a young pre-school child, we sometimes say well, that might be normal, it's hard to tell. When you see it in a teenager, though, that's definitely a problem we need to address.
Somatic complaints, such as headaches and stomach aches, are a common symptom of anxiety at all ages. Sometimes we might see just general worrying. Often a child talks about his worries if he's with someone he trusts. Maybe it's an excessive worry about earthquakes or disasters or mom and dad dying. Again, I see those things at all ages. Irritability can be a symptom of a lot of different things; it isn't always anxiety. But it's one of those vague complaints that might indicate anxiety.
Certainly, if anxiety goes on for more than a few weeks, parents might want to look into it. Another reason to recommend intervention would be if the anxiety is so severe that it interferes with a child's enjoyment of life or with his normal activities. For example, if they can't go to a sleepover at a friend's house when most kids their age are able to, because they're too anxious, that might be a time to seek some professional help.
Roberta Goldberg: In the research we conducted at the Frostig Center, all participants reported on a stress scale that the stress of having a learning disability is the worst in elementary school. 2 A big part of the stress is due to this period of identification - going from unknowing chaos, to an understanding of their learning difficulties, then on to intervention. Then all participants report that it gets less stressful as they move beyond elementary school. Middle school gets a little better. High school gets even better, and adulthood gets much better. But elementary school is a critical period for parents, because it's the worst time for children. In addition, we must take into account the teasing and victimization of children with learning disabilities that persists at school.
Ken Herman: Anxiety is one result when children with learning disabilities begin to wonder if they can trust their vision of the world, because they see it differently. Their visual or auditory processing may not be precise, their thinking or time management may be slightly disorganized, or they may have trouble reading subtle social cues. So many children feel out of control internally and try to take control in other aspects of their lives. Examples of ways they try to take control include refusing to participate in extracurricular activities, or rejecting prescribed medication or homework assistance. Because they generally feel safer and more in control at home, that's where children with learning disabilities may express anxiety through more oppositional behaviors.
Bruce Hirsch: A kid who is chronically anxious, wakes up every day and feels worried, can't go about their normal days feeling good about it, that - almost by definition - is depression. Unhappy mood is the distinguishing symptom. The origin of that may very well be the anxiety, the worry. But it pretty quickly becomes kind of a depressive phenomenon as well.
Ken Herman: One way many children attempt to cope with the overwhelming daily stress of a learning disability is by withdrawing. If parents sense that the child is more quiet than usual, that he tends to lose interest in things, and tends to avoid homework to a large degree, those can be signs of depression. Or, a child might become intensely angry and begin externalizing blame for his problems: "I needed some help on this graph, but you said to do this on my own, and I couldn't do it. It's all your fault; that's why I threw the pencil at you." Or, children externalize their frustration by bullying others or getting into fights.
I find that children with learning disabilities are more likely to withdraw in childhood years, and more likely to externalize the blame to others in their teenage years. What's really going on is the child feels incompetent but he can't say that because that makes him feel too vulnerable and sad. Instead, he covers that up, makes it the parent's fault.
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