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.
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