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This paper is a brief review of Anxiety disorders and how they present in an educational setting,

I am writing this paper as an assignment for a Introduction to Special Education class. I will

discuss and define such anxiety issues as test anxiety, generalized anxiety, school phobia, etc.,

including the prevalence of the disorders and the effects on the functioning of school age

children and adolescents. After a brief overview of the causality and history of anxiety disorders,

I will list some of the interventions used to treat these disorders with emphasis on techniques,

which can be used in a school setting. Inclusion of special education students will be explored,

ending with a summary of the discussion and some of my personal thoughts and opinions.

Anxiety Disorders and Students

The purpose of this paper is to offer a brief review of anxiety disorders and the effects of

such conditions on the functionality of students during the primary and secondary years of their

education, and to describe some of the most efficacious interventions which could be used in a

special education classroom, as well as a general education class. I will include definitions and

symptoms of the disorder and its various categories. Then a brief history of anxiety, its

prevalence and causality. As some categories of anxiety, such as Obsessive Compulsive Disorder

(OCD) and Post Traumatic Stress Disorder (PTSD) are generally treated in medical settings, I

will not be including these in my section on school interventions. In conclusion, I will offer a

summary of the main points of the paper and my thoughts on the full inclusion of students with

anxiety disorders in the general education classroom.


Anxiety is a natural human response and functions as a biological mechanism to warn us

of danger or a threat. The fight or flight response is a result of millennia of adaptation by our

distant ancestors. Anxiety becomes a pathologic disorder when it is extreme, pervasive and

beyond a persons control. Anxiety has also been known by other names such as hysteria,

shyness, reclusive, nervous wreck, high strung, battle fatigue, the vapors, shell-shocked, overly

sensitive, stage fright, etc. According the Diagnostic and Statistical Manual (DSM IV-TR) used

by mental health professionals, anxiety disorders are characterized by irrational fears of a

stimulus or situation that is excessive and uncontrollable. These fears persist over time and result

in a wide range of physical and affective symptoms, which effect behavior and interfere with a

persons functioning (Rowley & Hermida 2010). Some common symptoms include restlessness,

sleep disturbance, irritability, muscle tension, irregular heartbeat, repetitive behaviors, lack of

concentration, nausea, stomachaches and other physical complaints. Though anxiety disorders

share many symptoms, certain categories present differently and respond better to differing

forms of treatment. Acute stress disorder (ASD) and Post Traumatic Stress disorder (PTSD)

occurs after a person has experienced a traumatic event with physical symptoms, which the

person can re-experience the event and the symptoms when faced with similar behavioral

triggers. PTSD is the chronic form of this disorder. Obsessive-compulsive disorder (OCD)

shows repetitive, at times odd actions, which help the person who is afflicted reduce the anxiety

produced by intrusive and unwanted thoughts. Panic disorder is described as recurrent and

persistent panic attacks (intense fear, chest pain, dizziness and shortness of breath), often

accompanied by agoraphobia (fear of being unable to escaped a situation where panic attacks my

ensue). These anxieties are very often seen in medical emergency rooms and are treated with a

combination of medications and psychotherapy. Generalized Anxiety Disorder (GAD) is


characterized by excessive worry over several areas of a students life that last longer that six

months. These worries often cluster around schoolwork and performance on test, sporting events

and speaking in front of an audience. The student may be exceptionally well behaved and

compliant, yet choose not to participate in new activities because of the overwhelming feeling of

distress. This student may be perfectionistic with low levels of frustration tolerance and an

intense fear of failure. Test anxiety is usually included in this category. Specific phobias are an

extreme fear associated with a single situation, which is considered excessive when compared

with to the realistic danger of the situation. Some common phobias are fear of dogs, injections,

storms, and loud noises or even costumed characters. School phobia or refusal is often a very

visible problem, especially with very young children entering Kindergarten or a new elementary

school. The child can exhibit reluctance to come to school, or want to leave early, with the

presence of physical complaints, at times crying and can escalate into tantrums. Actually the

cause of this type of anxiety is more appropriately labeled as separation anxiety, as the child is

reacting to the separation from the primary caregiver. School refusal can also be caused by

learning problems, fear of bullying or family dysfunction with or without underlying anxiety

(McLoone, Hudson & Rapee, 2006). Social anxiety disorder is caused by excessive fear of

social situations, which can be generalized to almost all social interactions, differing from social

phobia, and can result in avoidance and withdrawal from almost all social relationships and

events (Rowley & Hermida, 2010). This impacts the student severely in being able to learn

necessary life skills, occupational skills and academic achievement (from the withdrawal from

classroom and small group learning activities).


1: Generalized Anxiety Disorder

This is the commonest, most widespread form of anxiety (therefore its designation). Also known
as GAD, generalized anxiety disorders affects tens of millions of people throughout the world;
its usually defined as an on-going state tension over something ephemeral or unrealistic.

In other words, if youre always worried about nothing in specific, or something that makes no
sense being worried about, this is probably your type of anxiety disorder. Remember, anxiety is a
natural part of life; its normal for anyone to experience this feeling occasionally, but normally
for a valid reason. If you feel anxiety every day for no reason in particular, you probably have an
anxiety disorder.

2: Social Phobia
This is the typical anxiety disorder in people with fear of crowds, public embarrassment, and any
kind of public scrutiny. In extreme cases, the patients may have problems with something as
normal as eating in public, interacting with people they dont know or authority figures, going to
parties or waiting in line.

People suffering from social phobia perceive public situations as being potentially painful and
distressing; they live in constant fear of being judged, observed and remarked upon. Its also
very common for a social phobic to have an irrational fear of doing something stupid and

3: Panic Disorder
In a fast-paced modern society such as our own, everybody is bound to feel scared and confused,
every now and then but this kind of normal panic usually has valid reasons and real

For example: if you dont meet your deadline, you may lose your job. If you lose your job, you
may end up homeless. Those are somewhat valid reasons to feel panic.

But if youre always either feeling intense panic without knowing the actual reason, or if youre
always worrying because you might start feeling panic at any moment, you likely have this type
of anxiety disorder.

4: Agoraphobia
If you feel terrified of open spaces and public scenarios, this is probably the category of anxiety
disorders you fit most accurately. Although, many people who have this problem also have panic
disorders; keep in mind that many anxiety sufferers actually fall in more than one of these

This type of phobia usually manifests in adulthood, unlike most other phobias which seem to
manifest from early childhood. People suffering from agoraphobia dont just have problems with
being in open spaces; usually, theyre terrified of losing control (both psychologically and
physically) in a social scenario from which they wont be able to escape

5: Specific Phobias:
Some of the most common specific phobias seem to be focused on scary things, objects or
animals. Typical objects of specific phobias include spiders, snakes, tornados, thunderstorm,
airplanes or blood.

If you have a phobia, youre bound to feeling an overwhelming and irrational fear when youre
in the proximity to the object of your phobia; in extreme cases, the very thought of it may be
enough to make you lose control.

6: Post-Traumatic Stress Disorder

Death is a part of life, as well as disaster. As long as there are humans, there will probably be
war, terror, brutality, torture and rape. This is something that most humans must come to terms
with sooner or later, but for some people especially patients who have lived through severe
trauma, a post-traumatic stress disorder may arise.

This kind of trauma can affect people for the rest of their lifetime, unless its properly managed.
Sometimes, the effects of PTSD may only arise for several years after the actual trauma that
caused the disorders. If left untreated, it may lead to a wide range of crippling reactions, both at
physical and psychological levels.

If you have personally experienced or witnessed an event that directly threatened your life, or the
life of another person, you may develop PTSD.

You may have post-traumatic stress disorder if a) you personally experienced or witnessed an
event that was potentially life threatening or caused a serious injury (to yourself or someone else)
or b) you discovered that someone close to you experienced such an event.

7: Obsessive-Compulsive Disorder
This category of anxiousness can be particularly destructive, because its sufferers are more active
than any other type of anxiety disorder. If you have OCD, youre likely to frustrate and confuse
yourself regularly, as well as the people surrounding you.

Compulsions and Obsessions are somewhat similar things, but theres a crucial difference:
obsessions relate with thoughts, while compulsions relate with actions. In both cases, they are
unwanted thoughts and actions which patients cant seem to get away from.

For example, you may be obsessive in your fear of germs, which may prompt you to
compulsively wash your hands every five minutes. You may have OCD if you have obsessions,
compulsions, or both.

Signs and symptoms of anxiety

Now that we understand what the definition of anxiety is, as well as risk factors of anxiety, lets
examine the signs and symptoms of anxiety. Common signs and symptoms of anxiety include:

Feelings of being powerless
Feelings of impeding danger
Increased heart rate
Hyperventilation (heavy breathing)
Weakness and fatigue
Lack of concentration and focus other than the cause of worry.

The signs and symptoms of anxiety also greatly affect the bodys systems. For example, anxiety
disorders can disrupt the digestive system, the cardiovascular system, respiratory response,
nervous system and immune system. All these major systems become affected when anxiety hits
which can lead to poorer health over time.

Signs and symptoms of anxiety can also affect a persons behavior. Some behavioral signs and
symptoms of anxiety include:

Repetitive or compulsive behaviors

Changes in personality

Relationship problems
Issues at the workplace
Wanting to remain isolated
Increased fear of situations or doing things.

As you can see, the signs and symptoms of anxiety truly take a large toll on the body as a whole
and the individual, changing them as a person. Because of these significant changes, anxiety can
transform a person into someone else and inhibit their ability to function.

In the central nervous system (CNS), the major mediators of the symptoms of anxiety disorders
appear to be norepinephrine, serotonin, dopamine, and gamma-aminobutyric acid (GABA).
Other neurotransmitters and peptides, such as corticotropin-releasing factor, may be involved.
Peripherally, the autonomic nervous system, especially the sympathetic nervous system,
mediates many of the symptoms. [4]

Positron emission tomography (PET) scanning has demonstrated increased flow in the right
parahippocampal region and reduced serotonin type 1A receptor binding in the anterior and
posterior cingulate and raphe of patients with panic disorder. [5] MRI has demonstrated smaller
temporal lobe volume despite normal hippocampal volume in these patients. [6] The CSF in
studies in humans shows elevated levels of orexin, also known as hypocretin, which is thought to
play an important role in the pathogenesis of panic in rat models. [7]

How to deal with anxiety

Because there is such a large number of anxiety disorders, how to deal with anxiety may not be
the same for every person. Common forms of treatment on how to deal with anxiety include the
use of medications, such as antidepressants, as well as psychotherapy, which allows the
individual to talk with someone to determine the cause of their anxiety and work through it.

There are also natural ways that can help someone deal with anxiety. Some of these methods are:

Exercise: Exercising releases mood-boosting hormones, making us feel happier and

more positive. It also reduces stress and clears the mind.
Avoid substances: If alcohol and drugs are the cause of your anxiety, or make it
worse, staying off these substances is vital.
Reduce the use of stimulants: Smoking and caffeine can make an anxious person
even more so, so quitting or cutting down caffeine intake are a must.
Meditate: Relaxation methods like meditation are useful to reduce stress.
Sleep: A good nights rest is important to feeling refreshed and calming your mind.

Food: Well-balanced meals, including lean proteins, fruits and vegetables, can work
to reduce anxiety.

Managing your anxiety is the key to overall well-being. Because anxiety disorders can take such
a large toll on the body and all its major systems, finding an effective treatment is highly

Understanding the underlying cause of your anxiety is the first step when it comes to how to deal
with anxiety. From there, you can seek out the proper treatment you need for recovery.

Anxiety can truly hold a person hostage within their own mind and body, preventing the
enjoyment of day-to-day life. Its very much a serious health condition and sharing your
concerns may offer relief and the support you need to seek professional help.

If you have experienced any of the signs and symptoms of anxiety, or maybe have some of the
risk factors of anxiety, take action to get yourself checked so you can begin enjoying life once

There's no way to predict for certain what will cause someone to develop generalized anxiety
disorder, but you can take steps to reduce the impact of symptoms if you experience anxiety:

Get help early. Anxiety, like many other mental health conditions, can be harder to treat
if you wait.
Keep a journal. Keeping track of your personal life can help you and your mental health
professional identify what's causing you stress and what seems to help you feel better.
Prioritize issues in your life. You can reduce anxiety by carefully managing your time
and energy.
Avoid unhealthy substance use. Alcohol and drug use and even nicotine or caffeine use
can cause or worsen anxiety. If you're addicted to any of these substances, quitting can
make you anxious. If you can't quit on your own, see your doctor or find a treatment
program or support group to help you.

Having generalized anxiety disorder can be disabling. It can:

Impair your ability to perform tasks quickly and efficiently because you have trouble
Take your time and focus from other activities

Sap your energy

Increase your risk of depression

Generalized anxiety disorder can also lead to or worsen other physical health conditions, such as:

Digestive or bowel problems, such as irritable bowel syndrome or ulcers

Headaches and migraines
Chronic pain and illness
Sleep problems and insomnia
Heart-health issues

Generalized anxiety disorder often occurs along with other mental health problems, which can
make diagnosis and treatment more challenging. Some mental health disorders that commonly
occur with generalized anxiety disorder include:

Panic disorder
Post-traumatic stress disorder (PTSD)
Obsessive-compulsive disorder (OCD)
Suicidal thoughts or suicide
Substance abuse


Several types of medications are used to treat generalized anxiety disorder, including those
below. Talk with your doctor about benefits, risks and possible side effects.

Antidepressants. Antidepressants, including medications in the selective serotonin

reuptake inhibitor (SSRI) and serotonin and norepinephrine reuptake inhibitor
(SNRI) classes, are the first line medication treatments. Examples of antidepressants
used to treat generalized anxiety disorder include escitalopram (Lexapro),
duloxetine (Cymbalta), venlafaxine (Effexor XR) and paroxetine (Paxil, Pexeva).
Your doctor also may recommend other antidepressants.
Buspirone. An anti-anxiety medication called buspirone may be used on an ongoing
basis. As with most antidepressants, it typically takes up to several weeks to become
fully effective.
Benzodiazepines. In limited circumstances, your doctor may prescribe a
benzodiazepine for relief of anxiety symptoms. These sedatives are generally used
only for relieving acute anxiety on a short-term basis. Because they can be habit-
forming, these medications aren't a good choice if you have or had problems with
alcohol or drug abuse.

Coping and support

To cope with generalized anxiety disorder, here's what you can do:

Stick to your treatment plan. Take medications as directed. Keep therapy appointments.
Practice the skills you learn in psychotherapy. Consistency can make a big difference,
especially when it comes to taking your medication.
Take action. Work with your mental health professional to figure out what's making you
anxious and address it.
Let it go. Don't dwell on past concerns. Change what you can in the present moment and
let the rest take its course.
Break the cycle. When you feel anxious, take a brisk walk or delve into a hobby to
refocus your mind away from your worries.
Socialize. Don't let worries isolate you from loved ones or enjoyable activities. Social
interaction and caring relationships can lessen your worries.
Join a support group for people with anxiety. Here, you can find compassion,
understanding and shared experiences. You may find support groups in your community
or on the internet, for example, the National Alliance on Mental Illness (NAMI).


Anxiety is one of the more prevalent psychiatric disorders, which occur in the general

population, and is also very common in childhood emotional disorders. Estimates of this

prevalence range from 10% to 21%. Females are more likely to have anxiety disorders one and a

half to two times as often as males (McLoone, Hudson & Rapee, 2006). I suspect, though this is

not supported by my research, that minority students are under represented as far as diagnosing

anxiety and over represented in behavior disorder placements and drop out rates. Students who

suffer from test anxiety can score up to 12 percentile points below non-anxious peers, which

could also lead to assumptions of intellectual disability (Bishop, 2006


Anxiety symptoms are believed to derive from disrupted neurotransmitter systems, with

heightened sympathetic nervous system response. Specifically, the neurotransmitters serotonin

and dopamine. Some researchers have discovered a few genetic at risk factors for two groups of

anxiety disorders. The specific phobia group and the panic-generalized anxiety-agoraphobia

group. There has also been research into the link between abnormal blood flow to the brain and

panic disorder (Shaw, 2010). Although factors in a persons environment are clearly important

as the person reacts and processes external stimuli. Co-morbidity is a frequent factor in anxiety

disorders with higher reported levels of depression and substance abuse, family dysfunction and

learning problems (Rowney & Hermida, 2010). Extreme trauma such as war, rape, death of a

loved one, child abuse, divorce, etc. are known to trigger anxiety symptoms, especially in

children (Walkley, 2002).

Risk factors
Women are diagnosed with generalized anxiety disorder somewhat more often than men are. The
following factors may increase the risk of developing generalized anxiety disorder:

Personality. A person whose temperament is timid or negative or who avoids anything

dangerous may be more prone to generalized anxiety disorder than others are.
Genetics. Generalized anxiety disorder may run in families.
Experiences. People with generalized anxiety disorder may have a history of significant
life changes, traumatic or negative experiences during childhood, or a recent traumatic or
negative event. Chronic medical illnesses or other mental health disorders may increase



As early as 400 BC some form of anxiety was observed by Hippocrates, the Greek

medical practitioner. He described very shy people as being hyper sensitive and loving darkness

as life (Cunic, 2012). Hysteria was a term used to describe symptoms of panic or phobic

anxiety, especially among women. During the 1600s hysteria was thought to be possession by

the devil and a cause for involvement in witchcraft, again principally among females. A civil

war doctor in the mid 1800s treated soldiers and civilians for irritable heart syndrome, which

presented as irregular heartbeat, sweating, and dizziness. His treatment included digitalis and

opium. By the early 1900s the new phenomena of electricity was used to treat anxiety

symptoms by hooking up the sufferer to various machines and running an electric currant

through the person. Psychoanalysis was gaining popularity and Sigmund Freud began describing

some of his patients as suffering from a social neuroses or free floating anxiety. The discovery

of barbiturates had some physicians prescribing them for anxiety symptoms well into the 1970s,

when the extent of the drugs addictive qualities became known. A South African doctor in the

1950s pioneered the development of systematic desensitization techniques. During World War I

and World War II, conditions of PTSD were being referred to as shell shock and battle fatigue.

(Cunic, 2012). The current classification system of anxiety disorders comes from the DSM IV,


Intervention Techniques

The most effective therapy for many forms of anxiety is the medical treatment of

medication therapy in conjunction with Cognitive Behavior Therapy (CBT), and muscle

relaxation training. These interventions involve the parents and other family member in

counseling and education. With young children, the use of medication may not be appropriate,

yet the school is a necessary partner in following through with behavior techniques and goals.

Relaxation training can be helpful to children in the special education classroom as well as the

general education class. This is also a part of systematic desensitization or graded exposure

where the child is introduced to anxiety provoking situations, in small steps while rehearsing

coping skills and being positively re-enforced. CBT uses thought restructuring by challenging

beliefs about fearful events and reframing them, using self-talk, rehearsal and self-monitoring.

Classroom accommodations, such as allowing extra time for tests, reading questions aloud and

having extra time to complete homework are also helpful interventions.

An Australian study noted a drop in anxiety symptoms to sub-clinical levels in 75% of

students by using a school wide prevention and intervention program called Friends

(McLoone, Hudson & Rapee, 2006). Small group counseling with a school counselor or social

worker has also been shown to be effective. These interventions have parent and family

components, which help to facilitate success.


Anxiety is one of the most prevalent and I think, under reported of disorders encountered

in school age populations. The school seems to be a primary source of identification and referral

for these students. By making use of appropriate screening and assessment, I think that the

children already being served in special education classrooms will benefit from anxiety

intervention methods and school wide prevention programs. These methods would be compatible

with the goal of full inclusion in the general education curriculum, which is manifestly

achievable. Coping with test anxiety is an extremely important issue for these students as the

reliance on tests to measure achievement and school accountability is increasing. I think family

functioning can also benefit as parents learn methods to support their children, as well as

practicing techniques to benefit themselves, as there is often a family history of anxiety disorde