Generalized Anxiety Disorder in High School Students

By: Anna Dannemiller, Hunter Hutchings, and MacKenzie Kazin

Introduction

Generalized Anxiety Disorder, commonly referred to as GAD, is a type of anxiety disorder that affects 3% of the population, including teenagers (Osmosis, 2016). This disorder is characterized by consistent and severe stress, sometimes without good cause or reason (Osmosis, 2016). This consistent stress—anxiety—can be very debilitating, causing strain in interpersonal relationships and everyday work-life occurrences (Osmosis, 2016). People with this disorder can experience a loss in ability to focus, an increase3% graphic in bubble letters in levels of irritation, trouble sleeping at night, and a range of physical health problems, as well as other symptoms (Osmosis, 2016).

It is important for teachers to understand generalized anxiety disorder so that they can accommodate for their students within the classroom that are dealing with GAD. For example, teachers knowing which of their students suffer from anxiety will help the teacher best learn and care for their students, and make their students’ learning individualized. The awareness and knowledge of anxiety disorders in the classroom cannot be obtained without an understanding of its underlying causes, often compounding to create an intersectional learning environment. In order to best serve students and ensure a culturally sustaining classroom, educators must consider the relationship between the various causes of GAD and how they interrelate. In understanding GAD rooted in trauma, academic, domestic, and social perspectives within students of different social classes, teachers can apply their knowledge in order to better accommodate to a diverse world of learners. 

Related Legislation

US captiol building

(Capitol 2014)

On a Federal level, IDEA presides as the main form of legislation regarding anxiety in an educational setting. The Individuals with Disabilities Education Act, or IDEA, was established on November 29, 1975 as the Education for All Handicapped Children Act under the presidency of Gerald Ford (1975). The aims of IDEA are to provide a free appropriate public education to all students in an environment that is least restrictive to a student’s learning abilities (IDEA, 1975). Psychological disorders are included under the umbrella of disabilities that IDEA supports, relevant to IDEA in regards to Generalized Anxiety Disorder. Several statues within IDEA further explain its provisions and applications within an educational environment.

An essential aspect of IDEA at work every day in the classroom is the IEP, or Individual Education Plan. An IEP is a document that provides a description of a particular student’s needs in the classroom environment regarding a disability or other accommodation (IDEA, 1975). While not restricted to mental health, students with Generalized Anxiety Disorder may have an IEP with accommodations such as extended time on assessments, technology needs in class, or other assets to ensure their success (Each Child, Our Future, 2019). It is of utmost importance that the accommodations within a student’s IEP are followed. Legal matters can unfold if an IEP is not upheld, and most importantly, it jeopardizes the learning and the well being of the student in the classroom. 

Sean VS Oxford Area School District proves to be a firm example of the consequences of failing to adhere to accommodations within an IEP. While this occurred outside of Ohio in the state of Pennsylvania, it recognizes the ignorance of an IEP in regards to Sean’s anxiety, preventing him from receiving a “free, appropriate public education” (Sean VS. Oxford School District, 2017). The family sued the school district for reparations for the extra online schooling costs Sean needed in order to graduate. 

In the state of Ohio, there are no legal measures or actions regarding mental health and anxiety in the classroom. However, the Ohio Department of Education encourages mental health awareness for students, teachers, and families alike through numerous programs. The Ohio Teaching Philosophy, strategy 7 states, “Work together with parents, caregivers, and community members to help schools meet the needs of the whole child” (Each Child, Our Future, 2019). This strategy focuses on providing resources to ensure every student’s safety, classroom engagement, health, support, and appropriate teaching in respect to ability. The Ohio Department of Education also works in cooperation with the Center for School-Based Mental Health and the Ohio Department of Mental Health and Addiction Services (OhioMHAS) to provide resources to a wide breadth of students.

Glossary and Key Terms

  • IDEA: Acronym for Individuals with Disabilities Education Act. Primary Federal legislation to accommodate mental health services and accommodations in schools.
  • FAPE: an acronym for “free, appropriate public education.” Stands as one of the foundations of IDEA, listed above. A free and appropriate public education caters to an individual student’s needs in a “reasonable” manner. "a free & appropriate education" bubble letters in red
  • LRE: an acronym for “least restrictive environment.” It is the responsibility of a public institution to create an environment in which a student with a disability may learn in a manner that best suits their needs without jeopardizing the learning of other students. 
  • IEP: acronym for “Individualized Education Program.” A legal document issued by the Federal government that describes a single student’s learning environment necessary to accommodate a disability.
  • Classism: External judgement in regards to an individual’s socioeconomic status.
  • CBT: An acronym for Cognitive Behavioral Therapy. While not used in the classroom, CBT is a psychological method system used to treat anxiety disorders.
  • Culturally responsive pedagogy: A way of teaching that emphasizes learning with respect to specific identities of students, such as race, gender, sexual orientation, ability, ethnicity, and so forth. 
  • Culturally sustaining pedagogy: An extension of culturally responsive pedagogy (see above). Culturally sustaining pedagogy broadens the definition of culture (youth culture, community culture) and acknowledges the ever-changing nature of culture. 
  • Trauma-informed teaching: Classroom instruction with the awareness of potential student traumas and their implications in the classroom. 

Literature Review

Generalized anxiety disorder can have a significant impact on factors that affect students’ academic performance. Although GAD can be overwhelming for teenagers, it does not affect their ability to think. People with GAD “suffer from significant psychopathological burden, but present intact cognitive functions across domains” (Leonard & Abramovitch, 2019, p. 6). They are able to problem solve, remember things, and process new information, just as people without GAD can (Leonard & Abramovitch, 2019). For those teens who have GAD, the mental weight of stress, anxiety, and worry can make these cognitive feats much more difficult, but they’re absolutely possible (Leonard & Abramovitch, 2019). That is very clear. Older childrGAD symptoms charten with anxiety are also very inclined to worry about school (Jarrett, Black, Rapport, Grills-Taquechel, & Ollendick, 2015). They tend to have a horrifically difficult time paying attention, and typically face problems with becoming tired easily, both of which can have a strong effect on students’ ability to perform well academically (Jarrett et al., 2015). “Alternatively or perhaps in combination, it may be that increasing cognitive development, greater awareness of anxiety, and increasing demands of school over time result in both greater worry and impairment in the school domain for older youth with GAD” (Jarrett et al., 2015, p. 1000).

Domestic causes of GAD are very prevalent amongst students. There are many different domestic situations that can produce anxiety. Generalized Anxiety Disorder (GAD) Symptoms & Causes by Boston’s Children’s Hospital talks about the causes of General Anxiety disorder. This article mentions four different medical conditions that generalized anxiety disorder may be linked to given that the root cause of the mental health condition is unknown. First, genetic factors are linked to generalized anxiety disorder which can run in families. “Just like children inherit personality and physical traits from their parents, they can also inherit tendencies toward anxiety” (Boston’s Children’s Hospital). The second domestic cause that can produce anxiety is biological. The brain contains serotonin and dopamine neurotransmitters that can cause feelings of anxiety when disrupted. Thirdly, temperament factors are a cause of GAD. A child whose temperament is timid or shy or who avoids anything dangerous may be more prone to generalized anxiety disorder than other children. Lastly, traumatic experiences, such as divorce, car accidents and or any major environmental factors may also trigger anxiety (Boston’s Children’s Hospital). These experiences can be carried into classrooms where teachers then have to learn how to care for and accommodate for the student. 

Scharfstein & Beidel Quote in red writingSocially, teenagers with GAD are able to function just fine, if a bit differently from other teenagers. They can have best friends just like the other kids their age can, but they typically have fewer friends overall (Scharfstein, Alfano, Beidel, & Wong, 2011). Reasons for these students having fewer friends are unknown, but there are a couple possible explanations: kids with GAD might be pickier about their friends so as to avoid connecting with rebels, or they might not have as many opportunities where they can make friends because they’re too busy with schoolwork to go out to activities (Scharfstein et al., 2011). Teens who have GAD are usually less assertive than other youth. This “correspond[s] to their clinical presentation, described as rule abiding, concerned with safety, and eager to please” (Scharfstein & Beidel, 2015, p. 835). Additionally, children with GAD tend to believe they have problems in their relationships with others, but others tend to think that people with GAD are enjoyable to be with and desirable as friends (Scharfstein & Beidel, 2015). The kids with GAD may have misconceptions of their relationships because their anxiety can make them overanalyze and worry about their interactions with others (Scharfstein & Beidel, 2015).

Generalized Anxiety Disorder crosses the boundaries of social class, but presents itself in different ways depending on one’s socioeconomic status. In numerous readings, research shows that students and individuals residing in poverty or of low socioeconomic status tend to develop Generalized Anxiety Disorder due to financial concerns or the lack of stability in a household. However, GAD also prevails among students of high socioeconomic status due to parental pressures and unreasonable expectations. In both scenarios, an educator must know how GAD manifests itself within students of different socioeconomic backgrounds in order to teach in a culturally responsive way that respects varying identities within the realm of socioeconomic status. 

Classroom Implications

classroom setting

(Classroom)

Students with GAD could benefit from many various changes in the classroom. First of all, educators should be understanding of their students with GAD. It’s very important for teachers to not become impatient with students due to the consistent worries that they cannot control. These students shouldn’t be teased for worrying too much, and the teacher should intervene if they see any kind of such teasing occurring amongst the students. Teachers should also be cognizant of these teenagers’ struggle with concentration. They should try to help the students stay focused, and shouldn’t blame them if they do have trouble paying attention.  It has been found that students with GAD have lower self-compassion than other students, so teachers should try to help promote healthy thinking (Hoge, Hölzel, Marques, Metcalf, Brach, Lazar, & Simon, 2013). Encouragement is key. Of course, educators could also try to incorporate literature, films, or other works that represent teenagers with GAD accurately. This can help the students struggling with this disorder to feel less alone, and may help other students to better understand and empathize with teens who are anxious. Teachers should also make their students who have GAD, and their parents, aware of IEP opportunities. If the student could benefit from additional test time or other accommodations, an IEP plan could make those accommodations possible. It could make a huge difference in the student’s academic performance. 

Recommended Resources

Nancy Rappaport, Associate Professor of Psychiatry, Harvard Medical School explains a select few of common underdeveloped skills that students with anxiety and oppositional behavior come across. 

  • resources header in red block lettersMindfulness as a school-based prevention program and its effects on adolescents stress, anxiety, and emotional regulation, by Rachel Potek talks about the anxiety within adolescents and how it is the leading cause of disability in all developed nations.
  •  The Developmental Psychopathology of Anxiety by Michael W. Vasey and Mark R. Dadds talks about generalized anxiety disorder and the development of the mental illness. GAD can be diagnosed in both children and adults, and the way that children cope and need to be treated can be different from how adults need to cope and be treated for their anxiety.
  • The Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students, by Jessica Minahan and Nancy Rappaport, talks about the Behavioral Code and how it functions and accommodates for students. It talks about a four step plan to work with challenging students that may be suffering greatly with mental illness, for example anxiety. 
  • Recognizing student fear: the elephant in the room by T. Scott Bledsoe and Janice J. Baskin talks about the reasons why students are struggling with anxiety and how it is important to know that fear is very prevalent with students in the classroom.
  • The article, Intensive Group Behavioral Treatmentdc (IGBT) for Children With Selective Mutism: A Preliminary Randomized Clinical Trial talks about selective mutism and how is it a common anxiety disorder amongst adolescents. 

Classroom Resources

  • Self-Esteem and academic anxiety of high school students with Montessori and traditional methods of education by Dhiksha. J and Suresh A. explains the differences between Montessori and traditional classrooms and the ways in which each type of education teaches in the classroom and how Monetessori has been proven to be more efficient with students and their learning and social skills. 
  • Healthy Young Minds: The effects of a 1-hour classroom workshop on mental health illness stigma in high school students by Sally Ke, Joshua Lai,  Terri Sun, Michael M. H. Yang, Jay Ching Chieh Wang, Jehannine Austin, explains the different mental health illnesses that students can be facing and the statistics of surveys from students with a mental health disorder. It also gives insight on how to design a classroom to accommodate for high school students that deal with mental illness. 
  • Developing appropriate IEP’s for students with anxiety or depression by Lauren Agoratus talks about students IEP’s and how students with anxiety and depression can benefit from having an IEP and what IEP’s are and do. She also gives a list of classroom resources that teachers can use to help reduce anxiety within the classroom. 
  • Recognizing student fear: the elephant in the room by T. Scott Bledsoe and Janice J. Baskin talks about the fear that students deal with and how as teachers, educators can have strategies within their classroom for students that are fearful to gain knowledge and succeed within their classroom. 
  • Anxiety and self-awareness in video feedback article explains students receiving feedback on videos and how having positive feedback more so than negative will boost their confidence and reduce their anxiety within the classroom. 
  • Helping Students with anxiety move forward gives teachers insight on how to best care for students with anxiety and best set them up well for success. 

References

Agoratus, L. (2019). Developing Appropriate IEPs for Students With Anxiety or Depression. Exceptional Parent, 49(2), 40–41. Retrieved from http://search.ebscohost.com/login.aspx?direct=true&db=rzh&AN=134844877&site=ehost-live 

Bledsoe, T., & Baskin, J. (2014). Recognizing Student Fear: The Elephant in the Classroom. Retrieved from https://www.tandfonline.com/doi/abs/10.1080/87567555.2013.831022 

Boston’s Children’s Hospital, (2005-2019). Generalized Anxiety Disorder (GAD) Symptoms & Causes. Retrieved October 14, 2019, from http://www.childrenshospital.org/conditions-and-treatments/conditions/g/generalized-anxiety-disorder-gad/symptoms-and-causes 

Cornacchio, D., Furr, J. M., Sanchez, A. L., Hong, N., Feinberg, L. K., Tenenbaum, R., … Comer, J. S. (2019). Intensive group behavioral treatment (IGBT) for children with selective mutism: A preliminary randomized clinical trial. Journal of Consulting and Clinical Psychology, 87(8), 720–733. Retreived from https://doi-org.proxy.lib.ohio-state.edu/10.1037/ccp0000422 

Dhiksha J., & Suresh A. (2016). Self-esteem and academic anxiety of high school students with montessori and traditional method of education. Indian Journal of Health & Wellbeing, 7(5), 543–545. Retrieved from http://search.ebscohost.com.proxy.lib.ohio-state.edu/login.aspx?direct=true&db=a9h&AN=115683947&site=ehost-live 

Dutil, S. (2019). Adolescent Traumatic and Disenfranchised Grief: Adapting an Evidence-Based Intervention for Black and Latinx Youths in Schools. Children & Schools, 41(3), 179–187. https://doi-org.proxy.lib.ohio-state.edu/10.1093/cs/cdz009 

Each Child, Our Future: Ohio Strategic Plan For Education 2019-2024. (2019). Ohio Department of Education, Retrieved October 16, 2019, from https://saferschools.ohio.gov/content/legislationrules

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