Please Don’t Make My Students Cry

One of my after-school students recently came home from his school in tears.  His third-grade class had watched a documentary about underwater exploration, and the idea of being stuck in a submarine had given him anxiety.  After the movie, his teacher said something about the class taking a field trip in a submarine; I wasn’t there, but I think she was trying to encourage the students to imagine going in a submarine.  My student misunderstood (probably because he was already anxious) and cried out, “Do we have to go in the submarine?”  His teacher apparently responded with something like, “[student], why are you always so scared of everything? You’re going to ruin the activity for everyone.”  According to my student, the teacher was very annoyed with him.

Again, I wasn’t there, so it’s possible that my student misinterpreted his teacher’s feelings.  He might be wrong about what she said or how she said it.  I hope he’s wrong, because the idea of an adult–a teacher–speaking that way to one of my students is very upsetting.  The idea of a teacher speaking that way to any anxious student is upsetting.  See, I would hope this teacher would be sensitive to my student’s feelings since she obviously knows that he struggles with his fears.  What she doesn’t know is that he has Generalized Anxiety Disorder (GAD), a condition “characterized by persistent, excessive, and unrealistic worry about everyday things.”  In fact, it’s very likely that this teacher doesn’t even know what GAD is; unlike depression and Obsessive-compulsive Disorder, GAD isn’t typically discussed in pop culture, and most teaching programs do not require training in psychology.

My student’s family has not disclosed his condition to his school.  They have chosen not to pursue accommodations for their son because they worry about stigma and discrimination, very real risks.

This incident inspires several questions.  First, should parents report their children’s mental illnesses to their school?  Second, was my student’s teacher out of line in her criticism of my student?  In considering that question, assume she really said what my student believes she said, and that she exhibited some amount of anger when she made those statements.  Finally, and most importantly, should all teachers be required to complete some amount of training in psychology?  Teachers are increasingly knowledgable about learning disabilities and the Autism spectrum (not knowledgable enough, many parents will say, and I agree), but childhood mental illness is largely ignored in both certification and continuing education programs for teachers.

Please share your feelings in the comments, and stay tuned for posts about disclosing your child’s mental illness and psychology training for teachers.

All stories about my students are shared with permission from the student and her/his family.

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Surprising Anxiety Trigger 4: Upset stomach

Welcome to part four of my Surprising Child Anxiety Triggers series!  Today’s trigger is gastrointestinal distress, or “upset stomach.”

The stomach flu is, in my opinion, the worst (non-serious) thing ever. The worst. Worse than stubbing your pinkie toe or getting ten paper cuts. Worse than reality TV. The worst. In fact, like many children with Obsessive-compulsive Disorder, many of my compulsions were done to prevent throwing up.  Gastrointestinal distress is so horrible I’ve separated it from other illnesses and given it its own post.

If an anxious child feels sick to her stomach, two separate things can cause her to panic:

First, if she’s afraid of the stomach flu/food poisoning, she’s likely to panic if she thinks that’s what’s causing her discomfort.  In fact, she might panic even if she knows she’s only sick because she ate too much or too fast, because feeling like she’s going to throw up is terrifying no matter what. (This is especially true for children who are afraid of losing control or embarrassing themselves.) If your child or student is specifically worried about GI symptoms, teach her how to minimize her risk of upset stomach by eating slowly and calmly.  A coach or a cognitive-behavioral therapist can help create a plan to help overcome fear of stomach upset.  In the meantime, have your child or student practice slow, steady breathing, and help her minimize her discomfort by addressing the possible cause.  Note: anxiety can cause or increase nausea, so address anxiety symptoms first or concurrently.

Second, like many of the triggers on this list, GI distress can mimic anxiety symptoms.   Both panic and GI distress can cause nausea, stomach pain, lightheadedness, and increased heart rate.  Anything that mimics panic can cause panic.  In part, this is because panic is terrifying, so thinking that you’re going to panic can …make you panic.  To combat this, encourage children to relax into their panic with complete acceptance.  Say, “you’re having a panic attack.  It’s very common, and it can’t hurt you.  It’ll be over soon even if you don’t do anything.”  Remind anxious children to breath slowly (without gasping or hyperventilating) and simply allow the panic to rise and then fall.  Accepting panic is extremely difficult, even for adults, but it’s extremely effective.

Coming soon: how to coach a child through a panic attack.

More in this series:
Hunger
Dehydration
Illness

Surprising Anxiety Trigger 1: Hunger

Welcome to the first installment of the Surprising Triggers of Anxiety in Children series.  When your child or student exhibits the symptoms of anxiety, you may assume that something frightening has occurred.  However, anxiety can be triggered by a variety of surprising situations.  This series discusses many of those triggers.

Today’s surprising trigger is hunger.

Why does hunger sometimes cause anxiety in children?  Intense hunger can cause dizziness, increased heart rate, shaking, and irritability.  Hypoglycemia, or low blood sugar, can cause both psychological and physical symptoms of anxiety.  Healthy humans do not experience hypoglycemia simply because they have missed a meal or waited too long to eat.  Hypoglycemia is diagnosed by a doctor.  If you suspect that your child suffers from hypoglycemia, contact your pediatrician.

A phenomenon called Idiopathic Postprandial Syndrome is often called hypoglycemia, but this syndrome is not actually characterized by low blood sugar.  The term “idiopathic” basically means “unexplained,” and “postprandial” means after eating.  Idiopathic Postprandial Syndrome is the name used to describe a pattern of feeling shaky and irritable an hour or two after eating.  Idiopathic Postprandial Syndrome is fairly common, and it can definitely trigger anxiety.  It may actually be related to anxiety disorders.  Very little information is available about Idiopathic Postprandial Syndrome, and some of the information that is available is inaccurate or misleading.  It’s possible that the symptoms of Idiopathic Postprandial Syndrome are related to sudden drops in blood sugar (as opposed to the unhealthily low blood sugar levels present in individuals experiencing hypoglycemia).

If you suspect that hunger is triggering anxiety in your child or student, suggest a healthful snack.  Make sure the child eats slowly; anxiety can cause nausea.  Some people believe that choosing “low glycemic index” snacks that minimize spikes in blood sugar can minimize mood instability.  Unfortunately, nutrition and metabolism are both extremely complex and misunderstood sciences, so you may want to play around with different snacks or ask your pediatrician for advice.  As always, make sure your child understands that anxiety and its symptoms cannot actually cause harm.

Teaching Empathy to Anxious Kids

The complete lack of empathy shown by the perpetrator of the Sandy Hook shooting has reminded many parents and educators of the need to encourage empathy in their children and students.  Although some amount of empathy comes naturally to most humans, it is important to nurture its development during childhood.  Anyone who lives or works with children knows that kids can be inconsistant in their ability to understand and respect the feelings of others.  Teaching empathy requires patience and, well, empathy.  Over-punishing a child for selfishness can backfire and lead to self-pity and anger.  You probably already know how to cultivate empathy in children.  Anxious children may require special considerations, though.  Here are a few tips for teaching empathy to anxious kids:

1. Watch for over-empathizing.
Sometimes, when children become overwhelmed by empathy, they behave as though they don’t care at all. They may ignore the people with whom they are supposed to empathize, or they may insist that those people’s feelings aren’t important. They may joke about tragedy or make fun of victims. Differentiating between callousness and behaviors intended to protect from over-empathizing can be very difficult. Rely on past behavior patterns, as well as professional opinion. If your child or student is typically compassionate and thoughtful and then becomes crass about a particular situation, it’s possible that he is actually trying to minimize his own anxiety about the situation. Forcing him to practice empathy could exacerbate his anxiety. On the other hand, if your child or student has a history of ignoring other people’s feelings, contact an expert.

2. Anxiety isn’t an excuse, but it is an obstacle.
When a child is overwhelmed by anxiety, it can be extremely difficult for her to practice empathy. If your child or student is rude or thoughtless during a period of extreme anxiety, it’s okay to remind her that anxiety isn’t an excuse for meanness. However, it’s also important to remember that an anxiety disorder is a serious and painful mental illness. Until your child or student’s anxiety wanes, keep criticism calm and focused: “I know you’re feeling very anxious, but it’s not okay to yell at Viktor” is fine; “I don’t care if you’re scared! Go to your room!” is not. When the anxiety does fade, address the child’s behavior and offer solutions for future crises. For example, a child who snaps at his sister when he panics may practice saying “I have anxiety and can’t talk now” instead. If your child or student uses anxiety as an excuse for cruelty, contact an expert.

3.  It’s okay to let empathy go.
Anxious kids, especially those who tend to obsess, may become fixated on other people’s suffering. If your anxious child or student seems preoccupied with someone else’s suffering, suggest taking a break from empathy. Praise the child for his compassion and concern, and remind him that tragedy reminds us to be grateful and enjoy what we have. Suggest actions your child or student can take to help the people who have suffered, and then, after those actions have been taken, change the focus to something positive. If your child cannot overcome guilt or anxiety about the suffering of strangers, contact your pediatrician or mental health professional. If your child or student seems to enjoy fixating on the suffering of others, contact an expert.

4. Empathy comes naturally.
For most children, the ability to empathize develops over time. Young teens are similar to young children in that they tend to be very egocentric. That’s totally normal. Keep teaching and practicing empathy, and don’t worry if your child or teen goes through stages of selfishness. If your child or student is consistently unable or unwilling to empathize with others, contact an expert. Antisocial Personality Disorder is a serious and potentially dangerous mental illness that is characterized by a lack of empathy. Only a professional can diagnose this illness.  More information here.

5. Empathy goes both ways.
It can be difficult for mentally healthy or mentally normative individuals to empathize with people with mental illness. In the classroom, it’s important to help all students understand and empathize with mental illness. (Don’t single out your anxious students, though!) At home, it’s important to make sure the whole family empathizes with an anxious child. The best way to learn to empathize with someone is to learn more about them. Find a book or two about anxiety, and ask questions.  Many people find anxiety disorders confusing because they hear “anxiety” and forget the “disorder” part.  Anxiety is a normal and manageable part of life.  An anxiety disorder is a serious illness that cannot be willed away.  While you teach your chid to empathize, make sure she is also receiving empathy , both from others in her life and from you.

Disciplinary Issues and Anxious Students

Have you ever worried about how to discipline an anxious student? An anxiety disorder is not an excuse for disruptive or defiant behavior. When a student with an anxiety disorder breaks classroom rules, it is appropriate to discipline her in the same way you would any other child. However, some punishments may trigger anxiety or even a panic attack in anxious students, so arm yourself with backup options. A child who panics when sent into the hall may react appropriately to being asked to move to another desk or give up five minutes of recess. If a child does panic during a disciplinary activity, consider allowing the child to calm down before re-administering the punishment. Make sure the child knows that the punishment is not meant to inspire panic, but that panic is not a viable tool for avoiding punishment in general.

It may be helpful to make a list of potential consequences for misbehavior. Then, eliminate any punishment that is particularly likely to inspire panic in your student. Remember, people with anxiety do not all have the same sensitivities. Grouping consequences by potential anxiety-triggers makes it easier to determine which consequences to avoid.

Below is a sample list of disciplinary actions grouped by potential anxiety trigger. Feel free to use your own trusted classroom consequences.

Potential Anxiety Trigger: Humiliation (Social Anxiety)
-Standing/sitting at the front of the class (facing the class)
-Apologizing to the class
-Having the student write her or his name on the board

Possible alternates
-Sitting at the front or back of the class while facing forward (toward the teacher)
-Writing an apology to the class (but don’t have the student pass out the note herself)
-Writing the student’s name on the board for her

Potential Anxiety Trigger: Abandonment/Isolation (Separation Anxiety)
-Sitting outside the class
-Sitting alone during recess
-Staying in a classroom alone (an unusual punishment for any child) or with an unfamiliar adult

Possible alternates
-Any of the above while accompanied by a familiar adult

Consequences that are Less Likely to Cause Anxiety
-“Pulling your card” if the card chart isn’t at the front of the class
-A note home
-Private conference with the student
-Loss of privileges (no access to balls at recess, missing out on a fun activity, etc.)

Use your own judgement when selecting consequences; you already know what works with your students.

Is Royce White the Victim of Sexism?

I’m not a big fan of professional sports, but I’ve been enthusiastically following the story of NBA rookie Royce White. White, who was drafted by the Houston Rockets, has Generalized Anxiety Disorder (GAD) and phobia of flying. Because he cannot board a plane, the Rockets pay for ground transportation for White.

White is extremely open about his anxiety, and his candor has drawn attention to anxiety disorders. White frequently shares brave and heartfelt insights via twitter, inspiring many of his supporters to tweet their own anxiety-related diagnoses.

Recently, a critical article by respected sports journalist Adrian Wojnarowski questioned White’s dedication to the NBA and accused White of using his anxiety as a bargaining tool to get more playing time. White denies the allegations. I don’t know White, Wojnarowski, or anyone associated with the Rockets. I don’t know what White’s motives are, and I don’t know anything about his negotiations. I have no guesses as to the accuracy of the article.

Here’s what matters to me: Royce White’s tweets have made him a hero to children with anxiety disorders. And many twitter users have responded to that heroism with horrifying hatred. To raise awareness, White retweets some of his most cruel and ignorant attackers. These attacks are not about White’s dedication to the NBA. They aren’t about whether he’s using his anxiety unfairly. These tweets are pure hate, the kind of fanatical hate you might see directed at a political or religious figure. Again, I don’t know Royce. I don’t know if he’s smart or nice or if he kills puppies. But this is a man who has made it to the NBA in spite of crippling mental illness. To me, that’s pretty neat. Why are so many tweeters, who know exactly as much as I know about White, so deeply offended by him?

I wonder if it has to do with sexism. The Anxiety and Depression Association of America (ADAA), who I like to cite, claims that “[w]omen are twice as likely to be affected” by GAD. However, sex disparities related to mental illness are sometimes blamed on differences in reporting. In other words, it’s possible that women are simply more likely to report GAD symptoms. The idea is that men (and boys) may hide their anxiety in order to avoid being seen as weak. (A discussion about why women are allowed or encouraged to be weak is beyond the scope of this blog.) Is the hate directed at White a biological reaction to an NBA player acting, according to antiquated concepts of gender, like a girl? Do some of White’s haters worry that his anxiety somehow detracts from their own manliness?

While our culture’s ubiquitous low-level sexism about weakness is clearly relevant to White’s case, I’m not insisting that sexism is the most important part of the problem. (I’m certainly not accusing Wojnarowski of sexism. Again, I’m not talking about him.) People are always weird about mental illness. Every mentally ill person has (probably) been told to “get over” their disease. Many people simply can’t understand mental illness. Many people are offended by the terrifying idea that you can be betrayed by your own brain. As painful as it can be to interact with such people, I hope that White’s twitter bullies are offended by mental illness in general, not just by men with anxiety disorders.

I have known and worked with several boys diagnosed with anxiety disorders. These boys have been brave, intelligent, adventurous, and strong. (Just like the girls I’ve known and taught!) If I heard someone bully one of my students the way people have been bullying Royce White, I would go full mama bear. I want my students to be able to share their diagnoses and get the help they need without fear of discrimination or attack. Royce White claims to be a warrior against stigma and ignorance, and his tweets reflect that. So I think he’s a hero.

Unless it turns out he kills puppies.