Teaching Students with Asperger to Deal with Anxiety

“Anxiety can be understood as a hidden disability,” say Jessica Minahan (a Newton, Massachusetts special educator) and Nancy Rappaport (Harvard Medical School and Cambridge Health Alliance) in this Kappan article. They believe anxiety is the culprit in many of the behavior problems experienced by children with Asperger syndrome. Standard behavior modification approaches (stickers, points, praise) are ineffective and can make things worse, say Minahan and Rappaport: “If students with Asperger are to succeed in school, they need a prescribed behavioral intervention plan that addresses anxiety, explicit instruction in underdeveloped skills leading to anxiety, which helps them learn alternative, more appropriate responses to use when they’re flooded with anxiety, and includes accommodations that teachers can use while students learn new skills.” 

Some students show obvious signs when they’re anxious – flushed cheeks, tense muscles. But with others, there aren’t clear signs until they act out and anxiety is expressed indirectly – increased insistence on routines and sameness, preference for rigid rules, repetitive behavior, anger outbursts, and silly behavior. Minahan and Rappaport use the analogy of a shaken can of soda: you can’t tell it’s been shaken by looking at it (the student looks fine); you only find out when you pop the can open (the student inexplicably explodes). Anxiety also undermines students’ academic performance by the effect it has on working memory, attention, and other abilities. 

“A student’s anxiety-related behavior is often motivated by escape or avoidance,” say Minahan and Rappaport – asking to see the nurse when a writing assignment is handed out, or cursing just before a math test. “If the teacher responds with a time-out or sends the student to the office,” they say, “this may accidentally reinforce the avoidant behavior…” What’s needed is explicit instruction in the following underdeveloped skills:

• Self-regulation – the ability to calm oneself and manage frustration;
• Thought-stopping and thought-interruption – the ability to short-circuit a cycle of negative thinking by refocusing attention on a replacement thought;
• Thinking traps – the ability to recognize common thought patterns that can increase anxiety and learn how to manage those thoughts;
• Social skills – the ability to take another person’s perspective and use conversation skills;
• Executive functioning – the ability to think before acting and follow sequential steps to complete a task effectively;
• Flexible thinking – when anxious, this can help a student avoid becoming upset when things don’t turn out as expected.

“These skills must be explicitly taught if the student is to change his or her behavior over the long term,” say Minahan and Rappaport. “Sadly, many behavior plans/programs don’t address these skills.”

It’s critically important for teachers to backtrack from a behavior meltdown and find the antecedents. These might include unstructured times (cafeteria and recess), transitions, writing demands, social demands, and unexpected events. “Ninety percent of every behavior plan should be dedicated to antecedent management,” say Minahan and Rappaport. “Students will continue to require accommodations until they develop the skills to cope and can succeed without them.” For example, a student might be given two 10-minute anxiety-reduction breaks during each day, and these shouldn’t have to be “earned” by good behavior. Academic accommodations are also important – for example, previewing a math worksheet early in the day and doing the first problem with the student, or providing a list of commonly misspelled words. Students need to be coached from statements like “I’m a horrible speller” to saying “I’m not a great speller, but I have a strategy.” 

Students with anxiety issues also benefit from cognitive behavior coaching. It’s a big step when they can understand that emotions start small and grow larger – from calm to an explosion – and what the outward signs are. “Once students understand this,” say Minahan and Rappaport, “they can learn to catch themselves at the frustration point and practice a coping strategy to regulate themselves before becoming explosive or shutting down.” A teacher might say, “I notice your face is scrunched, your shoulders are up near your ears, and your fist is clenched. You’re frustrated right now.” 

The authors also recommend using an “emotional thermometer” with pictures of various facial expressions and matching emotions and steps to take. Teachers can also provide a “calming box” containing small items the student can use to calm down – putty, a good-luck charm, a “lucky penny”, or noise-reducing headphones. 

“Anxiety in Students: A Hidden Culprit in Behavior Issues” by Jessica Minahan and Nancy Rappaport in Phi Delta Kappan, December 2012/January 2013 (Vol. 94, #4, p. 34-39), www.kappanmagazine.org 

From the Marshall Memo #466