Child Behavior: Anxiety and Severe ADHD
Ask Dr. Fernandez
- Grades: PreK–K, 1–2, 3–5, 6–8
Q | I have a kindergartner with anxiety issues. He’s terrified of a teddy bear outside a nearby classroom. How can I help?
A | You have an opportunity to help your student conquer his fear, which you can begin to do by showing him pictures of the bear. Then, tell your student that you will walk next to him when passing the teddy bear. Maybe start by walking on the side closer to the teddy bear. Encourage his efforts by praising him for brave behaviors (e.g., walking with you in the bear’s direction). If possible, reward him with a sticker or some other incentive every time he walks by without a major struggle. Be supportive by being warm and showing confidence in your student, but don’t pay attention to his anxious behaviors (diverting his eyes, slowing down)—overly reassuring him can actually make the anxiety worse. Once he has practiced several times and feels more comfortable, increase the difficulty. Plan with him in advance that he will walk on the side closest to the bear. Once he conquers that, tell him that you will walk a few steps ahead of him. Continue to encourage him and to withhold attention to anxious behaviors.
You have a student with anxiety. Keep in mind, though, that many childhood fears are normal. It may be appropriate simply to request that the teacher move the teddy bear so your students need not pass it at all.
Q | I have a second grader with severe ADHD in my self-contained EBD class. During every transition, he loses control. His parents no longer want the school to use therapeutic holding, even when other students are at risk.
A | First, I strongly recommend that you review the child’s IEP to confirm that a behavior intervention plan is in place. If not, work with a behaviorist to identify triggers for aggressive behaviors, as well as consequences that follow the behaviors and increase or decrease their likelihood.
As you mentioned, the parents have requested that therapeutic holding not be used; in fact, holding can at times inadvertently reinforce misbehavior. Similarly, sending a child out of the classroom can reinforce misbehavior if the child is trying to avoid an activity.
Consider using a daily report card. A DRC sets up very specific behavioral expectations, and a child gets feedback throughout the day. It acts as a preventive measure by providing a child with goals and incentives in the form of rewards he can earn. Having more class periods on the DRC gives your student more chances to succeed; having too many makes it difficult to be consistent in implementing the plan.
A consistently implemented DRC makes aggressive and destructive behaviors less likely. The question remains as to how to handle your student’s behavior when it does escalate. Again, understanding what motivates this particular child is necessary to get the right answer.
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Melanie A. Fernandez, Ph.D., ABPP, is board certified in clinical child and adolescent psychology and is director of the Parent-Child Interaction Therapy Program at the Child Mind Institute.