Anxiety in Developmentally Disabled Adults, Adolescents and Children

Disclaimer

The following is meant to be my own ideas and beliefs on anxiety. While I have an extensive background on the subject, the information provided is meant to be anecdotal in nature. While the ideas I present can generally be found in mainstream research, they are not necessarily completely supported by theories and literature that are considered to be mainstream.

Causes of Anxiety

• Fear is a belief that something untoward will happen in the future

• Fear is based on a memory of an incident(s), modeling by someone else, information received.

• Anxiety develops as a result of this fear if it goes unresolved. It is the chronic or ongoing form of fear.

What does anxiety look like?

Manifested anxiety looks like chronic fear or worry. Anxiety can last a lifetime. Symptoms can include: Perseveration of thoughts and worries, sleep disturbance due to perseverating thoughts (I have noticed that the thoughts can operate underneath the person’s awareness), eating disturbance (forgetting to eat becomes a consequence due to perseverating thoughts, overeating becomes a way of soothing the worried mind), forgetfulness/absentmindedness due to perseverating thoughts, shaking/trembling, headaches, reduced tolerance to stress due to an already stressed system, frustration/irritability as the anxiety is not overcome.

Unmanifested anxiety outwardly makes a person appear okay. Inwardly the person can have the emotional symptoms described above. The difference is the person is also expending energy on suppressing/denying the emotions. This tends to have the effect of depleting the person’s energy causing more tiredness, more susceptibility to illness, more frustration and irritability, more impulsive behaviors.

The emotional system can refuse to process the emotion whether it is manifest or unmanifest. At that point the physical system will begin to process the emotion.

For the most part, the physical system cannot suppress emotions. Some physical manifestations of anxiety are: fatigue, low tolerance to stress, frequent illness, hair loss, digestive problems, elimination problems, skin problems, allergies, hay fever, indigestion, chronic fatigue, arthritic symptoms, asthma, loss of appetite, "knots" in the stomach, hidden growths in the body.

Some common causes of anxiety:

Indecision, perfectionism, lack of trust or suspiciousness, fear of poverty, fear of abandonment, performance anxiety, fear of being revealed, fear of instability or fear of change are common causes of anxiety. Any fearful experience that a person is not able to come to terms with can turn into anxiety.

Treating anxiety

Fear of the future tends to cause a feeling of not being safe in the present. Feeling unsafe tends to be in 2 systems: The emotional and the physical.

Treatment strategies can address the underlying fears of emotional issues and/or physical issues.

Treatment can target the present need to feel safe emotionally and/or physically.

Treatment issues with children

In any treatment issue with children it is important to remember that a number of skills that we take for granted as adults are not developed or are still being developed as children. Some of these are: verbal skills, identifying emotions, accurately drawing from memories, abstract thinking.

Often children think concretely (from Piaget model). In so doing they can be perfectionistic in their ideas and see moral issues in a black and white manner. When interpreting a difficult issue this will also be seen concretely. Treatment can target this type of thinking allowing for a wider variety of choices in the given situation. The idea is to show the child how to use abstract thinking in this one area even though he/she may not be able to generally adapt abstract thinking.

A large number of child therapists believe that the first few years of life are critical in the development of the emotional system. Many believe that if a parent who the child identifies with leaves for an extended period of time, even a few days, this can cause anxiety that the child will be unable to process due its immature state.

"Mother is the name for God on the hearts and lips of all children." – the movie, The Crow. I think the quote probably came from somewhere else because I find it hard to believe that a script writer came up with such a cool quote. Wherever it came from, I find this to be a universal truth. The only difference I’ve noticed is that sometimes you can replace "mother" with "father." This quote means all that it implies. Since mother or father tend to be idealized, or God in children, God can be anxious, inadequate, neglectful, abusive with all the implications for the subjects who must live under the rule of a God who might be these things.

Treatment issues with adult consumers:

The main difference between adults, whether consumers or otherwise, and children is the length of time that they have been harboring their emotions. Generally, the longer a person does not come to terms with an issue, the more defenses are built to shield the person from feeling the emotion, and the more the person tends to deny the presence of the emotion so that they are able to function without its presence bothering them.

The difference between an adult dealing with mental retardation or a developmental disorder and an adult without these issues is often the lack of normal development of emotions and the ability for abstract reasoning (I read a study that suggested most adults do not grow emotionally much past adolescence).

An adult consumer may be 50 y.o. but function emotionally at 10 y.o. This is not necessarily a pro or con. However it means that when dealing with an emotional, moral, or ethical issue, staff should consider methods that may be more impactful for someone functioning at this level. This is complicated by the chronological age of the individual, suggesting that the anxiety may have been existing for a number of years with strong denial/suppression systems at work. Further, there is probably more that science does not know than it does know about how mental retardation and developmental disorders effect the psyche, the brain, and the development of human systems and communication. Effective treatment will likely take all these issues into account.

The latest research overwhelmingly shows that the most effective short-term results are found using cognitive/behavioral therapy with children and adult populations (I believe that other forms of treatment will yield better results in the long-term and that we do not yet have the tools to truly measure effective forms of therapy. But the research is from a number of resources and is certainly the current trend in both those seeking therapy and insurance companies). This form of therapy will likely prove the most beneficial since it does not require abstract thinking or insight into the issue.

Effective methods of intervention may include: Learning to recognize situations that may cause anxiety, techniques designed to desensitize one to the anxiety-provoking situation, avoiding anxiety-provoking situations, stress-reducing and relaxation exercises, visualization exercises, self talk, massage or soothing touch, behavior modification, etc. All these techniques are used with adults and children. They can be modified for use with consumers as well, taking into consideration the potential for delayed emotional development, increased defenses, and communication issues.

Acute and generalized forms of anxiety

Any anxiety has chronic fear attached to it. The subcategories in the DSM-IV are more so and can also have acute experiences and fears attached to them. Some of the sub-categories in the DSM-IV are:

Post Traumatic Stress Disorder

Generalized anxiety

Phobias

Obsessive-Compulsive Disorder

Panic attacks

Separation anxiety
This type of anxiety is generally considered to be manifested only in children, although my belief is that many adults can suppress this. Many clinicians now consider school phobia to be a manifestation of separation anxiety. There is a personality disorder called Dependent Personality Disorder that has features of separation anxiety.

This is by no means meant to be the definitive reference or theory for anxiety, but I hope it gives the reader ideas on how this emotion is manifested and things that can be done to address it. There is a very extensive amount of literature on the subject, both in print and on the internet.