Identification and Treatment of Anxiety in Students with Emotional or Behavioral Disorders: A Review of the Literature

Abstract

Abstract Anxiety affects school achievement, yet it is rarely targeted for intervention in students with emotional or behavioral disorders (EBD). This review of the literature summarizes existing research on (1) the prevalence of anxiety disorders in students with EBD, (2) the academic effects of anxiety disorders, and (3) the school interventions designed to ameliorate them. We offer conclusions regarding the state of educational intervention for these students. The review also highlights the scarcity of studies related to anxiety in students with EBD. Past research has focused primarily on students in general education settings, on prevalence within the general population, and on measuring psychosocial symptoms, rather than on academic achievement. We comment on the relevance of these findings to the field of EBD, and discuss implications for further research. ********** Students come to the attention of special educators when they differ from the norm: in family circumstances; in academic performance; or, in the case of students with emotional or behavioral disorders (EBD), in school behavior. Fears that exceed the spectrum of normal functioning are an example of such a behavioral disorder. While some degree of anxiety is part of normal child development (Gullone, 2000), excessive fear can be detrimental not only to a child's overall well-being, but also to school performance (Morris, Shah, & Morris, 2002). In the United States, the role of special education in public schools is defined by the Individuals with Disabilities Education Improvement Act of 2004 (IDEIA). Within the context of IDEIA, anxiety disorders are generally considered to fall within the category of emotional disturbance - a category that encompasses a wide array of EBD in children. Under federal law, emotional disturbance is defined as: a condition exhibiting one or more of the following characteristics over a long period of time and to a marked degree that adversely affects a child's educational performance: (A) An inability to learn that cannot be explained by intellectual, sensory or health factors. (B) An inability to build or maintain satisfactory interpersonal relationships with peers and teachers. (C) Inappropriate types of behavior or feelings under normal circumstances. (D) A general pervasive mood of unhappiness or depression. (E) A tendency to develop physical symptoms or fears associated with personal or school problems (Code of Federal Regulations, Title 34, Section 300.8(c)(4)). The degree of overlap between these characteristics and the indicators of anxiety disorders listed in the Diagnostic and Statistical Manual of Mental Disorders (American Psychiatric Association [DSM-IV-TR], 2000) confirms that students who experience internalizing and/or anxiety disorders in combination with diminished academic achievement might well meet the IDEIA criteria for an emotional or behavioral disorder. The last few decades have seen a surge of interest in anxiety in mental health settings (Barrett, 2000; Schniering, Hudson, & Rapee, 2000), with interventions that range from psychiatric medication to cognitive-behavioral therapy bringing increasing success to the treatment of anxiety disorders in children (Allen, Leonard, & Swedo, 1995; Forness, Freeman, & Papparella, 2006; Cartrighr-Hatton, Roberts, Chitsabesan, Fothergill, & Harrington, 2004; Compton et al., 2004; King, Heyne, & Ollendick, 2005; Silverman, Pina, & Viswesvaran, 2008). Despite these developments, educators concerned with student behavior continue to pay little attention to anxiety. Anxiety disorders appear only rarely in either descriptive or intervention-based education research. While studies do occasionally distinguish between the forms of emotional or behavioral difficulty exhibited by participants - most notably between internalizing and externalizing disorders (see Achenbach, 1991; Falk, Dunlap, & Kern, 1996; Gresham, Lane, Mac-Millan, & Bocian, 1999) - most research either draws little distinction between the various forms of behavioral deficits that participants exhibit (e. …