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December 1, 2017
Vol. 75
No. 4

Helping Anxious Students Move Forward

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Social-emotional learning
Engagement
Sitting across a graffitied desk from me, an exasperated 9th grade English teacher says, "We've given him every chance!" She's talking about Jeremy, a basketball star by all accounts, who is bright but getting little to no homework or schoolwork done and spending more time in the bathroom than in his classes. "Basketball is his only love, and many of us hope it is his ticket out of the inner city," the teacher tells me. The teacher also explains that Jeremy has a diagnosis of generalized anxiety disorder and has been struggling with academic performance and work engagement since elementary school.
The school's guidance counselor told Jeremy that unless his grades improved, he wouldn't be allowed to play basketball. Unfortunately, his grades did not improve and Jeremy was kicked off the team in January. He ended the school year failing all but one course.
Anxiety disorders are extremely prevalent among children and adolescents in the United States. With 31.9 percent of adolescents having had an anxiety disorder at some point in their lifetime, anxiety is the number one mental health concern that educators and counselors face (Merikangas et al., 2010). Yet most teacher preparation programs only mandate one course (or none at all) in behavior and mental health principles. Overwhelmed teachers like Jeremy's are trying, but lack the training to help their students adequately.

Work Avoidance Is Not an Issue of Motivation

In my work as a behavior analyst and consultant, I see work avoidance at all grade levels: a 1st grader staring at the wall during reading group, a 5th grader asking to see the nurse when she's called on in class, an 8th grader putting his head down and disengaging during independent math work. Many people might think this behavior indicates a lack of motivation, especially when attempts at incentivizing the student don't work. That's what it looks like.
And yet if we consider Jeremy's plight, we see this isn't true. Despite his anxiety, Jeremy couldn't have been more motivated to play basketball. Yet that wasn't enough. Why?
Though extremely motivated and academically capable, Jeremy lacked four crucial executive functioning and emotional skills:
Accurate Thinking: The ability to look at an assignment or situation and accurately judge its difficulty, the time it will take to complete, and one's own ability to engage in and complete it.
Initiation: The ability to organize one's thoughts and start engaging in a task.
Persistence: The ability to sustain effort, even when faced with a mistake or difficulty (perceived or real).
Help-Seeking: The ability to ask for help when difficulties arise (rather than avoid the task or feel defeated).
Penalties and incentives don't teach these skills and are unlikely to improve students' behavior. Instead, they often leave students like Jeremy feeling misunderstood and rejected. What is more helpful for students with anxiety is to teach them how to engage in work and to develop these skills.

Teaching Skills for Work Engagement

When we teach our children to ride a bike, we give them training wheels. Similarly, we should provide accommodations, such as placing math problems on cards on a key ring so students see one problem at a time instead of a long worksheet, to support students while explicitly teaching work engagement skills. Providing students with accommodations supports their ability to think accurately, initiate, persist, and seek help, allowing them to succeed while they are building these skills. If we remove the supports before students are ready, they'll crash.

Accurate Thinking

Behavior occurs for a reason. Work avoidance behavior—putting your head down on the desk—is the behavior we notice, but it is often precipitated by mild avoidance behaviors and an invisible series of negative thoughts. Students with anxiety or depression are at a particular risk for these kinds of inaccurate thoughts. Students may create an all-or-nothing situation in their minds ("I hate math" versus "I struggle with multiplication"), which can cause defeat before the student even begins. Another common version is catastrophic thinking ("I don't know how to do the third problem, so I'll probably flunk 6th grade"). Because thoughts are invisible, it is important that negative thinking should be measured—not assumed—through data gained from interviews and thought journals.
One approach to turning negative thinking into accurate or positive thinking is to have the student rate the difficulty of a writing assignment before and after the activity (Minahan & Schultz, 2014). Before the activity, the student might rate it "very difficult" due to his anxiety-fueled perception, but an hour after completion, he'll likely have a more accurate perception and assign a lower number. Referring him back to those ratings may shift his mindset for future work.
Another strategy is to create a chart that breaks a task into parts (Minahan, 2014). Make a list of different task parts, mixing in neutral items (writing lower case letters, using punctuation), favorite things (drawing, telling a friend about my idea), and some aspects they dislike (spelling). Then have students categorize each of the items into one of three columns: "I like it," "It's OK," and "I don't like it." Show the chart to the student when she makes an all-or-nothing statement such as, "I hate writing!" You can reframe by saying, "Actually it seems you like writing. Are you having trouble thinking of an idea? That's a small problem. I can teach you how!"
These strategies give the student a realistic view of tasks and isolate the exact skill that's a challenge. Combined with reframing language, it reduces the student's all-or-nothing thinking, empowering both student and teacher (Chambers, 2017).

Initiation

Have you ever asked a student to start work, only to realize a few minutes later that she is staring into space? If you offer help at that point, you may find that the child has already been wallowing in negative thoughts and is on the verge of shutting down. It isn't realistic to ask negative-thinking, anxious students who lack initiation skills to begin work independently. Instead, we must help them start and then ask them to continue on their own.
If teachers can assist the student within the first 30 seconds of assigning materials, they can help dissuade negative thinking (Minahan, 2014). Another helpful strategy is to look at the assignment together earlier in the day—or even the day before: "This is the math sheet we'll be doing later. Let's start the first and second problem together."
Chunking (breaking work into smaller pieces) can also help students with low initiation skills. Give them one sheet at a time instead of the whole packet, or tell them to do only the even-numbered problems. If a student still doesn't engage, teachers can give the student a math sheet that is completed except for the last few problems and ask the student to finish it. This is actually more effective than giving them a blank sheet and asking them to do only the first five because the sheet looks almost finished and easier to complete. It gives the student a sense of completion and gratification and can bypass negative thinking.
For a writing assignment, try filling in the first sentence and first half of the second. Stopping in the middle of a word, mid-sentence, is a great way to get the student to continue. He can be taught to stop mid-sentence so when he returns to the assignment it'll be easier to keep working.
For students who are risk-averse or perfectionistic, provide a whiteboard for writing. Teachers can also put worksheets in a transparent sleeve and allow students to use a dry-erase marker. In middle or high school, provide a second copy of a paper-based quiz to remind students that mistakes aren't permanent.

Persistence

Teaching and nurturing persistence can be accomplished using psychologist Carol Dweck's growth mindset theory, which teaches students that "every time you push out of your comfort zone to learn hard things, your brain grows new connections and you get smarter" (Dweck, 2006).
Rewarding persistence, not just product, can prevent students who work hard but don't earn great grades from "turning off" and not bothering to try. Do this by focusing part of the grade on small evidences of persistence, like, "Did I attempt more problems today than on my last quiz?" "Did I correct an answer?" "Did I attempt one of the challenge problems?" This allows a disengaged student to focus on effort and not be intimidated by a need for correctness.

Help-Seeking

Students with anxiety or depression may lack the initiative to ask for help when they're stuck or overwhelmed by a task, and instead feel defeated and give up (Minahan, 2017). In some students, it could be that they are embarrassed about asking. Pull them aside and decide on a nonverbal or private system they are comfortable with, such as putting a pencil behind their ear when they need help.
Once we get students to ask for help, the next step is to assist the student to reflect on and articulate specifically what they need to reduce dependency. While talking, they may realize there's another strategy available. When a teacher won't accept the nonspecific request for "help," and instead requires students to answer, "What do you need help with and why?", students are forced to look more closely at the challenge. In articulating, "I don't remember the formula," a student may realize the problem is one he can solve himself by looking in his math book. The teacher can then reinforce that independence by saying, "Great! You didn't need help! I'm glad you figured it out."
The flip side of this is that some students respond to anxiety by asking for help too frequently. Jeremy's classmate Monique always asked, "What do I do?" immediately after being given directions. When the teacher asked her, "What were the directions?" she would be able to repeat them perfectly. This type of help-seeking is actually reassurance-seeking, and making this distinction is important to building students' self-awareness. Helping them replace, "I don't know what to do," with "Can I have a check-in with you?" or "Did I understand the directions correctly?" will promote anxious students' more accurate and confident self-concept.

Increasing Independence

When all reminding and prompting attempts have failed, teachers commonly sit with reluctant students and plod through the assignment with them without explicitly teaching strategies. However, working one-on-one or profusely prompting them through each task can cause dependence.
A better strategy is to teach students how to self-monitor. If students can learn how to assess their own needs and find the strategies to get help, they will not need to overly rely on the teacher. Figure 1 shows an example of a self-monitoring sheet that visually lists strategies a student can use independently to initiate, persist, and seek help. For students who seek reassurance, teachers can add options such as "Ask the teacher for a check-in," "Ask three classmates before asking the teacher," or "Reread the directions." This type of chart can be made into a class poster for all to reference.
Helping Anxious Students Overcome Work Avoidance (fig 1)
Even with teachers' daily suggestions of strategies to help students solve problems independently, most students still believe that asking the teacher for help is their best tool when they are stuck. For that reason, the teacher needs to be persistent in referring to the self-monitoring sheet when prompting a student to solve problems independently. First, the teacher can label the struggle as one of the small skills, such as, "Looks like you are having trouble initiating." This reframes the student's all-or-nothing thoughts into smaller, easier-to-tackle problems he can solve independently. Teachers can then point to the strategies column on the chart and ask the student which strategy he's going to use to solve his own problem, saying, "Show me the strategy you've chosen to help yourself." The teacher can provide guidance if needed, but the student is gaining independence.

Independent Work

Often, I see a teacher work with students in a small reading group or one-on-one and then ask them to finish the assignment independently, only to be surprised when the students go off-task or become disruptive. The frustrated teacher often feels a particular student can do the work, as evidenced by his earlier production with her, so she assumes that he must be choosing not to do work back at his desk.
The teacher does not realize that she was essentially giving the student help without his asking for it, thereby preventing him from developing his initiation and persistence skills. Without the initiation, persistence, and help-seeking skills necessary to tackle the assignment independently, he becomes stuck and avoidant.
So how can she help him? An input/output inventory (see fig. 2) can help teachers think about where to meet students so they can be successful independently and give teachers guidance on how to gradually increase students' level of input/output as they show signs of success. For example, students may be intimidated by reading an entire chapter of a book, but might be able to easily listen to an audio book. They may fail fill-in-the-blank quizzes, but be excellent at verbally answering questions in class. If you can identify where they are on the inventory, then you can meet them there and help them succeed independently.
Helping Anxious Students Overcome Work Avoidance (fig 2)
If, however, a student's independent work skills are at a lower level than his capability in a supported environment, then we'll likely see work avoidance or disruptive or challenging behavior. Like a helium balloon, if the student is not tied to the structure of work, he'll float aimlessly. Meeting students where they are independently and systematically introducing more difficult methods of showing knowledge is the only way to shape behavior toward success while building work tolerance and skills.
For example, one day in class, Jeremy's teacher asked students to conduct research on the computer and answer two open-ended questions on a sheet of paper. Instead, Jeremy was scrolling through social media and encouraging classmates to join him. The teacher eventually asked him to leave the room. When meeting with Jeremy's team, I asked, "How often does Jeremy complete open-ended writing independently?"
"Never!"
His teachers were overshooting the method of output. Looking at work samples, we found Jeremy wouldn't engage in reading when there were more than two paragraphs on the page. I suggested they accommodate the work, requiring him to read only one or two paragraphs. I also suggested accommodating assignments from open-ended questions to multiple-choice. Jeremy's history teacher agreed to try this, and within five weeks, Jeremy was completing work and beginning to improve toward reading one page of text in a book and completing fill-in-the-blank answers. Jeremy told the principal, "It's like I'm a student! I hand in work and get graded." History was the one class he passed that term.
Simple changes, like increasing the font size of an assignment, can help a student think the task is less difficult. Students sometimes can find pencil-and-paper tasks intimidating, but almost all assignments or concepts have a non-paper equivalent that may be less off-putting (for example, a math game on a tablet or laptop). Being patient and flexible is also key—students' abilities may fluctuate daily, depending on underlying levels of anxiety. On Monday, they may need to take a step back, while on Wednesday they can continue to move toward more difficult methodology.
Teachers readily reduce or accommodate the way we give assignments to students with dyslexia, dysgraphia, or visual impairment, but we don't always think to make such accommodations for students with anxiety or other emotional disabilities. By meeting students where they are and systematically increasing the difficulty with support—while teaching initiation, persistence, and help-seeking skills—we build independent work tolerance.
To embrace the skill-building approach to work engagement and to expedite the learning of initiation, persistence, or help-seeking skills, recognize and celebrate when students use strategies instead of focusing on whether they did the work. This promotes independence and generalization of the skills, allowing teachers to increase learning time and meet the needs of every student.
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Social-emotional learning

December 2017 / January 2018 EL: Mental Health in Schools

5 years ago
References

Chambers, K. (2017). Cognitive behavioral therapy: A psychologist's guide to overcome anxiety, depression & negative thought patterns - Simple methods to retrain your brain. (n.p.): Author.

Dweck, C. S. (2006). Mindset: The new psychology of success. New York: Random House.

Merikangas, K. R., et al. (2010). Lifetime prevalence of mental disorders in U.S. adolescents: Results from the national comorbidity survey replication—Adolescent supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 49(10), 980–989.

Minahan, J. (2014). The behavior code companion: Strategies, tools, and interventions for supporting students with anxiety-related and oppositional behaviors. Cambridge, MA: Harvard Education Press.

Minahan, J. (2017, February 27). 5 tips for preventing dependency in anxious students. Retrieved from www.huffingtonpost.com/entry/58b4a421e4b0e5fdf61975f0

Minahan, J., & Schultz, J. J. (2014). Interventions can salve unseen anxiety barriers. Phi Delta Kappan, 96(4), 46–50.

Jessica Minahan is a licensed and board-certified behavior analyst, special educator, doctoral student, as well as a consultant to schools internationally. She has over 17 years of experience supporting students who exhibit challenging behavior in urban public school systems. She is the co-author of The Behavior Code: A Practical Guide to Understanding and Teaching the Most Challenging Students (Harvard Education Press, 2012) and author of The Behavior Code Companion: Strategies, Tools, and Interventions for Supporting Students with Anxiety-Related or Oppositional Behaviors (Harvard Education Press, 2014).

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