Download No adaptations for Mild to Moderate ID

Anxiety
Disorders
Understanding Anxiety Disorders
in Disability Services
Agenda
• Define Anxiety Disorders
• How Anxiety impacts individuals with disabilities
• Recommendations on supporting individuals with
disabilities who may have a anxiety disorder
Diagnostic Manual-Intellectual
Disability
“Consequently, the extent to which the criteria can be
validly and reliably applied in this population is
problematic and should be decided on the basis of
robust empirical data with relation to phenomenology of
the disorders” (DM-ID, pg. 317)
Prevalence of Anxiety in ID
Population
Adults with Autism are 3x more likely to have anxiety
than ID population
55.5 % of children with Autism met the criteria for
Anxiety Disorders
Studies show 14% to 26% of adult ID population have
anxiety disorder
Disabilities and Anxiety
• Cognitive deficits make it more difficult for individuals with
IDD to express themselves
• Dependence on others to assist them with personal care and
daily living activities
• Communication or physical impairments may over shadow
anxiety disorders
• Lack of awareness and education
• Lack of self advocacy training and a system which
encourages compliance
• People with disabilities often rely on others to recognize
mental health issues
What Causes Anxiety
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Risk Factors for Anxiety with ID
Population
Trauma/Bullying
Multiple Homes
Many transitions
Loss/separation
Stressful environments
Illness
Disabilities and Trauma
• Some studies estimate that close to 80% of women with
developmental disabilities have been sexually assaulted at
some point in their lives.
• Other studies show that people with disabilities are more
likely to experience more severe abuse, experience abuse
for a longer duration, be victims of multiple episodes, and
be victims of a larger number of perpetrators.
• Prevalence of abuse and neglect in the IDD population is
conservatively estimated to be at least four times more
likely than those people without disabilities.
Types of Anxiety Disorders
• Panic Disorder without Agoraphobia, Panic Disorder with
Agoraphobia, Agoraphobia without History of Panic Disorder,
Specific Phobia, Social Phobia
• Obsessive-Compulsive Disorder
• Post Traumatic Stress Disorder, Acute Stress Disorder,
Generalized Anxiety Disorder
• Substance-Induced Anxiety Disorder
• Anxiety Disorder Not Otherwise Specified
Panic Attack
A Panic Attack is a discrete period in which there is the sudden
onset of intense apprehension, fearfulness, or terror, often
associated with feelings of impending doom. Symptoms include
shortness of breath, palpitations, chest pain or discomfort,
choking or smothering sensations, and fear of “going crazy” or
losing control are present (DM-ID)
Panic Attack
No adaptations for Mild to Moderate ID for Panic Attack
Panic Attack might be observed rather than self-reported in
severe to profound ID population. The person may appear to be
intensely frightened/agitated/distressed.
Pounding racing heartbeats and skipped beats might be
identified by taking the pulse or listening through a stethoscope
in the Severe to Profound ID population
Chest pains may be observed if the person is clutching or
rubbing their chest in Severe to Profound ID. (DM-ID)
Agoraphobia
Agoraphobia is anxiety about, or avoidance of places or
situations from which escape is difficult or embarrassing.
Panic Disorder Without Agoraphobia is characterized by
recurrent unexpected Panic Attacks, about which there is
persistent concern.
Panic Disorder With Agoraphobia is characterized by recurrent
unexpected Panic Attacks and Agoraphobia.
Agoraphobia
No adaptations for Mild to Moderate ID
Inapplicable in persons with profound disability. Difficult to apply
in Severe IDD unless there is clear and reliable evidence from
the person with IDD or the caregiver attributable to the cause
and effect that satisfies criteria
Avoidance of situations is limited/impractical on account of
disabilities or through lack of choice in severe and profound ID
Panic Disorder Without Agoraphobia
No adaptations for Mild to Moderate ID (note: The person may
have difficulty with temporal sequencing following a panic attack.
Try to use important anchors in time such as birthdays, holidays,
important trips or events)
This condition cannot be detected in Severe to Profound ID
population, however consider if the person has the appearance
of being worried or distressed, increased search for
reassurance, clinging or crying.
Specific Phobia In ID Population
• Characterized by clinically significant anxiety provoked by
exposure to a specific feared object or situation, often leading
to avoidance.
• Marked and persistent fear of a situation or object (e.g.,
flying, heights, animals, receiving an injection, giving lab
work, loud sounds or noises, or crowded places/enclosed
places)
Specific Phobia in ID Population
No adaptations for Mild to Moderate ID Populations
A note for Severe to Profound ID is the anxiety may be
expressed by crying, tantrums, freezing, or clinging.
It may not be possible to avoid the phobic situation in persons
with Severe ID through lack of choice.
In individuals with ID the duration for this disorder is at least 6
months
Specific Phobia in ID Population
Sensory processing issues happen from the brain having trouble
receiving and responding to information that comes through the
senses. Common sounds may be painful.
Sensory problems in individuals with Autism can lead to
phobias. For example, exposure to clothes, which can chafe the
skin, or loud noises in crowded places.
Social Phobia in ID Population
Fear of one or more social or performance situations in which
the person is exposed to unfamiliar people or to possible
scrutiny by others.
No adaptations for Mild to Moderate ID Population
In persons with Severe ID the anxiety may be expressed by
crying, tantrums, freezing, or shrinking from social situations
with unfamiliar people.
Acute Stress Disorder in ID
Population
Exposed to a traumatic event in which both of the following are
present:
• The person experienced, witnessed, or was confronted with
an event or events that involved actual or threatened death,
serious injury, or threat to physical integrity.
• The person’s response involved intense fear, helplessness,
or horror
• Other criteria include possible numbing, detachment,
reduction in awareness of surroundings, absence of
response, dissociation
Acute Stress Disorder in ID
Population
• No adaptations for Mild to Moderate ID population
• Dissociative symptoms are difficult to apply and may only
be observed in persons with Severe/Profound ID- for
example, absence of response may look like “being in a
daze”
Generalized Anxiety Disorder in ID
Population
• Excessive anxiety and worry, occurring more days than not
for at least 6 months
• Focus of anxiety and worry is not confined to features of an
Axis I disorder such as Social Phobia or Panic Attack.
• Need three of the following six symptoms
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Person finds it difficult to control worry
Restlessness or feeling keyed up or on edge
Being easily fatigued
Irritability
Muscle tension
Sleep disturbance
Generalized Anxiety Disorder in ID
Population
• No adaptations for Mild to Moderate ID population
• For Severe/Profound ID only one item is needed from the
previous slides list of symptoms
• Difficult to apply in persons with Severe ID and inapplicable
to persons with Profound ID.
Anxiety Disorder Due to General
Medical Condition
• Prominent anxiety, panic attack or obsessions or
compulsions predominate clinical picture and seem to be
directly related physiologically to a medical condition.
• No adaptations for Mild to Moderate ID populations
• Severe/Profound ID individuals will usually not be able to
self-report but may be observed to be agitated for frightened
Obsessive-Compulsive Disorder in ID
Population
• Obsessions for defined;
• Recurrent intrusive thoughts , impulses , or images that cause
anxiety
• Not associated with real-life worries
• Person attempts to ignore or suppress such thoughts, impulses or
images with another thought or action
• Obsessions may be difficult to elicit in ID population due to
communication deficits.
• ID population may be unable to report wanting to ignore
Obsessive-Compulsive Disorder in ID
Population
• Compulsions are defined;
• Repetitive behaviors (hand washing, ordering, checking, asking
questions, hoarding or rubbing) or mental acts (praying, counting
repeating words silently) that the person feels driven to perform
according to rules that must be applied rigidly
• Behaviors are aimed at preventing or reducing distress or
preventing some dreaded event or situation
• May be difficult or impossible to elicit due to cognitive impairment
or communication difficulties in ID population
• For compulsions in Severe/Profound ID look for excessive ordering,
arrangements
• Challenging behaviors such as aggression or self-injury may occur
if the person is prevented from compulsion.
Obsessive-Compulsive Disorder in ID
Population
• Compulsions are defined;
• There are many possible underlying reasons for self-injurious
behaviors/movements in people with ID therefore, self-injury should
not be used for making a diagnosis of OCD
• Stereotypic actions such as rocking, banging objects, flipping,
swinging objects, and pointing at body parts does not by itself mean
a diagnosis of OCD in ID population
• Some repetitive behaviors with physiologically rewarding
properties should not be used to make the OCD diagnosis
(examples include; masturbating, stealing, overeating, overdrinking,
humming, pacing)
Post Traumatic Stress Disorder
Diagnostic criteria for PTSD include a history
of exposure to a traumatic event that meets
specific stipulations and symptoms from
each of four symptom clusters:
 Intrusion
 Avoidance
Negative alterations in cognitions and mood,
and
Alterations in arousal and reactivity.
The sixth criterion concerns duration of
symptoms; the seventh assesses functioning;
and, the eighth criterion clarifies symptoms as
not attributable to a substance or co-occurring
medical condition.
Genetic Syndromes
• Individuals with ID and specific chromosomal syndromes
such as Autism, Prader-Willi, Down Syndrome, Fragile X,
and Williams Syndromes have a heightened probability of
demonstrated ritualized or compulsive-like behavior. (DM-ID
pg. 357)
Anxiety Screening Tools for ID
Population
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Mood and Anxiety Semi-Structured Interview
The Fear Survey (children and adults)
Anxiety and Depression Mood Scale
Glasgow Anxiety Scale
Yale Brown OCD Scale
Aberrant Behavior Checklist (ABC)
Social/Environmental
Biopsychosocial Approach to
Treatment
• Biological
Biopsychosocial Approach to
Treatment
• Biological
Biopsychosocial Approach to
Treatment
• Biological
Biopsychosocial Approach to
Treatment
• Biological
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SSRI often used for repetitive behaviors, hair pulling, self-injury
Naltrexone used for self-injury
Propranolol-generalized anxiety
Rare to see Benzodiazepines
Overall wellness management through medical providers
Nutrition
Exercise
Sleep
Social/Environmental
• Reduce stimuli such as clutter, noise, lighting, temperature,
earphones, eye glasses
• Reduction in transitions
• Wellness and Lifestyle Supports (Intellectual, Spiritual,
Occupational, Environmental, Social, Emotional, and
Physical Wellness)
• Social connections (Special Olympics, community support
groups and events)
• Peer programs
• Sensory Diets
What is Mental Health First Aid
Mental Health First Aid is the help offered to
a person developing a mental health
problem or experiencing a mental health
crisis.
The first aid is given until appropriate
treatment and support are received or until
the crisis resolves.
Mental Health First Aid: ALGEE
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Assess for risk of suicide or harm
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Listen nonjudgmentally
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Give support and reassurance
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Encourage appropriate professional help
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Encourage self-help and other support
strategies
References
• ACE Study
• Diagnostic Manual of Intellectual Disabilities
• University of New Mexico, Dr Molly Faulkner,
March 2015
• Goodnewswellnessliving
• Bruce Perry, Boy Raised as a Dog, Child
Trauma Academy
Resources
• http://goodnewswellnesslifestyle.com/
• http://thenadd.org/
• http://vkc.mc.vanderbilt.edu/etoolkit/