All about accommodation – Anxiety in schools podcast

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Transcript

Melanie Cole (Host):  Hello, I’m Melanie Cole. Welcome to Anxiety in Schools, a special podcast series from Rogers Behavioral Health. This is episode number three of our six-part series where we look at anxiety and how it can impact learning. In this episode, we will discuss accommodation and I’d like to welcome Dr. David Jacobi. He is the lead psychologist, Child and Adolescent CBT Services, at Rogers Behavioral Health. Dr. Jacobi, what is accommodation and what are those specific behaviors intended to do?

David Jacobi, PhD (Guest):  Thank you Melanie. Accommodation is really a set of behaviors on the part of anybody who really has interactions with a child. So, typically we think of parents, but it could be really anyone. It could be teachers, coaches or even extended family members who have kind of constant or repeated interactions with the child. These are really behaviors that are designed to ease the child’s distress, certainly due to their anxiety, and also really to allow them to function or at least that’s the perception that these accommodations will help the child function socially in school and so forth.

So, some of the things that we think about when we are thinking about accommodation are in the world of obsessive compulsive disorder might be helping with completing rituals, so helping get through a shower, or a hand wash, or getting dressed in the morning, or getting organized and out to school. It could be giving in to the child’s demands about something. So, assisting with certain chores or the child may have an area in the house that’s just completely pristine and so they may say, no one can enter their room, for example. It can also take the form of providing reassurance to the child. So, a child may worry about some school related activity, exam or social interaction, be concerned about whether the doors are locked, or their hands are clean, and so the parent willing provides that reassurance, so the child feels better. It could be completing tasks for the child. So, for example, many of our kids really struggle with getting homework done because of their worry and anxiety so many of our parents will actually either assist quite heavily with that process or even do the child’s homework for them so that the child doesn’t experience failure or fall behind in school.

A couple of other things we see with accommodation would be reducing the child’s responsibilities around the house, say you don’t have to do chores or expectations of other siblings. And then lastly at time encouraging or allowing avoidance of situations that are really difficult for the child, such as social interactions, going to school, participating in extracurricular types of activities.

Melanie:  Dr. Jacobi, is accommodation, you have described all of these different specific behaviors and what they were intended to do - is this a good thing? Is it a positive thing? Or can it have some negative implications?

Dr. Jacobi:  We kind of think of it as being kind of a double-edged sword in a sense that parents and family members, teachers and so forth are doing what they believe is helpful for the child to certainly reduce their distress or improve their ability to function. But, in reality, what we find - and there has been a fair amount of research on this area - is that it really works against what we are trying to accomplish in terms of our interventions, treatment interventions.

Melanie:  So, if it seems like a parent is being overprotective and helping this child get through these things and it’s an anxious child, what are some of the specific strategies that you might recommend? Speak to us a little bit about accommodation and how it impacts that student and the school.

Dr. Jacobi:  Well certainly, again, parents are trying to help their child do well and be able to perform in school, to be able to deal with the stresses of school, to get their homework done and so forth. But in reality, what we are seeing are kids who are finding it difficult to pay attention in the classroom. They may kind of keep to themselves, whereas before they were involved in class discussions. They may be hesitant to offer opinions in the classroom setting, just look like they are sad or struggling, ask to leave the classroom setting as well as a way to kind of manage their anxiety if they are feeling overwhelmed. [They] may also ask a lot of questions of their teachers, a lot of reassurance seeking about what’s being assigned or about performance or things of that nature. So, in the classroom setting, it can take on a lot of different looks. But all of these sort of indicate that the child is really struggling well, particularly in comparison to maybe how they had been performing and doing prior to the onset of these anxiety symptoms.

Melanie:  Do you think it can limit opportunities for the student to learn if they don’t fear consequences? Does it reduce their motivation to change or to tackle some of these things by themselves?

Dr. Jacobi:  It can again, I think parents – we are certainly not in the process of trying to make parents feel bad about the accommodation or make school personnel feel bad about this. They are doing what they think is helpful. But it really does, at times, rob the child of the ability to realize that they can handle these situations effectively, that they can cope with them. So, by providing accommodations, we believe it kind of interferes with the child’s development of a sense of self-efficacy. So, the ability or the knowledge to believe that they can impact their environment in a positive way and also for the child to learn that oftentimes these things that they fear will happen, either don’t happen, so there is not really that likely to happen or that even if things don’t go well, that the child is able to cope with it. So, we really are encouraging family members and teachers and so forth to allow the child to experience their anxiety, to develop these coping strategies and get that sense of self-efficacy built up.

Melanie:  Do you think that there would be a good checklist or interference scale, as it were, to self-identify these accommodating behaviors, even by school professionals and or the parents?

Dr. Jacobi:  Well there certainly are measures out there, like a family accommodation scale that we can use from a clinical perspective. I think oftentimes we ask teachers and we try ourselves to educate teachers and school counselors as to what anxiety disorders look like in the classroom setting. Give them some diagnostic information so they can identify these sorts of issues, provide them with knowledge that they can impart not only to the child but to their family members, so an education component, and even at times, the ability for some of our in-school personnel and family members to intervene in a limited way to kind of do some exposure work and help that child. So, a lot of it is just coming from general knowledge about anxiety disorders, what accommodation looks like, examples of accommodation, and then kind of having the knowledge to know how to withdraw those accommodations in a more gradual way that, again, may lead to some temporary distress on the part of the child; but overall are going to be productive in terms of helping that child through their anxiety disorder.

Melanie:  So, wrap it up for us with your best advice on some strategies for reducing the need for accommodation, what you would like school professionals and parents to know about accommodating that anxious child, what you would like them to know.

Dr. Jacobi:  Well certainly, it takes some measure of understanding as I said about what accommodation looks like, are family members recognizing their behaviors, are teachers recognizing what they are doing in the classroom in terms of response to an anxious child, but some of the things the we do is we will respond, for example, to requests for reassurance with a very uncertain vague response, such as “what do you think?” in response to the child or “what’s your best guess?” or “I don’t know” – and what that does is again, it doesn’t provide that reduction in anxiety that the child is after it allows them to deal with that uncertainty.

We can also have parents and teachers limit the number of say reassurance requests in a given time period. So, set some goals, you get one question per 30 minutes and then we are going to try to reduce those number of questions over time. Another strategy again, even more so with reassurance, is to delay those reassurance providing. In other words let’s see if we can go five or ten minutes before we provide that reassurance to see if the child can learn to adjust to that. We can also set up some what we call token economy interventions where the child would be rewarded for limiting the number of requests for reassurance during a certain time period.

The other strategy that we use is really trying to look for other ways to replace those accommodation responses. So, in particular, with reassurance, we talk about something called validation. So, validation is kind of a – it can be a verbal, it can be a nonverbal communication to that child that they are – the way they feel, the way they think or even their behaviors have causes or understandable and that we are really trying to have parents and school personnel try to understand what that child’s experience is like, to show empathy and understanding through validation, or even get some clarification on what is it that the child is dealing with and trying to show that they understand how that works for the child. And there are lots of different ways to provide validation, but simply just showing that empathy and support can be really, really helpful for a child to understand that what they are experiencing makes sense, that it’s difficult for them, and that the parent or the teacher is there to support them.

Melanie:  Thank you so much for joining us Dr. Jacobi. Rogers Behavioral Health is working each day to ensure those with mental health challenges have access to the highest quality of care and most effective treatment available today. To learn more about the many way Rogers can help children, teens, families and schools, please visit rogerbh.org today. That’s rogersbh.org. I’m Melanie Cole. Thanks so much for listening.