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social pragmatic communication

The Special Relationship Between Language-Based Learning Disabilities and Anxiety

Blog Type:  Social and Emotional Issues Date Posted:  Tuesday, March 19, 2019

girl and mother at table anxiety learning disability

This is the fifth post in a five-part series about students, stress, and anxiety. The first article is an overview of anxiety, the second looks at a relaxation program for elementary and middle school students, the third discusses how a student learned to manage her anxiety, and the fourth explores how mindfulness can reduce anxiety. By Helene Dionne, Ph.D., and Laura Polvinen, LICSW

"I tried very hard to be normal…I tried to hide as much as I could…You think you go day by day…but…it’s like every day is a full lifetime. And it’s like, 'Oh my god! I have to get through this...the amount of anxiety, stress, and fear is enough to fill a lifetime...it is just so stressful…once I go to bed, it is like the end of my life…' "(Cole, 181)

As a student with a language-based learning disability (LBLD), Cole knows better than most what it means to live with anxiety.  Indeed, the literature reports that rates of anxiety are significantly higher for students with learning disabilities (Alesi, Rappo & Pepi, 2014). While the reasons for this remain unclear, students with LBLD connect their increased stress level to a number of factors. The difficulty of performing daily school tasks, as Cole describes, may certainly trigger a constant state of hypervigilance. Emily, 18, shares the same worry. Teachers “would go around the room and have us read. I remember chewing on my sleeves because I was so nervous about being picked,” she said. The acute sense of being different, described by many of our students as beginning in kindergarten or first grade, often tightens the grip of that anxiety. “I was so self-conscious about my learning and comparing myself to other kids…I would put myself down because I felt I was not as smart as the other kids,” recalled Emily. That anxiety may lead to school refusal (Kearney & Albano, 2004, 2008).  Many students with LBLD also describe an intense preoccupation with friendships. “Once I started having problems in the classroom, I became more shy, and I focused so much on having friends…even as a 6 year old, I was worried about socializing...,” added Emily. That worry may spread to social anxiety: “As I got older...I would get anxiety about getting anxiety. I would not want to go to social events...in my freshman or sophomore year, I could not even eat at the cafeteria,” she said.

Academic Support and Anxiety

School interventions to address the LBLD may have a negative impact on students’ sense of self and their peer interactions, thus increasing their anxiety. Whether from teachers’ inappropriate comments, as Jessica, 15, recalled: “[I had] constantly been told…that I was either not trying hard enough and I was not going to do anything with my life,” or the ​effect of instructional approaches, even if well intentioned and effective.“Getting taken out of class, taking tests in separate rooms, and having an aid walk up my way more often than she would to other people…things like that single you out…I guess seeing that made [other students] think that there was something wrong with me, and they wouldn’t think that I could play sports with them, or do the same kinds of arts and crafts…just because they thought I was different,” Mike, 18, shared.

What Can Parents Do to Help?

Parents reading this might be getting anxious just thinking about their child’s potential for developing anxiety! The truth is that parents are invaluable advocates and resources for their children with anxiety. Here are some helpful “dos” when it comes to helping your anxious child:

  • Parents should educate themselves on their child’s disability and its impact on learning. At times, students with LBLD can look as though they lack motivation, are lazy, apathetic about school, avoidant, defiant, or even just angry. Knowing more about their disability will help you understand what you see in terms of behaviors with regard to school. Then, explain the learning disability to your child. It is the first step in countering the thought that they are not smart enough to succeed, a conclusion that students with LBLD often draw from their repeated failures in school.
  • Parents can be their child’s advocate with the school system to develop an educational program that will lead to more successful learning and emotional well-being. This is an essential issue that will require significant commitment and resiliency as a parent.
  • Parents will need to nurture a relationship beyond and despite the tension caused by school demands. Many children with LBLD will require daily help with homework. You will likely help them stay organized, plan, and break down the work into more manageable units. This level of organization can help keep anxiety under control as well.
  • Amid all of this tough work, it is important that you maintain an ability to play with your child, appreciate the many sides of their personality and abilities in life, and enjoy one another. To this end, encourage your child to engage in interests to develop a sense of competency in other areas of their life: physical, artistic, dramatic, musical, scientific, or technological.
  • Examine the thoughts and emotions leading to your own reactions as you are helping your child with school-related tasks: anxiety about deadlines or test performance for your child, visualizing your own fears about the future, embarrassment about repeated failures, etc. Your ability to remain calm and model calm under pressure is more likely to foster a similar attitude in your child.  

When you encounter challenge with regard to school tasks or anxiety, remember that threats and angry demands are counterproductive and typically lead to the opposite result because your child becomes more anxious, feels misunderstood, and is resentful. Of course an LBLD diagnosis paired with anxiety is tough on parents; no parent ever wants to see their child struggle. Still, parents and their modeling of managing the disability and anxiety will be key to the child’s success and development of resilience.

What Can Kids Do to Help Manage Their Anxiety?

Procrastination and avoidance are the “go to” responses for students with anxiety, and they are typically automatic and unconscious.  Unfortunately, it leads to the child’s increasing fear since the fear is never “faced.” There are different ways of countering this tendency. Here are some strategies to use with your children.  

  • Help them learn how to manage their homework load. This may involve decisions about the order in which to tackle the assignments (from easy to difficult, or the opposite, or according to class order). Also break down the task into manageable units and have the student praise themself for completion.
  • Change the perception of their LBLD so that they see it as a manageable issue.  Kids with LBLD develop self-defeating thought processes that prevent them from even attempting work. With help, your child can learn to identify those thoughts and counter them. Whenever she made a mistake, Rose’s mind would spin out of control: “ I am so dumb, I will never be able to learn this, I will not go to college, and I will end up working at McDonald’s for the rest of my life.” She would rip up her work, and walk away.  When the self talk changes, then the behaviors can change, too. Encourage children to talk to their anxiety and help them form positive responses like, “I can do this, I’ve been able to before” or “I can try this and then ask for help if I’m unsure.” As Emily says, “When you are thinking and putting yourself down, like that I am dumb…you notice…” Instead, students can remind themselves that they are smart, that they succeeded before and can again.
  • Encourage their use of distraction to shift the thought process.  Students with anxiety often get stuck in a “hamster wheel” of worried thoughts. At times there is no using logic to get out, and distraction can be a useful technique to calm the anxiety.  Nicole, 17, said she likes “to go outside so I can feel not trapped or [I] listen to music and tune out to the beat of the song.” Jessie, 10, an elementary student prefers to “... watch funny Youtube videos or look at a picture of my dog to help distract my brain...that puts it back on track.” 
  • Support their practice of breathing exercises, mindfulness, and muscle relaxation to counter the anxious mindset and calm the fear response (Harvard Medical School, 2018). Jessie shares, “When I worry, I use my calm app to listen to rain sounds and practice breathing.” A high schooler notices “muscle relaxation…[for] when you feel you have the body symptoms…helped a lot with anticipatory anxiety I had before public speaking or if I had a race…it helps your body relax...it helps your head.” Students who take part in mindfulness at the start of each day at school notice that they are able to reset or take a quick “nap” to quiet their mind before class and that they can tap into this feeling before a test, or when their worries flare up.  
  • Remind students to reach out for support. Sometimes anxious feelings are so strong that students need to talk to a trusted adult or peer to practice one of the strategies above, or have validation that their worry makes sense, but it still does not need to be taking over.  Students who are really feeling stuck and might need adult support could find it helpful to take a walk or get a drink, as an additional way to reset the body so that the mind will reset, too.
  • Lastly, it is worth mentioning that anxiety may be so overwhelming that students cannot access their internal resources and help themselves. A medication evaluation may be indicated and make a significant difference in making them more able to take advantage of other therapeutic strategies.  

In a world where we are being told that anxiety is at pandemic levels for youth, we know that our students with LBLD are well versed in what it is like to live with both a learning disability and anxiety. Despite these challenges, they can go on to be resilient, creative adults with fulfilling lives.

  1. Denotes student’s name (changed for anonymity) and current age.

References

Resources

About LBLD

Franklin, D. (2018).  Helping your Child with Language-Based Learning Disabilities: Strategies to Succeed in School and Life with Dyslexia, Dysgraphia, Dyscalculia, ADHD and Processing Disorders. New Harbinger Publications, Oakland, California 94609.

About Anxiety

Recommended Website

Apps for Breathing/Mindfulness/Relaxation

​About the Authors

Helene Dionne

Dr. Helene Dionne has been the director of counseling services at Landmark School since 2003, after working for 25 years in the mental health world, in hospitals, outpatient clinics, and private practice.

Laura Polvinen

Laura Polvinen is the counseling team leader at Landmark’s Elementary Middle School. A Licensed Independent Clinical Social Worker, she has spent the past 10 years working with children and families with needs ranging from trauma, chronic illness, traumatic brain injury, anxiety, depression, ADHD, and learning disabilities.

 

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Tags:  Executive Function Executive Functioning situational awareness social pragmatic communication social thinking theory of mind

The Relationship Between Social Pragmatic Communication and Executive Function

Blog Type:  Social and Emotional Issues Date Posted:  Monday, February 10, 2020

By Ruth Bossler, M.S., CCC-SLP

Many parents, including those of children with language-based learning disabilities (LBLD), have seen their children miss deadlines and assignments, struggle to manage school work, and stumble in social situations. I recently came across two articles that establish a relationship between executive functioning (EF) and social pragmatic communication. By citing previous research in the fields of both psychology and communication disorders, the authors demonstrated how and why weakness in executive function can lead to deficits in social communication.  

The authors, Sarah Ward, Kristen Jacobsen, and Michelle Garcia-Winner, are widely known for their contributions to the field of speech-language pathology. While Garcia-Winner has pioneered a therapeutic intervention program, Social Thinking, that helps children and adults improve their social pragmatic communication skills, Ward and Jacobsen have established a thriving private practice in Concord, Mass., Cognitive Connections, that provides assessment and therapeutic intervention to improve language and executive functioning skills.  

By citing previous research in the fields of both psychology and communication disorders, the authors demonstrated how and why weakness in executive function can lead to deficits in social communication. 

Situational Awareness

Ward and Jacobsen cite a student’s difficulty with situational awareness as the main cause of executive dysfunction and social communication weakness.  Borrowing Wicken’s definition, they define situational awareness as “the ability to perceive elements in the environment within a volume of time and space, the comprehension of their meaning, and the projection of their status in the near future” (Wickens, 2008). They further break Situational Awareness down into four sequential competencies, any one of which can pose a challenge for students with LBLD:

  1. Extracts information (aware of the relevant features of STOP: Space, Time, Objects, People) from one’s environment and integrates it with internal knowledge (what they refer to as “episodic memory”). 
  2. Determines purpose: recognizes their role/status and that of others.
  3. Predicts their expected behaviors.
  4. Shifts flexibly—according to the changing demands. 

In their article, Ward and Jacobsen present the case study of “Matthew,” a young student who has difficulty in all of the above four areas, and as a result, has few close peer relationships. In particular, Matthew lacks the ability to extract the relevant information about the “P” (People) in his environment; he is oblivious to the fact that his peers are repulsed and annoyed by his behaviors in the classroom (e.g., sniffling repeatedly and loudly, picking at a scab on his leg, stepping on their personal belongings as he tries to find a seat). Matthew lacks the situational awareness to observe the nonverbal and verbal social cues that his peers are sending out in abundance (e.g., eye rolling, looks of disgust, kids whispering about him). Is it any wonder, then, that Matthew lacks friends? 

Social Executive Functioning

Similar to Ward and Jacobsen, Garcia-Winner urges educators and service providers to look at “social executive functioning” when providing assessment and intervention for students with social communication weaknesses. Most educators and service providers, she argues, tend to think of EF as those cognitive processes needed to complete academic tasks, particularly those long-term projects that require multiple steps and time management skills (e.g., writing a paper, producing a model, etc.).  She references a previous definition of EF as those cognitive skills that function in a coordinated way to “enable an individual to engage in purposeful, organized, strategic, self-regulated, goal-directed behavior” (McCloskey, 2012). Further, EF can be further broken down into the following four aspects:

  1. Response inhibition or deferment to a more appropriate time/place
  2. A strategic plan of action sequences
  3. A mental representation of the desired future goal state (stimulus event is encoded in memory= “episodic memory”)
  4. Cognitive flexibility, shifting focus, self-monitoring, problem-solving (Welsh & Pennington, 1988)

Given this definition, Garcia-Winner challenges us to think about the “Social EF” skills involved with initiating and maintaining a new friendship, as these involve the same cognitive processes that are used to carry out a long-term academic project:

….this involves everything from paying attention to the student at school to making first contact learning more about the person (his/her interests) as their friendship gets underway, gathering information to stay in touch (social media, phone number, email), initiating an invitation, thinking about what to say, etc. At some point, the “getting together” part of the social experience happens: making a group plan about what to do (hang out, play video games together, go to a movie or the mall), and then following through to get together at the mutually agreed upon time and execute the plan—or change it up at any point and still stay connected!... 

Similar to Ward and Jacobsen’s theory about a lack of situational awareness, Garcia-Winner also notes that a student’s EF skills can be further impaired due to weaknesses in “cognitive coherence”; that is, a student’s inability to extract the important details that make up the “gist” of the activities of their daily lives (Happe and Frith, 2006). These students have a processing tendency toward what is directly in front of them (irrelevant details), while failing to process the relevant details that make up the big picture. Additionally, these students often possess weaker theory of mind. Theory of Mind is a research-based construct that involves “understanding another person’s knowledge, beliefs, emotions and intentions, and using that information to navigate social situations” (Thompson, B.N., 2017). Students with weaker theory of mind tend to have difficulty with perspective-taking, narrative language, and conversational skills. If we return to Ward and Jacobsen’s case study, there was ample observational evidence to suggest that “Matthew” lacks both situational awareness because of both weakened cognitive coherence and theory of mind.

Help Students “Read the Room”

So what is the solution? How do we successfully assess and intervene to help students with this “double deficit” of both weak executive functioning and social pragmatic communication skills? Based on their own work, Ward and Jacobsen argue that weakness in executive functioning is difficult to measure through standardized testing alone, and in fact the nature of standardized testing, which typically occurs in very controlled 1:1 settings, can actually compensate for deficits in the cognitive processes (i.e., attention, problem solving, shifting focus) that make up EF. Thus, a student may actually appear much stronger “on paper” in terms of his or her EF skills. They argue (as do I) that it is critical to observe students in real-time contexts and collect more subjective qualitative data. To this end, Ward and Jacobsen have recently developed exactly such a tool (Situational Awareness Observation Tool) that is intended to complement more widely used rating scales such as the BRIEF and the BASC.

Once weaknesses in EF and SC are established, Ward and Jacobsen urge all service providers to become “feature teachers.” They argue that we need to help students “read the room” and extract the relevant features of Space, Time, Objects, and People (S-T-O-P). Similarly, according to her Social Thinking program, Garcia-Winner charges us to help students become better “social detectives” or “social observers” regarding the verbal and nonverbal communication of others.  Accordingly, Garcia-Winner’s Social Behavior Mapping could be a useful tool in helping students understand the “social-emotional chain reaction” that occurs when they do or say something that is either “expected” (socially acceptable for a given context, time and place) or “unexpected” (socially unacceptable). The end goal for both authors is to help students improve their executive functioning and strengthen their central coherence and theory of mind, so that they develop pro-social skills that lead to greater social competence across a variety of contexts.

Garcia-Winner charges us to help students become better “social detectives” or “social observers” regarding the verbal and nonverbal communication of others. 

Tips for Parents, Service Providers, and Teachers

Based on this research, the following are suggested strategies for developing situational intelligence and improving executive functioning and social communication:

  • Be a “feature teacher.” For example, when walking down the frozen food aisle, help your child/student “zoom in” on types of frozen foods as the overarching category, with frozen fruits, frozen vegetables, and frozen desserts being the sub-category. Then, have them focus on the distinguishing features (the sub-sub category, such as generic vs. Birds Eye brand, for example). You are getting kids to “zoom in” and notice the distinguishing features.
  • Help your child/student see the “same but different” features of different social and academic situations (e.g., science class vs. math class; going to a friend’s house to sleepover vs. going to sleepover camp).
    • Use visual supports (Venn diagrams, comparison tables, pictures/photographs, www.educreations). This helps build internal schema (prior knowledge), situational intelligence, cognitive flexibility, and generalization of skills and behaviors.
  • If the child/student is acting in a socially “unexpected” manner, think about how it connects to Space, Time, Objects, or People (STOP).
  • Make your observations of your child/student using non-judgmental language: 
    • “I notice when Timmy is talking, you often interrupt him and he looks annoyed with you.”
    • “I noticed that when you keep sniffling and don’t get a tissue, your friends seem really grossed out and annoyed.”
  • Ask questions so that the child/student is aware of what you observed and how you perceived their behavior:
    • “When you used that tone of voice, I thought you were being disrespectful or rude. Is that what you meant?”
  • Discuss possible strategies with your child; what verbal or nonverbal cues will best help them “zoom in” on those relevant features (e.g., picture schedule, if...then...so statement, pointing to a schedule or agenda, tap on the desk, pointing to the clock).
  • Help your child/student formulate their own “if....then...so ” statement about the features
    • Your modeling → internal/self-cueing
    • If students struggle with cause/effect, try: therefore, so what?
      • Example: “If I blurt out in class about something off topic, then my teacher and classmates will be annoyed; so I will save that for a more appropriate time and place.”
  • How this relates to Landmark's Six Teaching Principles:
    • Provide opportunities for success: Start with small and attainable goals.
    • Use multi-sensory approaches: Pair verbal with visual/nonverbal.
    • Micro-unit & structure tasks: Break it down with S-T-O-P
    • Ensure automatization through practice & review: Use consistent language. 
    • Provide models: Provide scripting.
    • Include students in the learning process: Work on the plan WITH students:
      • What cues work best for you?  
      • How will working on these goals help you in this class?
      • What else could you do in this situation?

Since 1998, Ruth Bossler has provided speech and language assessment and intervention in the state of Vermont, as well as in various settings throughout Massachusetts, working with children and students from birth to grade12. She has worked within early intervention agencies, three public school districts, and one private independent school prior to joining the faculty at Landmark School, where she's been consulting Speech and Language pathologist since 2016. She earned her B.A. in English from Dartmouth College and her M.S. in Communication Sciences and Disorders from Emerson College.

References:

 

Happe, F. and Frith, U. (2006). The weak coherence account: Detail-focused cognitive style in autism spectrum disorders. Journal of Autism and Developmental Disorders, 36(1), 5-25.

https://efpractice.com/

https://efpractice.com/

https://www.socialthinking.com/

McCloskey, G. (2012). Essentials of executive function assessment. Hoboken, NJ: Wiley.

Thompson, B.N., Theory of Mind: Understanding others in a Social World, Psychology Today, July 2017.

Ward, S. and Jacobsen, K., Executive Function Situational Awareness Observation Tool, ASHAwire, Perspectives on School-Based Issues, December 2014.

Welsh, M.C. & Pennington, B.F. (1988). Assessing frontal lobe functioning in children.  Views from developmental psychology. Developmental Neuropsychology, 4(3), 199-230.

Wickens, C. (2008).  Situation Awareness: Review of Mica Endsley’s 1995 articles on situation awareness theory and measurement.  Journal of Human Factors, 50(3) 397-403.

Winner, M.G., Crooke, Executive Functioning and Social Pragmatic Communication Skills: Exploring the Threads in Our Social Fabric, ASHAwire, Perspectives on Language Learning and Education, 2014

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