Tyra is a Year 6 student in a large mainstream metropolitan primary school. Tyra was diagnosed with generalised anxiety disorder (GAD) in Year 4 after experiencing difficulties in separating from her parents in all contexts, including school, and showing overt signs of excessive worry on most days even when at home with her family. Given Tyra’s low attendance rate in the early years of primary school, there was some discussion of alternative schooling options, but Tyra was keen to attend her local school where her younger brother also attends. Her parents, after discussing the options with Tyra, met with the school's leadership team and regional support staff to discuss the adjustments that can be implemented at the school and have commenced discussions with the local high school about how these could also be implemented in the secondary setting. Tyra was invited to attend the meetings but felt it would be too stressful at this stage and was happy to provide notes reflecting her wishes for her parents to present to the meeting.
Tyra’s attendance since enrolling in formal schooling has improved since the diagnosis was confirmed and her therapy commenced. Tyra’s parents have worked collaboratively with the school psychologist, her clinical psychologist, the classroom teacher and the Deputy Principal to develop a comprehensive individual plan to support Tyra and her family. At this stage, Tyra doesn’t attend the two formal case conferences held each term (which would ideally have all stakeholders present), or the ad hoc informal planning and review meetings to discuss ongoing supports, as she finds them very stressful. The option to participate from home via video conferencing has been considered, but Tyra has preferred to discuss the meeting agenda items with her parents and have them represent her. After every meeting she discusses the proposed plans with her parents and gives feedback before the plans are finalised. The school have introduced a communication app that enables Tyra to send and receive messages from her school team and Tyra has agreed to trial using it to establish more direct communication. As an interim step, Tyra has agreed that she can respond with an emoji to any messages and that the use of the app will be reviewed at the end of the term. Tyra has recently engaged with a psychosocial recovery coach with lived experience through her NDIS plan, who she is considering using as a support person when planning for secondary school, so she can participate in person.
One of Tyra’s agreed adjustments was that the school psychologist, in consultation with Tyra’s parents and her private clinical psychologist, who Tyra sees weekly, develop sessions for school staff regarding the use of the positive coping methods such as ‘graduated exposure’ being taught in her individual therapy, rather than avoidance, and other strategies that complement the ongoing individual cognitive behavioural therapy (CBT). Given the changing nature of GAD, Tyra’s classroom teacher communicates regularly with Tyra and her parents about Tyra’s triggers and how she is responding to planned strategies. While the frequent but brief catchups are sometimes difficult to fit into the weekly routine, they have found that it is important to ‘troubleshoot’ promptly, as Tyra’s symptoms of anxiety can quickly escalate and impact her participation in class activities. Currently they are using a communication book to arrange meetings after school, but are planning to try secure video conferencing next term instead, so that both parents can participate.
Children and adolescents with GAD tend to worry about many things, such as trying to be perfect, feeling fearful in new or unfamiliar situations, and often seeking constant reassurance. However, Tyra’s anxiety mostly manifests around social situations. Her current classroom teacher has observed that Tyra does not enter the classroom with all the other students but holds back until the rest of the class has entered. At recess and lunch breaks, Tyra does not move far from the classroom entrance. In general, she avoids social interactions with most students in the class and tends to seek reassurance from the teacher or one particular student, who has been a close friend for several years.
While Tyra is achieving academically at a grade-appropriate level, she struggles to complete tasks given to her in the time usually allocated as she focuses on perfecting her work to her own very high standard. In the past when having to present her work to others, whether as a small group or the whole class, Tyra experienced symptoms of anxiety, including short shallow breathing, stiffening of the body and limbs, and feeling nauseous and dizzy. When these symptoms occur during lessons, Tyra appears to be struggling and overwhelmed by her emotions, which then impacts her cognitive functioning. The agreed adjustments have meant that this does not occur now, but while there has been some improvement in the intensity and frequency of her symptoms, there are still regular episodes when new staff or students are part of the classroom.
The agreed strategies in the current management plan provide Tyra with a reduced workload with alternative options to present her work (e.g. through video or audio pre-recorded at home, or alone with the teacher). Additionally, it was agreed with Tyra and her parents that Tyra’s classroom teacher work with the school psychologist to better understand the constructs and principles of CBT and reflect those in her communication with Tyra in order to model helpful thinking processes in trigger situations. This seems to have benefitted not only Tyra but other students in the class who have difficulties with emotional regulation.
The school has also undertaken to run a Social Emotional Learning (SEL) program as part of the school’s Personal and Social Capability curriculum. This is delivered in a small-group setting by the school psychologist and a staff member twice a week, and Tyra has agreed to take part in it, as part of her personalised program, along with several other students in her class that have difficulties. The program focuses on self-awareness, self-management, social awareness, relationship skills and responsible decision-making. Two of the students in the program participate in a buddy system during recess and lunch that has been designed for Tyra in order to encourage her to participate in organised structured activities (e.g. netball games, board games). The staff on playground duty have been made aware of the strategies to assist Tyra in the playground and encourage her to expand her peer engagement by gradually increasing the number of students involved in the activity. Some of the students have noticed Tyra’s reluctance to participate in larger groups and this has sometimes led to Tyra feeling rejected. The school has reminded students of their code of conduct, which recognises diversity and positive inclusion that emphasises the need to treat everyone with respect, courtesy, fairness and honesty. Where there are issues between individuals, the school practises restorative justice strategies and informs and involves parents in the process as soon as possible. The school is also considering expanding the SEL program to include all students in a universal program that focuses on self-regulation and mindfulness skills.