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<p>There’s a child in your class who never raises their hand.</p>
<p>You’re sure they know the answers, but for whatever reason, they are anxious and never ask to be called on. What can you do?</p>
<p>Dr Anastasia Hronis is a clinical psychologist, lecturer and researcher at the University of Technology, Sydney and author of <a href="https://www.penguin.com.au/books/the-dopamine-brain-9781785045738" target="_blank" rel="noopener">The Dopamine Brain</a>. She explains how Cognitive Behaviour Therapy, or CBT for short, can assist people in identifying unhelpful patterns in their thinking while facing anxiety-driven fears. </p>
<p>“If a child is afraid of putting up their hand to ask questions in class, CBT will help identify and challenge any unhelpful or untrue patterns in their thinking, and help the child to face their fear,” she explains.</p>
<p><a href="https://www.school-news.com.au/latest-print-issue/" target="_blank" rel="noopener"><strong>Read the latest print edition of <em>School News</em> HERE</strong></a></p>
<p>But while CBT is considered the gold standard therapy for treating children with anxiety concerns, it has not always been used for children with intellectual disabilities.</p>
<p>“Historically, CBT was overlooked for children with intellectual disabilities as it was assumed that children with intellectual disabilities didn’t have the cognitive capacity to engage in the cognitive elements of CBT,” Hronis explains.</p>
<blockquote>
<p><strong>There has been a shortage of treatment options for children with intellectual disabilities with mental health concerns. Treatment has tended to focus on medication or behaviour intervention.</strong></p>
</blockquote>
<p>Yet the prevalence of mental illness in children with ID can be as high as 50%, in particular, anxiety and increased rates of internalising and externalising problems. Hronis and her team have been working on a way to adapt CBT for children and adolescents with intellectual disabilities, developing the Fearless Me program, which has been made freely available online.</p>
<p>“In the work and research we have done, we have found that children with mild to moderate intellectual disabilities, who have verbal capacities, can in fact effectively engage with CBT,” explains Hronis. “This sometimes takes more training and time than for children who don’t have an intellectual disability, however it is possible.”</p>
<p>Developed and evaluated in individual consultations and group therapy conducted at schools, the program is based on standard CBT principles with activities that help clinicians deliver therapy and make the sessions more fun and engaging for the children.</p>
<p>Hronis explains:</p>
<p>“Fearless Me includes three modules:</p>
<p>Keep Calm (which is all about helping children learn relaxation and emotion regulation strategies),</p>
<p>Stop and Think (which involves identifying and challenging unhelpful thoughts) and</p>
<p>Facing Fears (which is where children work step by step to explore themselves to the thing which causes them anxiety).”</p>
<h4><strong>Adapting CBT for children with ID</strong></h4>
<p>Cognitive Behaviour Therapy examines how our thoughts, emotions and behaviours are all connected and influence one another. It assists people to identify unhelpful patterns in their thinking, while facing anxiety-driven fears. </p>
<p>Importantly, the program has been adapted in various ways for children with intellectual disabilities to account for differences in dopamine levels in attention, learning and memory, working memory, executive functioning, and reading/language.</p>
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<p><strong>These adaptations are also relevant to educators who wish to help children with ID in their classrooms. </strong></p>
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<p>Some of the adaptations include:</p>
<ul>
<li>Breaking down tasks into their smallest components</li>
<li>Using a variety of visual aids such as the website, videos, cartoons and more to engage children and capture their attention</li>
<li>Repetition through multiple practice examples to consolidate learning</li>
<li>Text-to-speech function on the website</li>
<li>Short, simple sentences containing a single concept.</li>
</ul>
<blockquote>
<p><strong>“With practice and patience, children with cognitive deficits can be taught to identify unhelpful patterns in their thinking, and further challenge these thoughts.” Anastasia Hronis</strong></p>
</blockquote>
<p>Hronis and co-author Ian Kneebone recently published a <a href="https://kids.frontiersin.org/articles/10.3389/frym.2024.1301601" target="_blank" rel="noopener">detailed yet accessible article</a> written especially for young people. The article covers a range of topics, including what an intellectual disability is, what CBT is, and how the program was developed in language and terms suitable for children.</p>
<p>Fearless Me is <a href="https://www.fearlessme.com.au/" target="_blank" rel="noopener">available online here</a> and the <a href="https://link.springer.com/article/10.1007/s44202-021-00017-z">Treatment Manual is available here</a>.</p>

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