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Minnesota Adult Basic Education Disability Specialists

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Problems Likely to Affect ABE Students

Any of the many mental disorders can affect an adult student. This section focuses on the more common ones. In the descriptions that follow, the aim is not to make the teacher a diagnostic expert. Diagnosis should only be made by a professional. The intent is to point out some of the signs a teacher may notice, with the intent of helping him or her respond effectively as an educator.

Anxiety

This is a family of mental health conditions, among which several are more common in the ABE population:

Generalized Anxiety Disorder is characterized by excessive worry and anxiety that is far out of proportion to the likelihood or impact of the feared event(s). Often adults with this disorder worry excessively about routine, everyday circumstances such as their job, finances, health of themselves or others, family responsibilities, and getting around. The worry is hard to control.

At least some of the following features accompany this problem:

  • Difficulty concentrating or mind going blank
  • Feeling restless or keyed-up
  • Irritability
  • Sleep disturbance
  • Excessive fatigue
  • Muscle tension

Advice to “calm down, don’t worry” has no affect and may provoke anger. Even offers of help may have no impact. This level of anxiety is resistant to reassurance. Sometimes this disorder is accompanied by panic attacks and/or obsessive-compulsive behavior. Such problems represent maladaptive responses to fear.

Panic Attacks are a limited period of time during which a person experiences a sudden onset of intense apprehension, fearfulness, or terror and often a feeling of impending doom. The person may experience shortness of breath, heart palpitations, chest pain or discomfort, a choking or smothering sensation, and fear of losing control. These sensations typically add to the generalized anxiety and confirm for the person their worst fears. They may be resistant to put themselves in a situation where others may witness their panic (Agoraphobia).

Obsessions and Compulsions are preoccupations the person cannot set aside. Obsessive thoughts contribute to anxiety and distress; compulsive behaviors demonstrate the person’s attempt to reduce anxiety through ritualistic actions.

Post-traumatic Stress Disorder (PTSD) is characterized by severe anxiety associated with events that have threatened the life, safety, or integrity of oneself or others, and which produced intense fear, helplessness, and horror at the time of the event and at least one month later

All of the following features accompany this experience but in varying ways depending on the person and circumstances of the trauma:

  • Re-experiencing the event in one’s mind, in nightmares, by sensory flashbacks, by associating it to events that resemble the traumatic episode in some respect, and by experiencing the same feelings one had when initially exposed
  • Avoidance - (1) external avoidance of places, objects, people, etc. associated with the traumatic event and (2) internal avoidance of feelings, or emotional numbing
  • Persistent, increased arousal -This is evident in sleep difficulties, irritability or angry outbursts, difficulty concentrating, hyper-vigilance, or an exaggerated startle response

An interactive tutorial or PDF is available from the US National Library of Medicine and National Institutes of Health at http://vsearch.nlm.nih.gov/vivisimo/cgi-bin/query-meta?v%3Aproject=medlineplus&query=post-traumatic+stress+disorder

The US Department of Veterans Affairs has developed a PTSD Information Center at http://www.ptsd.va.gov/public/index.asp

Acute Stress Disorder (ASD) is similar to PTSD. When the above symptoms are evident within one month of a traumatic event and last two or more days afterwards, this applies. During this period, the person may appear dazed and confused and fail to respond “normally” to the event. For example, the person may not act as sad or horrified as expected due to emotional numbing. He or she may not be able to recall details of the event.

Medication is available to help reduce the intensity of anxiety, but most medications are addictive when taken over the long term. Some individuals are able to practice helpful relaxation techniques.

Mood Disorders

This is a family of mental health conditions that includes various levels of depression and bipolar disorder.

Major Depression is characterized by episodes of deep sadness and hopelessness accompanied by many of the following symptoms:

  • Loss of interest or pleasure in activities normally enjoyed
  • Tearfulness or self-reported sadness or emptiness
  • Fatigue or loss of energy
  • Reduced ability to think, concentrate, or make decisions
  • Feelings of worthlessness or excessive guilt
  • Changes in level of physical movement—either restless or slow
  • Changes in sleep patterns—sleeping too little or too much
  • Decrease in appetite, weight loss
  • Possible irritability
  • Recurrent thoughts of death or suicide

When symptoms such as these accompany the loss of a loved one, they are regarded as normal bereavement until they last more than two months or are accompanied by functional impairment and morbid thoughts.

Depression and anxiety disorders often occur together. Duration is variable. Mood may lift for a while before plunging into despair

Dysthymia is characterized by lack of interest or pleasure and social withdrawal, accompanied by many of the following features:

  • Feelings of inadequacy
  • Feelings of guilt or brooding about the past
  • Subjective feelings of irritability or excessive anger
  • Decreased activity and productivity
  • Early onset (childhood or adolescence)
  • Chronic course (fairly continuous, not waxing and waning as for major depression)

Less often, the person with dysthymia experiences problems with sleep, appetite, weight change, and slow or restless movement. In the past, the problem was viewed as a personality disorder, as it appears to be a characteristic of the person over time.

People experiencing chronic dysthymia may also have episodes of major depression and frequently have co-occurring problems affecting coping, adjustment and relationships. Despite such problems, they may be able to continue working or going to school and have one or more friends/partners.

When, an individual who has been depressed becomes unusually cheerful, excited, or “high” or demonstrably irritable and angry, it may be that a manic phase has begun, ushering in bipolar disorder.

Bipolar Disorder is characterized by alternating or co-occurring periods of depressed and elevated mood. Mania is associated with 3-4 or more of the following symptoms, which are typically more apparent to others than to the person:

  • Inflated self esteem or grandiosity (sense of self-importance and power)
  • Decreased need for sleep (e.g., feels rested after three hours or does not sleep at all some nights)
  • More talkative than usual; sounds like he or she can’t get the words out fast enough
  • Racing thoughts
  • Easily distracted by unimportant or irrelevant stimuli
  • Works almost compulsively toward a particular goal; may appear agitated
  • Excessive involvement in pleasurable activities such as shopping, gambling, sexual activity, questionable business ventures
  • Possible delusions (plans, ideas, or beliefs not based on reality)
  • Possible hallucinations (sensory perceptions not based on reality)

When no delusions or hallucinations are present and the disorder is not severe enough to cause marked impairment in social or occupational functioning (but significant changes in mood and behavior are obvious), it is classified as Hypomania.

Manic behavior can also follow a drug overdose or toxin exposure. If so, the person may return to normal when the body is drug- or toxin-free.

While a manic episode may begin as a highly productive or creative period, it can devolve into destructive acts toward oneself or others, including a break from reality. It is also followed, eventually, by significant depression.

Three levels of bipolar disorder are recognized, all associated with either Major Depression or Dysthymia:

Bipolar I:  Characterized by at least one episode of Major Depression followed by a Manic episode. These may cycle back and forth rapidly, seasonally, or over a longer time.

Bipolar II:  Characterized by at least one episode of Major Depression followed by a Hypomanic episode. These may also occur cyclically.

Cyclothymia:  Characterized by cycling dysthymia and hypomania.

A number of medications are available to relieve severe symptoms. Newer antidepressants have fewer side effects, but the effectiveness of any mood-altering medication is not guaranteed and is found through trial and error. The risk in treating bipolar disorder only with antidepressants is that they may trigger a manic episode.

Many people with bipolar disorder, as well as anxiety, enjoy symptom relief from anti-epileptic medications, as they “quiet” the electrical impulses in the brain that arouse the person to manic activity and intensify anxiety.  Individuals with depression and anxiety tend to respond well to cognitive-behavioral therapy or DBT (dialectical behavior therapy).

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