Anxiety disorders occur on a spectrum and can impact children in a variety of ways. Some children may deal with low levels of apprehension, while other children develop severe and intense anxiety. While students with anxiety will benefit from the following recommendations, consider implementing them in larger groups such as classrooms or group therapy. This promotes an inclusive environment from which all learners can benefit.

1. Use structure:

Incorporate daily and weekly routines to help children learn what to expect. Post schedules in a visible area. This is especially important for older children who have rotating or complex schedules.

2. Provide a ‘just right’ challenge:

Allow students to learn and grow while building their self-confidence. Grade your activities so that they are just challenging enough to stretch the child’s learning.

3. Offer choice:

By using a topic, subject, or medium that is exciting to students, they will naturally gravitate toward engagement. Especially when an assignment or activity is new and daunting, a small piece of choice can motivate children toinitiate the task.

4. Use positive feedback:

Positive reinforcement signals to children that they are doing what is expected and can be a great way to boost the confidence of children who have anxiety. Feedback can be in the form of a token system, a smile, nod, or words of affirmation.

5. Teach challenging skills:

Sometimes, learners need extra direction. Direct instruction can be a great way to improve skills and, therefore, confidence for activities with a physical component, such as writing or playing a sport.

6. Use clear expectations:

Letting students know exactly what you expect is a great way to communicate mutual respect. Particularly when a project or activity is brand new, knowing the outcome will be helpful to children with anxiety.

7. Be flexible about participation:

Try making group participation optional. Let students know that they can contribute to the conversation when they are ready and that you will not call on them.

8. Eliminate busywork:

A child working on fractions does not need to complete 100 problems to master the skill and demonstrate competence.

9. Identify strengths:

Use one-on-one time to reflect on past successes, strengths, passions, and skills.

10. Teach self-management:

Another strategy that students with and without anxiety disorders can benefit from is self-management skills. Talk about self-regulation, brainstorm symptoms of being dysregulated, develop language, and teach strategies.

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Documentation for therapy services can be a time-consuming yet essential component of service delivery. Many practitioners and clinicians attempt to streamline their daily note process. Some critical details should not be overlooked, though it is still possible to create a concise note while including everything that reimbursement experts need to see.

Many professions, including occupational therapists, physical therapists, speech-language pathologists, ABA therapists, and others, use SOAP notes for their daily sessions. SOAP is an acronym that stands for Subjective, Objective, Assessment, and Plan. SOAP notes are valuable because they provide information about different therapy components, and since therapists use them widely, the interdisciplinary team can use them as a means of timely communication.

S: Subjective: What is the client saying about their experience?

Subjective information may include reports of pain, challenges since the last session, or what the client shares they can or cannot do. You may record behavior during the session for pediatric clients, including arousal level and engagement in therapy. You can also include reports from the client’s family or teachers.

O: Objective: What are you observing? What data can you collect?

Include any compensatory strategies your client uses, physical or cognitive strategies for participation, and data you collect. The objective section could include the percentage of trials completed correctly and the client’s level of support needed to perform the activity. If your client needed any adaptive equipment, assistive technology, or modification of a task, include that information here as well. It is vital to make sure that you focus on the active experience of the client rather than the therapist. For example, note that the “Client needed moderate physical assistance for bathroom mobility” rather than “Provided moderate physical assistance to the client.”

A: Assessment: What is your interpretation?

Consider what you wrote in the subjective and objective categories. What does this mean? You’ll use your clinical expertise to interpret the information into an analysis of the client’s performance. Note any improvement, regression, or progress toward your client’s goals. Refer back to the subjective and objective categories to support your assessment.

P: Plan: What is going to happen next?

Include the frequency, duration, and location of recommended services. If you are recommending discharge, include specific information about recommendations for follow-up. Otherwise, include detailed information about your intervention plan and how you will use it to address the problems noted in this session.

CBS Therapy is the premier provider of school-based and pediatric special education staffing services in the Northeast.

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