Williams Syndrome Rachel Royston Dr Jane Waite Prof Patricia Howlin amp Prof Chris Oliver Cerebra Centre for Neurodevelopmental Disorders CCND Contents Meet the team What is anxiety ID: 935668
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Slide1
Anxiety in adolescents and adults with Williams Syndrome
Rachel Royston
Dr Jane Waite,
Prof.
Patricia Howlin &
Prof.
Chris Oliver
Cerebra Centre for Neurodevelopmental Disorders (CCND)
Slide2ContentsMeet the teamWhat is anxiety?Why is anxiety more likely in people with WS?How to spot signs of anxietyStrategies
Slide3The team
Slide4Williams Syndrome Research at the CCNDThree year research project:
Interview study (n=13, mean age=21.9, 8 female)Online survey study focusing on mental health
(n=34, mean age=25.5, 14 male)
Direct assessment anxiety study (n=35, mean age=30.0, range=13-58, 13 male)
Anxiety in adolescents and adults -
12+
Slide5What is anxiety or worry?“a feeling of worry, nervousness, or unease about something”When is it ‘normal’?
Situation that is threatening/difficultExample: public speakingAnxiety stops during or after the event When is it a problem?
Constant anxiety all the timeNo reason Out of proportion to threat of situation
Slide6General Population
Royston et al., 2016
Slide7General Population
Intellectual disability
Royston et al., 2016
Slide8Rare genetic syndromes (e.g. Williams, fragile-X or Cornelia de Lange syndromes
Royston et al., 2016
Slide9Anxiety in WS – what we know from existing research
X
X
Age
Anxiety
Papaeliou
et al., 2012
Stinton
et al., 2010
Woodruff-Borden et al., 2010
48% of individuals with WS may experience clinical levels of anxiety
Royston et al., 2016
Slide10Royston et al., 2016
%
Slide11Royston et al., 2016
%
Slide12Why do people with WS experience more anxiety?
Genetic vulnerability?
But not everyone with WS experiences anxiety…
Slide13Risk factors for mental health problems
Intolerance of uncertainty
Slide14AgeIn our sample of 34 adolescents and adults:
x
Slide15Health
Type of health problem
PercentageDental problems
83%Stomach difficulties
80%
Cardiovascular
problems
80%
Ear problems
60%
Bowel problems
57%
Slide16HealthIn our sample of 34 adolescents and adults:
Slide17Sensory processingHyperacusis: sensitivity to specific frequencies and volumes of sound
Loud soundsEvery day soundsExperienced by up to 80% of individuals
(Levitin et al., 2005)
Slide18Sensory processingIn our sample of 34 adolescents and adults:
Slide19Anxiety triggers– specific phobias
Noise82.4%
Unpredictable situations
50.0%
Storms
64.7%
Routine changes
55.9%
Upcoming events
52.9%
New or unknown
situations
70.6%
Slide20Intolerance of uncertaintyCognitive bias where individuals interpret ambiguous of uncertain situations negatively (Dugas et al., 2005)Association between an intolerance of uncertainty and anxiety has been identified in autism spectrum disorder
(Hodgson, Freeston, Honey & Rodgers, 2017; Wigham, Rodgers, South, McConachie &
Freeston, 2015)
Slide21Intolerance of uncertaintyIndividuals with a higher intolerance of uncertainty scored higher on the anxiety scale
Slide22How can we best manage anxiety?
Slide23What to look for…
seeking proximity
more repetitive
behaviours
Many signs of anxiety overlap with signs of physical health difficulties.
Slide24The vicious cycle of anxiety
Slide25Understanding the triggers for anxiety
Knowledge of the type of anxiety and triggers associated are important
Date/Time
What
happened before? Immediate Trigger
How long
did it last?
What did the person worry about?
What
happened afterwards? How did the person calm down?
Slide26Overview: StrategiesInterventions Practice labelling emotions and increasing communication
Increase copingMake life more predictableAddressing sensory issues
Not all strategies work for everyone
Slide27Labelling emotions and increasing communication
Knowing you have a way to let people know that something is difficult can reduce anxietyCard or picture cue to ‘take a break’ or ‘leave the situation’
Avoidance = more likely to experience anxiety in the future: pair this strategy with gradually increasing the amount of time the person spends in feared situationHaving an allocated “worry time”
Slide28Increasing the person’s coping skills
Self-calming strategiesListening to calming sounds or music (Blomberg et al., 2006; Dykens et al., 2005)
Deep breathing Stress ball
Strategies should be used to help reduce anxiety in difficult situations rather than avoiding the situation
Slide29Making life more predictableEnsure predictable pattern to the day
Visual schedulesSocial storiesOnce the person has a predictable routine it may be possible to gradually introduce more flexibility so that the person can begin to tolerate more variety.
Slowly! Monitor progress.Use a cue to indicate a change is coming
Not too early as this anticipation can increase anxiety
Slide30Addressing sensory issuesExample: hypersensitivity to noise, ear painTreat physical health problem (i.e. an ear infection)
Strategies: ear defenders for loud noises
Slide31In summaryHigher levels of anxiety are associated with WSHealth problems and sensory processing difficulties may increase the risk of developing mental health problemsThere are several things that we can do to try to reduce anxietyThere is still a lot for us to learn!
Slide32Thank you for listeningRachel Royston: rxr180@bham.ac.uk