When John was 15 years old, he moved from his parents’ home to a group home. When someone new comes to visit, John starts to sweat and runs to his room. He asks support staff over and over again, “Do I have to move?”

What are stress and anxiety?

Stress happens when a person feels upset or afraid. Stress can be caused by people, places or situations. Changes in someone’s life can also cause stress. When a person’s mind tells their body there is something to be upset about or to fear, they will feel stress. So, stress depends on how a person thinks about people and situations.

Stress can differ from person to person. One person may feel upset or afraid in situations that are not stressful to someone else. People also react to stress in different ways. Some people get sweaty hands or a headache. Others feel their heartbeat race, or they start breathing faster.

Anxiety happens when someone worries about something. Someone might be anxious because he is in a new place and is not sure how to get home. A person might worry about a problem that she does not know how to solve. A little stress or anxiety can help a person to do their best. However, too much stress or anxiety can actually make someone sick. Some people cannot stop worrying. Life can be hard for a person who is always anxious.

About John

One of the things that stresses John is when someone new comes to the house. This makes him think about the time when his parents and a social worker came to tell him he would be moving to a new home. This stress tells his body he is afraid and he starts to sweat. He thinks about it over and over again, and gets more and more upset. Finally, one of his support staff tells him why the visitor is there and he calms down. It’s important for all staff to know this about John. John’s behavior would be much harder to figure out if he did not use words to communicate.

Stress and anxiety are an issue for people with developmental disabilities.

For people with developmental disabilities, stress and anxiety can be very difficult. Everyone feels stress or anxiety from time to time. One common way to relieve stress or anxiety is to figure out what is causing it. 

People with developmental disabilities may not know when they are safe and when they need to be afraid about new people, places, or activities. So, they may feel stress more often than others might. Because they also may not know what is causing their stress or anxiety, or what to do about it, people with developmental disabilities may be fearful and worried much of the time.

What kinds of things cause anxiety and stress?

People often feel stress when their lives change in important ways. Some common changes include:

• The death of a close relative or friend
• A serious injury or illness
• Getting married (or finding a girlfriend or boyfriend)
• Getting a divorce (or breaking up)
• Losing a job

Many other things can cause stress, too - particularly for people with developmental disabilities:

• Moving away from family
• Moving into a new home
• Spending a holiday alone or away from family
• Changing jobs
• Unable to make choices independently
• Not being able to get around easily
• Dealing with doctors or hospitals

Usually stress goes away with time. Stress can go away more quickly if people change their situations or learn ways to calm themselves down. If stress does not go away, it can harm a person’s body and mind.

People feel anxiety when they worry that something bad might happen. Some people keep worrying even after they see that nothing will happen after all. People who can’t stop worrying may have a chemical imbalance in their brains. This imbalance causes anxiety. It may also cause health problems, if their worries start to wear them down.

What do stress and anxiety feel and look like?

The people you support may describe some of these feelings if they feel stress or anxiety:

• I feel tired all of the time even though I sleep a lot
• I have scary dreams or nightmares
• My moods change for no reason
• The palms of my hands get sweaty
• I can't seem to concentrate
• I drop and break things a lot
• Sometimes, I cry over stupid things
• I fall or bump into things – I’m just clumsy
• I’m having trouble sleeping
• I’m hungry all the time
• I get a lot of headaches
• I don’t feel like doing anything
• I feel scared, but I don’t know why
• I’m just not happy

 The people you support may have physical signs or symptoms if they feel anxious:

• Trembling or twitching in their body
• Tight muscles all over
• Lots of headaches
• Sweating a lot
• Dry mouth and trouble swallowing
• Stomach aches

How can you tell that someone is stressed or anxious if they can’t communicate clearly?

People may show signs of stress or anxiety even if they can’t talk about what’s bothering them. For example, they may show any to these signs:

• Dizziness
• Frequent loss of temper
• Fast or irregular heart rate
• Difficulty sleeping
• Fast breathing
• Having bad dreams or nightmares
• Diarrhea or frequent need to go to the bathroom
• Can’t seem to concentrate or focus on anything
• Being tired all the time
• Problems with sex
• Vomiting or retching
• Doing the same thing over and over again
• Tendency not to listen
• Picking at self or other self-injurious behavior

How can you figure out what’s causing stress or anxiety for people you support?

You can’t always figure it out. However, this tool may help you learn what’s causing a person’s stress or anxiety. You can share this tool with other staff.

Take a piece of paper and draw a table with 4 columns and 2 rows—like the one you see in the table below. Use the questions you see in the table.

Let’s answer the questions using John’s behavior as an example. This one is easy to do because we know what John does (he starts to sweat) and when (when someone new comes to visit). We know what his actions mean (he’s afraid he will have to move) and how to support him (tell him why the visitor is at the house). You can also talk about this with John to see if you have it right.

1. What does John do? Starts to sweat, runs to his room, asks staff if he has to move
2. When does it happen? Someone new comes to visit
3. What do we think it means? John is afraid that he will have to move
4. How can we best support him?  Talk to him about why the visitor is here

If you are working with someone who does not use words to communicate:

1. Start by filling in #1. What does the person do?
2. Talk with people who know them best (for example, family or favorite staff) to make a good guess about #3. What do we think it means?
3. Work your way back to #2. When does it happen? And then answer #4 How can we best support the person? by trying things until you get it right.

Here’s another example:

Sara has lived at Bonita House for ten years. She really likes it. Her favorite staff person is Wilma. Wilma had to quit her job suddenly to take care of her mother who is very sick and Wilma did not have a chance to say goodbye. Other staff tried to tell Sara about it, but she didn’t seem to understand. Sara has started picking at herself whenever new support staff work with her. This is something she hasn’t done for years.

Let’s use the questions and table above to figure out what’s causing Sara’s stress.

1. What does Sara do? Picks at herself
2. When does it happen? New staff start to work with Sara 
3. What do we think it means? We think it means that she is worried. She thinks something has happened to Wilma.
4. How can we best support her? We will a) invite Wilma to come to the house and work with new staff as they work with Sara, and b) ask Wilma to give Sara a picture of her.

How can I help the people I support deal with stress and anxiety?

Even if you can’t figure out the cause when someone shows signs of stress or anxiety, there are ways to help. You can encourage them to have a healthy lifestyle, relax, and have fun. Here are some healthy ways the people you support can deal with stress :

• Eat a healthy diet and don't overeat
• Make sure to get enough sleep
• Try to exercise regularly
• Don’t drink coffee or cola with caffeine
• Avoid alcoholic drinks
• Don't smoke or use drugs
• Learn ways to relax like yoga, deep breathing
• Spend more time doing things for fun

Sometimes stress and anxiety can get so bad that the people you support might need outside help.

Call the person’s health care provider if they:

• Can’t seem to do anything but sit and worry about something
• Have a sudden feeling of panic
• Have a constant fear of something
• Repeat an action over and over again, like washing their hands
• Talk about killing themselves

Call 911 if someone you support:

• Feels chest pain with shortness of breath, dizziness, or sweating

If the person you support is taking any prescription or over-the-counter drugs, don’t forget to ask a pharmacist or health care provider if these drugs can cause anxiety as a side effect.

Additional Resources

The Yoga Experience for People with Developmental Disabilities

• Yoga has many well-known benefits. Increased flexibility and stamina, decreased stress and anxiety, and improved mental health are just a few. Imagine how useful these benefits are for people with developmental disabilities.

Dual Diagnosis: Anxiety Disorders and Developmental Disabilities II

This video talks about dual diagnosis of anxiety disorders and developmental disabilities and the challenges of diagnosis. It describes signs and symptoms of anxiety disorders - specifically post-traumatic stress disorder (PTSD) and obsessive-compulsive disorder (OCD). It also includes interviews with professionals, care providers, and people with developmental disabilities. For more information, contact . Cost: $44.95 plus $5 S&H.

Fact Sheet on Traumatic Stress and Children with Developmental Disabilities

National Child Traumatic Stress Network

• This brief report provides information about the incidence of trauma for children with developmental disabilities as well as suggestions for adapting therapy for posttraumatic stress.

“Anxiety Disorders and Related Conditions” on, Self-Directed Instructional Courses: Young People and Adults with Mental Retardation/Intellectual Disabilities.

• This is a self-instructional DVD designed to provide basic information for direct support staff. It is available from NADD (The National Association for the Dually Diagnosed) Cost: $59.95 + S/H for Non Members.