Mental Health is Important!

A growing number of people around the world are struggling with their mental health. For example, they may experience stress, depression, or anxiety. Anxiety is when we feel fear and worry. Anxiety is a normal and common feeling, but some people feel it very intensely and a lot of the time. It is very important for people with anxiety or other mental health issues to be able to get the right kind of help as early as possible, so they can start feeling better. Just like when you have a cut on your arm, it is best to treat it and bandage it as soon as possible, so it does not become worse or get infected. Similarly, if we do not take care of our feelings and our mental health, any problems we are experiencing might become even worse later on [1].

What is an Intellectual Disability?

People with intellectual disabilities have difficulty learning, understanding, and processing information. These people may need extra help or special assistance to learn. About 1–3 out of every 100 people around the world have some sort of intellectual disability. That means there are quite a few people who might need some extra support when they are learning things.

Children with intellectual disabilities have high rates of mental health concerns. In particular, they experience a lot of anxiety [2]. One type of therapy that has helped children with anxiety is called cognitive behavioral therapy (CBT). The effectiveness of this therapy has not been thoroughly studied with children who have intellectual disabilities. Therefore, in our research, we wanted to discover whether children with learning difficulties could benefit from CBT, if it was changed a bit to fit their needs.

What is Cognitive Behavioral Therapy?

CBT is one of the most studied types of psychological therapies. Therapists use CBT to help children and adults who feel really worried or sad, or who have other mental health struggles. Many studies show that CBT can help people feel better.

Think of your brain as the control center for your feelings and actions. CBT is like a guidebook for this control center. According to CBT, the way we think affects how we feel, and how we feel affects what we do.

For example, imagine you see a dog while walking down the street (Figure 1). If you think the dog looks scary and might bite you, that thought can make you feel anxious or scared. Then, you might cross the road or run away from the dog—those are your actions. On the other hand, someone else might see the same dog and think it looks friendly. That thought could make them feel excited, and their action might be to walk up to the dog and ask to pat it.

So, what we think can have a big impact on how we feel and what we do (Figure 2). CBT helps us understand this process and learn how to manage our thoughts and feelings better.

CBT helps us see patterns in the way we think. Sometimes our minds tells us things that are not really true, or things that make us feel really bad. For instance, some people always imagine the worst things happening, even if those things are not likely to happen. CBT helps us catch these unhelpful or untrue thoughts. When we catch them, therapists can help us challenge those thoughts, so we can think in a more helpful way. So, if someone always thinks things are going to be super awful, CBT can teach them to see things in a more calm and realistic way.

Developing a CBT Program for Children with Intellectual Disabilities

Researchers have found that adults with learning challenges can use CBT and that it helps them feel less worried. Researchers have also learned that children with other kinds of learning needs (like autism) can also feel less worried through CBT. So, we wanted to see if CBT could help children with intellectual disabilities who have anxiety. We wanted to figure out how to provide therapy in a way that would work best for these children. Here is the process we followed:

Step 1: Checking What We Already Know

First, we looked at all the information and research that had already been done. This was to better understand the challenges that children with intellectual disabilities face when learning [3], and how to improve CBT for them. For example, many children with intellectual disabilities have trouble focusing for a long period of time. To help them, therapy sessions can be made shorter or can include breaks. Technology and videos can also be included, to help make therapy more fun and keep kids interested.

Step 2: Ask the Experts

We also asked mental health experts in Australia about their work with children with intellectual disabilities [4]. We wanted to find out if the confidence therapists have in themselves, in terms of their ability to help kids with intellectual disabilities, might be a barrier to these kids getting effective treatment. A study in the United Kingdom showed that, if therapists have low confidence, treatments for people with intellectual disabilities might be less useful. We found that therapists felt confident with their general counseling skills, like listening to the person and talking with their family. They were least confident knowing what questions to ask, or the best treatment options to provide. Therapists also said they would like a treatment guidebook to follow, to help them feel more confident in providing therapy to children with intellectual disabilities.

Step 3: Feedback from Parents

We also asked parents who have children with intellectual disabilities for information. We wanted to find out what parts of therapy they thought might be tough for their child. This was done through an online survey.

Creating Fearless Me!

From all this information, we created the Fearless Me! Program [5]. Fearless Me! was created specifically for children with intellectual disabilities and is based on CBT. Fearless Me! is designed for children 8–17 years old with mild, moderate, or severe anxiety. It involves 10 sessions with a therapist. There is also a website that has fun activities for children to do, both with the therapist and at home.

The Fearless Me! website has activities to make therapy more fun for children. The activities are divided into three categories Figure 3:

1. Keep Calm: These activities help children learn how to relax when they are feeling anxious.
2. Stop and Think: Through these activities, children learn how to recognize and change thoughts that do not help them.
3. Facing Fears: Through these activities, children learn to slowly tackle the things they are scared of, step by step, and to do things that made them nervous.

There are 10 therapy sessions included in the Fearless Me! Program [5]. These 10 sessions cover the main parts of CBT, and the topics are outlined in Table 1.

Is Fearless Me! Working?

So far, the Fearless Me! program has been provided to children and adolescents, and results indicate that it can help children feel less anxious. Our research shows that CBT can be useful for children with intellectual disabilities, particularly when it is adjusted for their way of learning. The Fearless Me! program has been run as a group therapy program at a school for children with intellectual disabilities [6]. Participants found the program easy to understand and use, and they said that it helped the children feel less anxious. Fearless Me! has also been run at a university clinic where children received one-on-one therapy. Nine children finished the program and all of them reported feeling less anxious on at least one measure of anxiety.

What is Next?

We are not done yet. We are going to keep doing research on the Fearless Me! program to figure out how to make it even better, so that it can help even more children. Right now, Fearless Me! is all about helping overcome anxiety, but we might also explore whether it can help with other things, like feeling really sad or angry. We are hoping that this program will help many children who could not access therapy before because they learn differently. The best part is that the Fearless Me! website and treatment program are totally free to access on the internet. This means that therapists all over the world can use it to help many children. Check out the Fearless Me! website yourself!

Glossary

Mental Health: ↑ How we feel, think, act and cope with stress.

Anxiety: ↑ a feeling we have when we think something bad might happen.

Intellectual Disability: ↑ When someone has difficulty with learning, understanding information, or figuring out new ideas and skills. Sometimes reading, writing, and talking to others can be more difficult, too.

Cognitive Behavior Therapy (CBT): ↑ A type of therapy shown to be very useful for treating anxiety, depression, or other mental health issues. It helps a person understand and deal with thoughts, feelings, and behaviors.

Therapist: ↑ A person who helps other people by talking to them about their feelings and helping solve problems.

Autism: ↑ A condition some people are born with, that impacts the way they think and communicate.

Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.