Separation Anxiety Disorder (SAD)

Generalized Anxiety Disorder (GAD)

Specific Phobia

Social Phobia (Social Anxiety)

Obsessive-Compulsive Disorder (OCD)

Panic Disorder (PD)

Panic Disorder with Agoraphobia

Acute Stress Disorder

Post-Traumatic Stress Disorder (PTSD)

% lifetime prevalence of an anxiety disorder

8-27%

at least one child in each elementary classroom likely has one

20x higher costs for families with an anxiety child

Anxiety

Anxiety Disorder

Anxiety: a mood state characterized by strong negative emotion, bodily symptoms of tension, apprehensively anticipates future danger or misfortune

Anxiety disorder: excessive and debiitating anxieties; chronic course; experience fears beyond a certain age, in situations that pose no real threat/danger, to an extent that seriously interferes with daily acivities.

• in moderate doses, helps people to think and act more effectively
• readies children both physically and psychologically for coping with people, objects, or events that could be dangerous

Pattern of self-defeating behavior that can become self-perpetuating.

Even if child knows there is little to be afraid of, he or she does everything possible to avoid the situation

Example) repeatedly pushing a rock up a hill and having it roll right back down again each time

Physical, Cognitive, and Behavioral systems

sympathetic nervous system > fight/flight response

produces chemical and physical effects that mobilize body for action:

chemical- adrenaline and norepinephrine

cardiovascular- heart rate and strength increase

respiratory- speed and depth of breating increase

sweat- increases to cool and create slipperiness

other- pupils widen, salivation and digestive system decrease, muscles tense to prepare for fighting or flight

activation of fight/flight response produces an immediate search for potential threat

if can't find proof of danger, children:

1) blame selves, "something must be wrong with me"

2) conclude that there must still be danger even if they can't see it

3) do both

leads to: subjective feelings of apprehension, nervousness, difficulty concentrating, and panic.

overwhelming urges: desire to escape or aggression

social constraints may prevent these

avoidance behaviors are negatively reinforced; strengthened by rapid reduction in anxiety

Fear: immediate alarm reaction to CURRENT danger or LIFE-THREATENING emergencies; PRESENT-oriented (vs anxiety= future-oriented)

Anxiety: feelings of apprehension and lack of control

Fear and anxiety both warn of danger or distress, but only anxiety is frequently felt when no danger is actually present

Panic: a group of physical symptoms of the fight/flight response that UNEXPECTEDLY occur in the ABSENCE of any obvious threat or danger.

with no explanation for the physical symptoms, the person may invent one, like "i'm dying"

anxiety: girls generally more than boys; types and symptoms similar though

SAD, spec phobia, social phobia, panic, PTSD : g>b

School refusal: g=b

GAD: b=g, teen girls> teen boys

OCD: boys 2x> girls

developmentally inappropriate

excessive anxiety

concerning separation from home and loved ones

3+:

1)recurrent obsessive distress when separated

2) persistent and excessive worry about losing or harm to loved ones

3) pers.&excess worry about bad thing happening to lead to separation

4) pers. reluctance to go to school/places b/c of separation

5) pers.&exces. fearful or reluctant to be alone

6) pers. reluctance or refusal to go to sleep alone

7) repeated nightmares involving theme of separation

8) repeated complaints of physical symptoms upon separation (anticipation)

excessive anxiety and worry

occurs more days than not

at least 6 months

about many events or activities

difficult to control worry

3+:

1) restlessness

2) easily fatigued

3) difficulty concentrating

4) irritability

5) muscle tension

6) sleep disturbance

persistent fear that is excessive and unreasonable

cued by presence or anticipation of specific objects/situations

exposure produces immediate anxiety response

person recognizes fear is unreasonable or excessive

situation is avoided or faced with intense anxiety or distress

persistent fear of social or performance situations

exposed to unfamiliar people or possible scrutiny

fears acting humiliating or embarassing

exposure produces anxiety

person recognizes fear is excessive or unreasonable

feared situations are avoided or endured with intense distress/anxiety

Obsessions:

recurrent or persistent thoughts, impulses or images

intrusive and inappropriate and cause anxiety/distress

not simply excessive worries abt real-life problems

person attempts to suppress or ignore or neutralize them

recognizes they are from their own mind

Compulsions:

repeated behaviors feel driven to perform in response to an obsession

according to rigid rules

beh aimed at preventing/reducing distress or some dreaded situation/event

not connected in a realistic way to what designed to neutralize

at some point recognize excessive/unreasonable (not for children tho)

discrete period of intense fear or discomfort

4+:

1) palpatations, pounding heart, accelerated heart rate

2) sweating

3) tembling

4) shortness of breath sensations

5) feeling of choking

6) chest pain

7) nasea or abdominal distress

8) dizzy, lightheaded, or faint

9) feelings of unreality or being detached from oneself

10) fear of losing control or going crazy

11) fear of dying

12) numbness or tightening sensations

13) chills or hot flashes

change from previous functioning

same 2 week period

1+ symptom is depressed mood or loss of pleasure/interest

5+:

1) depressed mood most of the day, most days (subjective by self or others)

2) diminished interest/pleasure

3) weight loss/gain

4) insomnia or hypersomnia nearly every day

5) psychomotor agitation or retardation nearly every day

6) fatigue or loss of energy nearly every day

7) feelings or worthlessness or guilt

8) diminished ability to concentrate or indecisiveness

9) recurrent thoughts of death, suicidal thoughts, plans or attempt

depressed mood most of the day, more days than not

subjective account by self or others

at least 2 years (1 year for children, may be irratible instead)

never been without symptoms for more than 2 months at a time

2+:

1) poor appetite or overeating

2) insomnia or hypersomnia

3) low energy/fatigue

4) low self-esteem

5) poor concentration or difficulty making decisions

6) feelings of hopelessness

SAD: earliest reported onset (7-8) and youngest age of referral.

1/3+ persist into adulthood

More likely to experience relationship difficulties, other anxiety disorders, other mental health problems, and impairment in social and personal lives

GAD: onset 10-14 years;

1/2 re-diagnosed after 2 years

Specific Phobia: onset 7-9 years; peak 10-13 years

more likely to persist than normal fears

Social Phobia: usually 10+ years, after puberty

2/3 have another anxiety disorder -esp specific phobia or panic disorder

20% have MDD, also drugs/alcohol

OCD: onset 9-12 years; 2 peaks

early onset likely to be fam hist

1/2- 2/3 persist 2-14 years later

<10% show complete remission

Panic Disorder: onset 15-19 years; 95% are post-pubertal

1/2+ don't have any other disorder

lowest rate of remission of any anxiety disorder

PTSD: onset any age; some delayed

young children symptoms likely to persist

75% comorbid depression or substance abuse

Acute Stress Dis: 20-30% of children with trauma

Overall: 8-27% children

SAD: 4-10%

GAD: 3-6%

Specific Phobia: 4-10%

Social Phobia: 1-3%

Selective Mutism: 0.5%

OCD: 2-3%

Panic: atacks= 3-4%, disorder= 1%

Acute Stress Disorder: 20-30% of trauma victims

PTSD: 3-7%

HPA axis

limbic system

brain stem

frontal cortex

specific parenting practices

family functioning

parent-child attachment

parent's beliefs about child's behaviors

a defense against unconscious conflicts (Freud)

a learned response

an adaptive mechanism needed for survival

Aimed at modifying 4 primary problems:

1) distorted info processing

2) physiological reactions to perceived threat

3) sense of lack of control

4) excessive escape and avoidance behaviors

Most common therapies:

1) behavior therapy

2) Cog-beh ther

3) family interventions

4) medications

• Exposure -while providing alternative coping mechanisms
• graded exposure based on subjective units of distress stress (SUDS)
• systematic desensitization
• flooding

most effective treatment

teaches children to understand how thinking contributes to anxiety and how to modify their maladaptive thoughts to decrease their symptoms

Coping Cat- SAD, GAD, and social phobia

decreases neg thinking, increases active problem-solving and provides a functional coping method/outlook

Skills training: Modeling

role-play

exposure

relaxation training

social reinforcement

FEAR plan- recognize physical symptoms and anxious cognitions, coping self-talk and behavior to use, and evaluating performance and self-rewarding

2nd part- exposure and practice