I need someone to write 5-6 pages essay

3/17/2019

1

ANXIETY DISORDERS

Part 1

What do child anxiety disorders look like?

3/17/2019

2

 Moderate amounts of anxiety are adaptive

 BUT excessive, uncontrollable anxiety can be debilitating (e.g., test anxiety)

 Anxiety disorders involve experiencing excessive and debilitating anxieties

 Anxiety disorders common in youth (lifetime prevalence 8-30%)

Experiencing Anxiety

 Fear: present-oriented emotional reaction  Occurs in the face of a current danger and marked by a

strong escape tendency

 Anxiety: future-oriented mood state  A potential threat

 May occur in absence of realistic danger

 Worry: repetitive thinking about potential future threat  “What if…..”

 Children with anxiety disorders worry more intensely than other children

Definitions

3/17/2019

3

 Moderate fear, anxiety, and worry are common and normal during childhood and adolescence:  Separation anxiety

 Anxiety about harm to a parent

 Test anxiety

 Concern about competence

 Fears that are normal at one age can be debilitating a few years later (e.g., not wanting to separate from mom)

 Number and types of fears change over time  Most fears decline with age, but social fears increase into

adolescence

Normal Fears, Anxieties, and Worries

 Includes 7 diagnoses that all load onto one higher- order factor (NA), co-occur, have similar causal factors, and respond to the same treatments  Separation Anxiety Disorder (SAD)

 Generalized anxiety disorder (GAD)

 Specific phobia

 Social anxiety disorder

 Selective mutism

 Panic disorder (PD)

 Agoraphobia

PTSD and OCD no longer included with Anxiety Disorders in DSM-5

DSM-5 Anxiety Disorders

3/17/2019

4

 Separation anxiety is important for a young child’s survival  It is normal from about age 7 months through preschool

 SAD is distinguished by:  Age-inappropriate, excessive, and disabling anxiety about

being apart from parents or away from home

Separation Anxiety Disorder (SAD)

Separation Anxiety Disorder

A. Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least three of the following:

1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.

2. Persistent and excessive worry about losing attachment figures or about possible harm to them, such as illness, injury, disasters, or death.

3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.

4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.

5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.

6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.

7. Repeated nightmares involving the theme of separation. 8. Repeated complaints of physical symptoms (e.g., headaches,

stomachaches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.

B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.

3/17/2019

5

 One of the two most common childhood anxiety disorders

 Occurs in 4-10% of children  More prevalent in girls than in boys

 Usually the first anxiety disorder to appear (average onset age 7-8) and has the youngest age at referral

 Persists into adulthood for more than 1/3 of affected children and adolescents

 More than 2/3 of children with SAD have another anxiety disorder and about half develop a depressive disorder

SAD: Prevalence and Comorbidity

 Refusal to go to school in morning or difficulty remaining in school for an entire day

 Occurs most often in ages 5-11

 Common in youth with SAD or Social Anxiety

 Fear of school may be fear of leaving parents (separation anxiety), but can occur for other reasons

 Serious long-term consequences result if it remains untreated

School Refusal

3/17/2019

6

 Age-inappropriate persistent, irrational, or exaggerated fear of a specific object or situation  Child goes to great lengths to avoid the

object/situation

 Causes impairment in normal routine

 Extreme distress if unable to avoid

Specific Phobia

Specific Phobia

A. Marked fear or anxiety about a specific object or situation (e.g., flying, heights, animals, receiving an injection, seeing blood).

•Note: In children, the fear or anxiety may be expressed by crying, tantrums, freezing, or clinging.

B. The phobic object or situation almost always provokes immediate fear or anxiety.

C. The phobic object or situation is actively avoided or endured with intense fear or anxiety.

D. The fear or anxiety is out of proportion to the actual danger posed by the specific object or situation and to the sociocultural context.

E. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

Specify if: Animal, Natural Environment, Blood-Injection-Injury, Situational, or Other

3/17/2019

7

 Prevalence and comorbidity  About 20% of children are affected at

some point in their lives, although few are referred for treatment

 More common in girls

 Phobias involving animals, darkness, insects, blood, and injury onset between ages 7-9  Similar to normal development

 Peak between ages 10-13

Specific Phobia

 A marked, persistent fear of social or performance requirements that expose the child to scrutiny and possible embarrassment  Anxiety over mundane activities

 Shrink from people they do not know. May blush, fall silent, cling to their parents, or try to hide when forced to interact with somebody new

 Lifetime prevalence of 6-12% of children

 Twice as common in girls

 Most common age of onset is early to mid-adolescence, and is extremely rare in children under 10

Social Anxiety Disorder

3/17/2019

8

Social Anxiety Disorder A. Marked fear or anxiety about one or more social situations in which the individual is exposed to possible scrutiny by others. Examples include social interactions (e.g., having a conversation, meeting unfamiliar people), being observed (e.g., eating or drinking), and performing in front of others (e.g., giving a speech).

Note: In children, the anxiety must occur in peer settings and not just during interactions with adults.

B. The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).

C. The social situations almost always provoke fear or anxiety.

D. The social situations are avoided or endured with intense fear or anxiety.

E. The fear or anxiety is out of proportion to the actual threat posed by the social situation and to the sociocultural context.

F. The fear, anxiety, or avoidance is persistent, typically lasting for 6 months or more.

Specify if Performance only: restricted to speaking/performing in public

 2/3 also have another anxiety disorder

 20% also suffer from major depression and may self- medicate with alcohol and other drugs

 Chronic (average duration is 20-25 years if untreated)  As adults, may have significant problems in educational and

occupational attainment and romantic relationships.

 Lower remission without treatment and poorer treatment response than other anxiety disorders

 Although many celebrity success stories

Social Anxiety: Comorbidity and Course

3/17/2019

9

 Often secondary to Social Anxiety Disorder

 Failure to talk in social situations, even though they may speak loudly and frequently at home or other settings

 Estimated to occur in 0.7% of children

 Average age of onset is 3-4 years

Selective Mutism

 Generalized anxiety disorder (GAD)  Excessive, uncontrollable anxiety and worry

 Worrying can be episodic or almost continuous

 Worry excessively about minor everyday occurrences

 Expect the worst to happen in most situations  “What if????”

 Accompanied by at least one somatic sx  Headaches, stomach aches, muscle tension

 May seek constant reassurance from parents and teachers that things will be ok

Generalized Anxiety Disorder

3/17/2019

10

Generalized Anxiety Disorder A. Excessive anxiety and worry (apprehensive expectation), occurring more days than not for at least 6 months, about a number of events or activities (such as work or school performance).

B. The individual finds it difficult to control the worry.

C. The anxiety and worry are associated with three (or more) of the following six symptoms (with at least some symptoms having been present for more days than not for the past 6 months):

Note: Only one item is required in children.

1. Restlessness or feeling keyed up or on edge

2. Being easily fatigued

3. Difficulty concentrating or mind going blank

4. Irritability.

5. Muscle tension 6. Sleep disturbance (difficulty falling or staying asleep, or restless,

unsatisfying sleep)

What do kids with GAD worry about?

 Grades and tests

 Sports or other extracurricular activities

 Doing everything perfectly

 What other people think about them

 Making mistakes

 The weather

 World events

 Their health

 Other people’s health

 The future  Will I get into college?

 Will I find somebody to marry?

 Family finances

 How they look

 Being late

 Safety

3/17/2019

11

 Prevalence and comorbidity  2-5% in community

 But 37% in youth referred for anxiety

 Equally common in boys and girls

 Accompanied by high rates of other anxiety disorders and especially depression

 Onset, course, and outcome  Average age of onset is early adolescence

 Symptoms persist over time

GAD: Comorbidity and Course