Running head: NURSING CASE 1
Katy Diagnosis
Student Name
Course
NURSING CASE 2
Instructions
Review the interactivePediatric Case Studyand analyze the data to determine the
health status of the patient.
Follow the requirements posted in the rubric.
Use the Word document that is located within the case study to complete the case study
assignment.
Your case study should be between five to seven pages
Katy Transcript
Katy is a six-year-old girl, the second of two children of a middle-class family living
in a suburban area of a northwest city. Katy has one sister that is two years older
than her. Her mother’s pregnancy was normal and Katy’s birth was normal. Katy
had colic the first three months, cried extensively and was difficult to comfort. After
three months she became passive and cried very little with comfort from her
mother. Her growth and development appeared to be normal. She met all the
developmental milestones her first three years. She interacted normally with her
sister and parents, except that she would become tearful and anxious when her
parents would get a babysitter.
At age four, she was in nursery school and appeared to function normally except
during the first month when Katy had difficulty when her father would drop her off at
school. The nursery school was a small private school with a lot of personal
attention given to each child. Although shy, she made friends and liked going to
nursery school after she became adjusted to the new setting. Her parents liked the
school so much that they decided to keep Katy in kindergarten at this school with
her same teachers and friends. However, tuition at the school became a problem
after Katy’s mother became sick with lupus and was unable to work.
At age six, Katy’s parents enrolled her in first grade at the public elementary school
in their neighborhood. For the last two weeks, she has refused to go to school and
has missed six school days. She is awake almost all night worrying about going to
school. As the start of the school day approaches, she cries and screams that she
cannot go, chews holes in her shirt, pulls her hair, digs at her face, punches the
wall, throws herself on the floor, as well as experiences headaches, stomachaches,
and vomiting. Over the past two weeks, she has become gloomy, has stopped
reading for fun, and frequently worries about her mother's Lupus and that she may
die. In addition, Katy is phobic of dogs, avoids speaking and writing in public, and
wets the bed every night.
Her parents immediately made an appointment to see her PCP. Her doctor
conducted a thorough physical exam, found no physical abnormalities and then
referred her to you, a Family PMHNP.
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Family history of mental health includes the following: mother has a history of panic
disorder; her father has a history of treatment with medications for ADHD as a child;
and she has a cousin diagnosed with Asperger’s syndrome.
Family mental health history
Mother has a history of panic disorder
Father has a history of treatment with medications for ADHD as a child
Cousin diagnosed with Asperger’s syndrome
For your assignment, write a paper that addresses the following prompts using
evidence-based references to support your answers:
1. What is your provisional diagnosis, as well as the possible differentials?
2. Justify your answer with DSM-5 criteria (be short, brief and to the point).
3. Is Katy too young to diagnose, or is there a basis for early identification
and intervention?
4. What psychiatric scales or assessment tools might you use with this
patient? With the parents? List and describe briefly.
5. How would the typical symptom patterns and phases be manifested in
children this age? In adolescents?
6. What would be your treatment plan for medications, if any? If you do
choose to offer medication as part of the treatment plan, please address
the following medications issues:
a. Target symptoms
b. Receptors affected
c. Psychiatric and system effects
d. Possible parental concerns
7. What would be your school-based treatment plan, if any?
8. What would be the implications for the families of children and
adolescents with these diagnostic pictures?
9. How does the mother’s health play into the picture of Katy’s diagnosis?
What type of therapy would you recommend for Katy (and her family) to
work through her issues?
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10.Identify resources for patients/families with this diagnosis in the form of
community groups, web-sites, advocacy, as well as treatment resources
available in your service area.
11.What are you worried about (if anything)? Consider this question in
terms of treatment, assessment, alliance, compliance, effectiveness,
safety, and other factors.
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1. What is your provisional diagnosis, as well as the possible
differentials?
Separation Anxiety Disorder
Separation Anxiety Disorder (SAD) is a condition where children become nervous and
fearful when they are separated from their loved ones or they are away from home. It is normal
for children to have separation anxiety between the age of 8 and 14 months because they have
developed attachment with the people they interact with every time. Children who show
separation anxiety beyond 6 years old and the conditions lasts for more than four weeks, they are
suffering from separation anxiety disorder (Lavallee & Schneider, 2019). Some of the symptoms
of such a disorder include stomachaches, headaches and distress when separated from loved
ones. These symptoms may interfere with normal activities like playing with other children or
going to school (Lebowitz, 2019). Other symptoms associated with SAD include unrealistic and
lasting worry of something bad happening to their parents or a loved one, worry of being left by
his/her parent, refusing to go to school in order to stay with his/her parents or caregiver, fearing
to go to sleep alone or staying alone, nightmares about being separated, bed wetting, and
repeated tantrums due to high temper (Lavallee & Schneider, 2019).
Katy suffers from Separation Anxiety Disorder because she has shown symptoms and
reactions that resemble the disorder. She had difficulties being dropped at school by her father.
At first, she was shy and feared the school environment until she adjusted to the new setting.
After enrolling in new elementary school, she began to fear the new environment, refusing to go
to school. She spends many hours awake in the night worrying about going to the new school she
was enrolled in. She throws tantrums every morning through loud cries and screams as a reaction
of refusing to go to school. She also pulls her hair, digs her face, and throws herself on the flow,
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and has been experiences headaches, stomachaches and vomiting every morning because she
fears going to school. She has stopped reading and become gloomy.
According to Diagnostic and Statistical Manual of Mental Disorders, four percent of
children and about 1.6 percent of adolescents usually experience separation anxiety disorder. The
disorder is common for children under 12 years old (Lebowitz, 2019). It is characterized by tears
at drop off at school because of being attached to their loved ones. The manual gives symptoms
of SAD such as sleep disturbance, school refusal, excessive distress when the child is about to be
separated from his/her parents and caregivers, and interference of normal daily activities.
Katy is not too young to be diagnosed with SAD because the disorder occurs to children
and adolescents too. For SAD diagnosis, the condition should last for more than four weeks and
cause distress that cannot be attributed to any other cause. A child psychiatrist or any other
professional mental health practitioner can easily diagnose SAD. The professional has to do
mental health evaluation of the child (Lebowitz, 2019). One of the notable reactions of children
with this disorder is school refusal which causes poor school attendance as well as poor school
performance. The condition also impairs social interactions and relationships as observed in
Katy. Early identification of this disorder include reactions of distress and prolonged periods of
fear of being left by those the child has developed attachment with. When the disorder is
diagnosed, treatment interventions should be initiated to prevent any further complications and
worsening of the condition (West, Wilbanks & Suveg, 2020).
Provisional Diagnosis and Possible Differentials for Katy:
Based on the information provided in the case study, Katy presents with a constellation of
symptoms that suggest the presence of an anxiety disorder, specifically generalized anxiety
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disorder (GAD), with comorbid phobias and symptoms of depression. Here's a breakdown of
the provisional diagnosis and possible differentials:
Provisional Diagnosis: Generalized Anxiety Disorder (GAD)
Katy exhibits excessive worry and anxiety about attending school, which has led to physical
symptoms such as headaches, stomachaches, vomiting, and sleep disturbances.
She experiences avoidance behaviors, including refusal to attend school, which is a hallmark
feature of GAD.
Additionally, Katy's worries extend beyond school to concerns about her mother's illness, fear
of dogs, and social anxiety (avoidance of speaking and writing in public).
Possible Differentials:
Separation Anxiety Disorder (SAD): Katy's extreme distress about attending school, nighttime
bedwetting, and fear of separation from her mother could indicate SAD. However, the age of
onset for SAD typically occurs earlier, and symptoms usually improve with age, which might
make this less likely.
Social Anxiety Disorder (SAD): Katy's avoidance of speaking and writing in public, coupled with
her difficulty in adjusting to new social situations (e.g., nursery school), may suggest social
anxiety disorder. However, her symptoms extend beyond social situations to include
generalized worries and physical symptoms, which align more closely with GAD.
Major Depressive Disorder (MDD): Katy's loss of interest in activities she previously enjoyed,
feelings of gloominess, and worries about her mother's health may indicate comorbid
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depression. However, her primary symptoms revolve around anxiety and school avoidance
rather than pervasive sadness, which makes GAD a more likely diagnosis.
Specific Phobia: Katy's intense fear of dogs could represent a specific phobia. However, her
symptoms extend beyond this specific fear to encompass broader worries and avoidance
behaviors, suggesting a more generalized anxiety presentation.
Adjustment Disorder: Katy's difficulty adjusting to transitions, such as starting first grade and
coping with her mother's illness, could initially resemble an adjustment disorder. However, the
severity and duration of her symptoms, as well as their impact on her daily functioning, suggest
a more pervasive and chronic anxiety disorder like GAD.
In summary, while Katy's symptoms overlap with several possible diagnoses, her presentation is
most consistent with generalized anxiety disorder (GAD) with comorbid phobias and symptoms
of depression. However, further assessment and evaluation are necessary to confirm the
diagnosis and develop an appropriate treatment plan.
Generalized Anxiety Disorder (GAD):
GAD is characterized by excessive and uncontrollable worry about a variety of events or
activities, occurring more days than not for at least six months.
Physical symptoms such as restlessness, fatigue, muscle tension, difficulty concentrating,
irritability, sleep disturbances, and gastrointestinal distress are common.
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Individuals with GAD often experience excessive worry about minor matters, difficulty in
controlling their worry, and a tendency to anticipate disaster even when there is no clear cause
for concern.
The onset of GAD can occur at any age, but it often begins in childhood or adolescence.
Comorbid conditions commonly associated with GAD include depression, other anxiety
disorders, and somatic symptom disorders.
Separation Anxiety Disorder (SAD):
SAD typically involves excessive fear or anxiety concerning separation from attachment figures
or home.
Symptoms may include recurrent distress when separation occurs or is anticipated, reluctance
or refusal to go to school or other places due to fear of separation, nightmares involving
separation themes, physical complaints when separation is imminent, and persistent worry
about losing attachment figures.
SAD often emerges in childhood and may remit as the child grows older, although it can persist
into adulthood.
Social Anxiety Disorder (SAD):
SAD involves intense fear or anxiety about social situations where the individual may be
scrutinized or evaluated by others.
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Symptoms may include avoidance of social situations, fear of embarrassment or humiliation,
physical symptoms of anxiety in social situations, and impairment in social, occupational, or
other important areas of functioning.
Onset typically occurs in adolescence or young adulthood.
Major Depressive Disorder (MDD):
MDD involves persistent feelings of sadness, hopelessness, and loss of interest or pleasure in
activities that were once enjoyed.
Symptoms may include changes in appetite or weight, sleep disturbances, fatigue, feelings of
worthlessness or guilt, difficulty concentrating, and thoughts of death or suicide.
MDD can occur at any age, including childhood, and often coexists with anxiety disorders.
Specific Phobia:
Specific phobias involve intense, irrational fears of specific objects or situations.
Symptoms may include immediate anxiety or panic upon exposure to the feared object or
situation, avoidance of the feared stimulus, and significant distress or impairment in daily
functioning.
Phobias typically emerge in childhood and may persist into adulthood without treatment.
Adjustment Disorder:
Adjustment disorder involves emotional or behavioral symptoms that develop in response to
identifiable stressors, such as starting school or coping with a family member's illness.
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Symptoms may include depressed mood, anxiety, conduct disturbances, and impairment in
social or occupational functioning.
The onset of symptoms occurs within three months of the onset of the stressor and typically
resolves within six months after the stressor's termination.
Based on the information provided in the case study, a comprehensive assessment, including a
detailed clinical interview, standardized assessment tools, and collateral information from
family members and teachers, would be essential to confirm the diagnosis and rule out other
possible explanations for Katy's symptoms. Additionally, considering her family history of
mental health disorders, a thorough exploration of familial patterns and dynamics would be
crucial for treatment planning and identifying potential risk factors.
Generalized Anxiety Disorder (GAD):
Children with GAD often exhibit excessive worry about everyday events and activities, such as
school performance, family issues, and health concerns.
Physical symptoms like headaches, stomachaches, and sleep disturbances are common
manifestations of the anxiety experienced by children with GAD.
GAD may coexist with other anxiety disorders, depressive disorders, and behavioral disorders.
Environmental stressors, genetic predisposition, and temperament may contribute to the
development of GAD in children.
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Cognitive-behavioral therapy (CBT), relaxation techniques, and medication (e.g., selective
serotonin reuptake inhibitors) are commonly used in the treatment of GAD in children and
adolescents.
Separation Anxiety Disorder (SAD):
SAD is characterized by excessive fear or anxiety related to separation from attachment figures,
such as parents or caregivers.
Children with SAD may exhibit clinginess, reluctance to go to school, nightmares about
separation, and physical symptoms like stomachaches or headaches when faced with
separation.
SAD often emerges in early childhood and may persist into adolescence or adulthood if left
untreated.
Family factors, traumatic experiences, and temperament may contribute to the development of
SAD in children.
Treatment approaches for SAD include cognitive-behavioral therapy (CBT), family therapy, and
pharmacotherapy in severe cases.
Social Anxiety Disorder (SAD):
Social anxiety disorder involves intense fear or anxiety about social situations in which the
individual may be scrutinized or judged by others.
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Children with SAD may avoid social interactions, experience physical symptoms like sweating or
trembling in social situations, and have difficulty making friends or participating in group
activities.
SAD often emerges in adolescence, but symptoms may be present in childhood.
Genetic factors, environmental influences, and negative social experiences may contribute to
the development of SAD.
Treatment for SAD may include cognitive-behavioral therapy (CBT), exposure therapy, social
skills training, and medication in severe cases.
Major Depressive Disorder (MDD):
Major depressive disorder involves persistent feelings of sadness, hopelessness, and loss of
interest or pleasure in activities.
Children with MDD may exhibit changes in appetite or weight, sleep disturbances, fatigue,
difficulty concentrating, and thoughts of death or suicide.
Risk factors for MDD in children include family history of depression, adverse life events,
chronic medical conditions, and neurobiological factors.
Treatment for MDD in children often includes psychotherapy (e.g., cognitive-behavioral
therapy), family therapy, antidepressant medication (e.g., selective serotonin reuptake
inhibitors), and support from caregivers and mental health professionals.
Specific Phobia:
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Specific phobia involves an intense, irrational fear of a specific object, situation, or activity.
Children with specific phobias may experience panic attacks, avoidance behaviors, and
significant distress or impairment related to the feared stimulus.
Phobias may develop in childhood and persist into adulthood without intervention.
Treatment for specific phobias often involves exposure therapy, cognitive-behavioral
techniques, relaxation strategies, and medication in severe cases.
Adjustment Disorder:
Adjustment disorder involves the development of emotional or behavioral symptoms in
response to identifiable stressors or life changes.
Children with adjustment disorder may experience symptoms such as depressed mood, anxiety,
conduct disturbances, and impaired social or academic functioning.
The duration of adjustment disorder symptoms typically corresponds to the duration of the
stressor and may resolve once the stressor is removed or coping mechanisms are developed.
Treatment for adjustment disorder may include supportive therapy, stress management
techniques, and family counseling to address underlying stressors and enhance coping skills.
In Katy's case, a comprehensive assessment by a mental health professional, such as a
psychiatric nurse practitioner, would be essential to differentiate between these potential
diagnoses and develop an appropriate treatment plan tailored to her specific needs and
circumstances. Collaboration with Katy's family, school personnel, and other relevant
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stakeholders would also be important to gather additional information and support Katy's well-
being and academic success.
Generalized Anxiety Disorder (GAD):
GAD is characterized by persistent and excessive worry or anxiety about various aspects of life,
including school, family, health, and everyday events.
Children with GAD often exhibit physical symptoms such as restlessness, fatigue, muscle
tension, difficulty concentrating, irritability, sleep disturbances, and gastrointestinal discomfort.
The onset of GAD can occur at any age, but it often begins in childhood or adolescence.
Genetic predisposition, environmental stressors, family dynamics, and neurobiological factors
may contribute to the development of GAD.
Treatment options for GAD in children may include cognitive-behavioral therapy (CBT),
relaxation techniques, mindfulness-based interventions, parental involvement, and, in severe
cases, medication such as selective serotonin reuptake inhibitors (SSRIs) or serotonin-
norepinephrine reuptake inhibitors (SNRIs).
Separation Anxiety Disorder (SAD):
SAD involves excessive fear or anxiety about separation from attachment figures, leading to
distress when separated from home or caregivers.
Children with SAD may experience physical symptoms such as headaches, stomachaches,
nausea, and reluctance or refusal to attend school or be apart from parents.
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SAD often manifests during early childhood and can persist into adolescence and adulthood if
left untreated.
Factors contributing to SAD may include genetic predisposition, insecure attachment, traumatic
experiences, and family dynamics.
Treatment approaches for SAD may include cognitive-behavioral therapy (CBT), exposure
therapy, relaxation techniques, social skills training, and family therapy.
Social Anxiety Disorder (SAD):
SAD involves intense fear or anxiety about social situations in which the individual may be
scrutinized or judged by others.
Children with SAD may avoid social interactions, experience physical symptoms such as
blushing, sweating, trembling, or nausea in social settings, and have difficulty making friends or
participating in group activities.
SAD often emerges in adolescence but may have roots in childhood experiences of social
discomfort or rejection.
Genetic predisposition, environmental factors, negative social experiences, and cognitive biases
may contribute to the development of SAD.
Treatment options for SAD in children may include cognitive-behavioral therapy (CBT),
exposure therapy, social skills training, group therapy, and, in severe cases, medication such as
SSRIs.
Major Depressive Disorder (MDD):
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MDD involves persistent feelings of sadness, hopelessness, and loss of interest or pleasure in
activities that were once enjoyable.
Children with MDD may exhibit changes in appetite or weight, sleep disturbances, fatigue,
difficulty concentrating, feelings of worthlessness or guilt, and thoughts of death or suicide.
Risk factors for MDD in children may include genetic predisposition, family history of
depression, adverse life events, chronic stress, and neurobiological factors.
Treatment for MDD in children often includes psychotherapy (e.g., cognitive-behavioral
therapy), family therapy, antidepressant medication (e.g., SSRIs), supportive interventions, and
involvement of caregivers and mental health professionals.
Specific Phobia:
Specific phobia involves an intense, irrational fear of a specific object, situation, or activity.
Children with specific phobias may experience panic attacks, avoidance behaviors, and
significant distress or impairment related to the feared stimulus.
Phobias may develop in childhood and persist into adulthood without intervention.
Treatment for specific phobias often involves exposure therapy, cognitive-behavioral
techniques, relaxation strategies, and, in severe cases, medication such as benzodiazepines or
beta-blockers.
Adjustment Disorder:
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Adjustment disorder involves the development of emotional or behavioral symptoms in
response to identifiable stressors or life changes.
Children with adjustment disorder may experience symptoms such as depressed mood, anxiety,
conduct disturbances, and impaired social or academic functioning.
The duration of adjustment disorder symptoms typically corresponds to the duration of the
stressor and may resolve once the stressor is removed or coping mechanisms are developed.
Treatment for adjustment disorder may include supportive therapy, stress management
techniques, problem-solving skills training, and involvement of family members and school
personnel.
In Katy's case, a thorough assessment by a mental health professional, such as a psychiatric
nurse practitioner, would be crucial to accurately diagnose her condition and develop an
individualized treatment plan tailored to her specific needs and circumstances. Collaboration
with Katy's family, school personnel, and other relevant stakeholders would also be essential to
provide comprehensive support and address any underlying issues contributing to her
symptoms.
2. Justify your answer with DSM-5 criteria (be short, brief and to the
point).
Treatment of SAD
Treatment of separation Anxiety Disorder in children should begin as soon as diagnosis is
done in order to have positive outcome. The treatment procedure depends in the child’s age,
symptoms and general health. It will also be informed by severity of the condition. Many
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professionals use a mix of interventions and treatment procedures in children to ensure the
children overcome such disorders (Lavallee & Schneider, 2019). There are various treatment
interventions and psychotherapy that can be used which include cognitive behavior therapy
(CBT), family therapy, school input and play therapy, as well as medication in cases where the
conditions are severe.
DSM-5 Criteria for Generalized Anxiety Disorder (GAD):
Excessive anxiety and worry about various events or activities, occurring more days than not for
at least 6 months.
Difficulty controlling the worry.
Presence of three (or more) of the following symptoms: restlessness, fatigue, irritability, muscle
tension, difficulty concentrating, and sleep disturbances.
The anxiety and worry are associated with significant distress or impairment in social,
occupational, or other important areas of functioning.
Justification for Provisional Diagnosis of GAD for Katy:
Katy exhibits excessive worry and anxiety about attending school, her mother's illness, and other
everyday events.
She experiences difficulty controlling her worry, as evidenced by her sleep disturbances,
physical symptoms (headaches, stomachaches), and school refusal behavior.
Katy's symptoms have persisted for at least two weeks and have led to significant distress and
impairment in her daily functioning, including missed school days and avoidance behaviors.
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Based on these criteria, Katy's presentation aligns with the diagnostic criteria for Generalized
Anxiety Disorder (GAD) outlined in the DSM-5.
Excessive Anxiety and Worry:
Individuals with GAD experience excessive anxiety and worry about various events or activities,
such as school performance, family matters, health concerns, or daily responsibilities.
The worry is difficult to control and may be disproportionate to the actual likelihood or impact of
the feared event.
Duration and Frequency:
The excessive anxiety and worry persist for a period of at least six months.
The anxiety and worry occur more days than not during this six-month period.
Presence of Associated Symptoms:
Alongside the excessive worry, individuals with GAD may experience a range of physical and
psychological symptoms, including restlessness, fatigue, irritability, muscle tension, difficulty
concentrating, and sleep disturbances.
These symptoms are often manifestations of the underlying anxiety and contribute to the
individual's distress and impairment in functioning.
Difficulty Controlling Worry:
Individuals with GAD find it challenging to control their worry, even when they recognize that it
is excessive or unreasonable.
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Attempts to suppress or manage the worry may be ineffective, leading to increased distress and
preoccupation with anxious thoughts.
Significant Distress or Impairment:
The anxiety and worry associated with GAD cause significant distress or impairment in various
areas of functioning, including social, occupational, academic, or other important domains of
life.
Individuals may experience difficulties in relationships, work or school performance, and daily
activities due to the impact of their anxiety symptoms.
In Katy's case, her symptoms of excessive worry about attending school, fear of separation from
her mother, physical complaints (headaches, stomachaches), sleep disturbances, and avoidance
behaviors align with the DSM-5 criteria for Generalized Anxiety Disorder (GAD). These
symptoms have persisted for at least two weeks and have led to significant distress and
impairment in her ability to attend school and engage in daily activities. Thus, based on the
DSM-5 criteria, a provisional diagnosis of GAD is justified for Katy.
Characteristics of Generalized Anxiety Disorder (GAD):
GAD is characterized by persistent and excessive worry and anxiety about various aspects of
life, including school, family, health, and daily activities.
Children with GAD often experience difficulty controlling their worry, even when they
recognize that it is disproportionate to the actual threat.
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The worry associated with GAD is often accompanied by physical symptoms such as
restlessness, fatigue, muscle tension, difficulty concentrating, irritability, sleep disturbances, and
gastrointestinal discomfort.
Individuals with GAD may also exhibit avoidance behaviors, including avoidance of situations
or activities that trigger their anxiety.
DSM-5 Diagnostic Criteria for GAD:
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5),
the diagnostic criteria for GAD include excessive anxiety and worry about various events or
activities, occurring more days than not for at least six months.
The anxiety and worry are associated with three or more of the following symptoms: restlessness
or feeling keyed up or on edge, being easily fatigued, difficulty concentrating or mind going
blank, irritability, muscle tension, and sleep disturbances.
The anxiety, worry, or physical symptoms cause clinically significant distress or impairment in
social, occupational, or other important areas of functioning.
Risk Factors and Etiology:
The development of GAD is thought to involve a combination of genetic, environmental,
neurobiological, and psychological factors.
Family history of anxiety disorders or mood disorders may increase the risk of developing GAD.
Traumatic experiences, chronic stress, parenting styles, and temperament may also contribute to
the development of GAD in children.
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Neurobiological factors, including abnormalities in neurotransmitter systems (e.g., serotonin,
gamma-aminobutyric acid), may play a role in the pathophysiology of GAD.
Treatment Approaches for GAD:
Treatment for GAD often involves a multimodal approach, including psychotherapy,
pharmacotherapy, and lifestyle interventions.
Cognitive-behavioral therapy (CBT) is considered a first-line treatment for GAD and focuses on
identifying and challenging maladaptive thought patterns and behaviors associated with anxiety.
Medications such as selective serotonin reuptake inhibitors (SSRIs), serotonin-norepinephrine
reuptake inhibitors (SNRIs), and benzodiazepines may be prescribed to alleviate symptoms of
anxiety and facilitate the effectiveness of therapy.
Lifestyle interventions, including stress management techniques, relaxation exercises, regular
exercise, healthy sleep habits, and dietary modifications, may also be beneficial in managing
symptoms of GAD.
In Katy's case, her symptoms of excessive worry, physical complaints, sleep disturbances,
avoidance behaviors, and impairment in functioning align with the diagnostic criteria for
Generalized Anxiety Disorder (GAD). A comprehensive assessment by a mental health
professional is necessary to confirm the diagnosis and develop an individualized treatment plan
tailored to Katy's specific needs and circumstances. Collaboration with Katy's family, school
personnel, and other relevant stakeholders is essential to provide comprehensive support and
address underlying factors contributing to her anxiety symptoms.
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Cognitive Behavioral Therapy (CBT) is a form of psychotherapy that is highly
recommended for treatment of SAD. This treatment approach involves helping children to learn
how to understand and manage their distress and fears (Lebowitz, 2019). A specialized form of
CBT known as exposure therapy can be tailored to meet the needs of the child. This form of
CBT involves exposing the child to separation in small and controlled levels that help them
reduce the anxiety in bits over a period of time (West, Wilbanks & Suveg, 2020). The process of
CBT also involves helping the children to develop coping skills that they can rely on when at
times when they become anxious. Children are taught how to recognize anxious feelings or
triggers of fear as well as any associated thought patterns which may contribute to fear. This is
couple with training strategies on how to manage such feelings, emotions and thoughts.
Family therapy involve incorporating parents and family members into the process of
treatment in order to improve the outcome. Parents and siblings are taught ways in which they
can interact with the child through tease out patterns to help the child learn how to cope without
them. Additionally, they are taught useful strategies which they can use to help the children at
times of anxiety (Lavallee & Schneider, 2019).
Play therapy involves helping children learn how to develop and process their feelings
and emotions, as well as learn how to manage and cope with them. This is because children may
not understand or connect the dots between feelings, thoughts and also actions. As such, they
may not be able to interpret what they are required to do when fears come their way (Lebowitz,
2019). Relaxation training can be used for children and adolescents in order to reduce the effects
of separation anxiety disorder. This may include guided relaxation, deep breathing as well as
progressive muscle relaxation which helps the children to self-soothe anxious moments.
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In Katy's case, several psychiatric scales and assessment tools can be valuable for evaluating her
symptoms and gathering information from both Katy and her parents. Here are some tools that
might be used:
Screen for Child Anxiety Related Disorders (SCARED):
The SCARED is a self-report questionnaire used to assess symptoms of anxiety disorders in
children and adolescents.
It consists of 41 items that assess various domains of anxiety, including generalized anxiety,
separation anxiety, social anxiety, panic disorder, and school phobia.
The SCARED can provide insights into the severity and nature of Katy's anxiety symptoms.
Children's Depression Inventory (CDI):
The CDI is a self-report questionnaire designed to assess depressive symptoms in children and
adolescents aged 7 to 17 years.
It consists of 27 items that assess various aspects of depression, including negative mood,
interpersonal problems, ineffectiveness, and anhedonia.
The CDI can help assess whether Katy is experiencing symptoms of depression in addition to her
anxiety.
Pediatric Anxiety Rating Scale (PARS):
The PARS is a clinician-rated scale used to assess the severity of anxiety symptoms in children
and adolescents.
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It consists of 50 items that assess anxiety symptoms across multiple domains, including
generalized anxiety, separation anxiety, social anxiety, and physical symptoms of anxiety.
The PARS allows the clinician to systematically evaluate the frequency and severity of Katy's
anxiety symptoms.
Child Behavior Checklist (CBCL):
The CBCL is a widely used parent-report questionnaire that assesses a broad range of emotional
and behavioral problems in children and adolescents.
It consists of items that cover various domains, including internalizing problems (e.g., anxiety,
depression) and externalizing problems (e.g., aggression, conduct problems).
The CBCL provides valuable information about Katy's behavior and emotional functioning from
her parents' perspective.
Pediatric Quality of Life Inventory (PedsQL):
The PedsQL is a self-report and parent-report questionnaire designed to assess health-related
quality of life in children and adolescents.
It consists of items that assess physical, emotional, social, and school functioning.
The PedsQL can provide insights into the impact of Katy's anxiety symptoms on her overall
quality of life and functioning in different domains.
Structured Clinical Interview for DSM-5 (SCID):
The SCID is a semi-structured interview used to make reliable psychiatric diagnoses based on
DSM-5 criteria.
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It involves a systematic assessment of symptoms, duration, and impairment, allowing the
clinician to formulate accurate diagnoses.
The SCID can be used to gather detailed information from both Katy and her parents about her
symptoms and mental health history.
These assessment tools can help guide the diagnostic process, monitor treatment progress, and
inform the development of an individualized treatment plan tailored to Katy's specific needs and
circumstances. It's important to consider cultural and developmental factors when administering
these tools and interpreting the results to ensure a comprehensive understanding of Katy's
presenting concerns.
Screen for Child Anxiety Related Disorders (SCARED):
The SCARED is a validated self-report questionnaire designed to assess anxiety symptoms in
children and adolescents aged 8 to 18 years.
It consists of 41 items covering various anxiety domains, including generalized anxiety,
separation anxiety, social anxiety, panic disorder, and school phobia.
Each item is rated on a 3-point scale (0 = Not true or hardly ever true, 1 = Somewhat true or
sometimes true, 2 = Very true or often true).
The SCARED provides a quantitative measure of anxiety symptoms and helps identify specific
anxiety disorders present in the individual.
Children's Depression Inventory (CDI):
The CDI is a widely used self-report questionnaire designed to assess depressive symptoms in
children and adolescents aged 7 to 17 years.
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It consists of 27 items covering various aspects of depression, including negative mood,
interpersonal problems, ineffectiveness, and anhedonia.
Each item is rated on a 3-point scale, with higher scores indicating more severe depressive
symptoms.
The CDI provides valuable information about the severity and nature of depressive symptoms
experienced by the individual.
Pediatric Anxiety Rating Scale (PARS):
The PARS is a clinician-rated scale used to assess the severity of anxiety symptoms in children
and adolescents.
It consists of 50 items covering multiple domains of anxiety, including generalized anxiety,
separation anxiety, social anxiety, and physical symptoms of anxiety.
Each item is rated on a 5-point scale, with higher scores indicating more severe anxiety
symptoms.
The PARS allows clinicians to systematically evaluate the frequency and severity of anxiety
symptoms and monitor treatment progress over time.
Child Behavior Checklist (CBCL):
The CBCL is a parent-report questionnaire that assesses emotional and behavioral problems in
children and adolescents aged 6 to 18 years.
It consists of items covering various domains, including internalizing problems (e.g., anxiety,
depression) and externalizing problems (e.g., aggression, conduct problems).
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Parents rate each item based on their child's behavior over the past six months.
The CBCL provides comprehensive information about the child's emotional and behavioral
functioning from the parent's perspective.
Pediatric Quality of Life Inventory (PedsQL):
The PedsQL is a self-report and parent-report questionnaire designed to assess health-related
quality of life in children and adolescents aged 2 to 18 years.
It consists of items covering physical, emotional, social, and school functioning.
Respondents rate each item on a 5-point scale, with higher scores indicating better quality of life.
The PedsQL helps assess the impact of the child's health condition or symptoms on various
aspects of functioning and well-being.
Structured Clinical Interview for DSM-5 (SCID):
The SCID is a semi-structured interview used to make reliable psychiatric diagnoses based on
DSM-5 criteria.
It involves a systematic assessment of symptoms, duration, and impairment, allowing clinicians
to formulate accurate diagnoses.
The SCID can be administered by trained clinicians to gather detailed information about the
individual's symptoms, history, and mental health status.
These assessment tools play a crucial role in the evaluation and diagnosis of psychiatric disorders
in children and adolescents, providing valuable information for treatment planning and
intervention. They help clinicians gather comprehensive data, monitor treatment progress, and
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make informed decisions about the individual's care. It's important for clinicians to select
appropriate assessment tools based on the individual's age, developmental level, cultural
background, and presenting concerns to ensure accurate and effective evaluation.
Parents’ Help
Parents can help their children learn a number of things on how to cope and manage
anxious feelings and emotions while at home. In SAD treatment, parental involvement and
support is very crucial in help the child manger the feelings independently. The parent should
design a plan of making the child transition to school without much difficulties (Lebowitz,
2019). This may involve taking the child early to school and helping him/her play or exercise
before they begin classes. The parent can also help the child reframe his/her thoughts through
initiating positive thoughts to avoid the child developing fear (West, Wilbanks & Suveg, 2020).
It is also important for the parent to increase playtime, healthy sleep and downtime to help the
child rest well. The parent should also be able to help the child adjust to changes by informing
him/her any routine changes before time. The parent should also help the child through
empathizing with him/her and comment on progresses made.
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5. How would the typical symptom patterns and phases be manifested in children
this age? In adolescents?
Understanding how symptom patterns and phases manifest in children and adolescents with
anxiety disorders is crucial for accurate diagnosis and effective treatment. Here's how symptom
patterns and phases may manifest in each age group:
Children (Ages 6-12):
Symptom Patterns:
Children in this age group may exhibit a wide range of symptoms associated with anxiety
disorders, including generalized anxiety disorder (GAD), separation anxiety disorder (SAD),
social anxiety disorder (SAD), specific phobias, and panic disorder.
Common symptoms may include excessive worry, physical complaints (headaches,
stomachaches), irritability, restlessness, difficulty concentrating, sleep disturbances, avoidance
behaviors, and fear of separation from caregivers.
Children may express their anxiety through somatic complaints or behavioral issues rather than
explicitly verbalizing their worries.
Phases:
Early childhood (ages 6-8): Children may experience separation anxiety, fear of the dark, or
specific phobias related to animals or objects.
Middle childhood (ages 9-12): Anxiety symptoms may become more nuanced and may include
worries about school performance, social interactions, and family relationships.
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Phases may vary depending on developmental milestones, environmental stressors, and
individual temperament.
Adolescents (Ages 13-18):
Symptom Patterns:
Adolescents may experience symptoms of various anxiety disorders, including GAD, SAD,
social anxiety disorder, panic disorder, and specific phobias.
Symptoms may be similar to those seen in adults, including excessive worry, rumination,
physical symptoms (such as headaches, stomachaches), avoidance behaviors, and social
withdrawal.
Adolescents may also experience symptoms of depression alongside their anxiety, including
feelings of sadness, hopelessness, and loss of interest in activities.
Phases:
Early adolescence (ages 13-15): Adolescents may struggle with social anxiety, body image
concerns, peer relationships, and academic stress.
Mid-adolescence (ages 16-18): Anxiety symptoms may intensify as adolescents face increased
academic demands, college or career decisions, romantic relationships, and peer pressure.
Phases may be characterized by periods of heightened anxiety followed by periods of relative
stability, influenced by developmental changes, social contexts, and life events.
Cross-cutting Issues:
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Developmental Transitions: Both children and adolescents experience developmental transitions
that can exacerbate anxiety symptoms, such as starting school, transitioning to middle or high
school, puberty, family changes, and peer relationships.
Coping Mechanisms: Children and adolescents may employ various coping mechanisms to
manage their anxiety, including avoidance behaviors, reassurance-seeking, distraction, and social
withdrawal.
Risk Factors: Risk factors for anxiety disorders in children and adolescents include genetic
predisposition, family history of anxiety or mood disorders, adverse childhood experiences,
trauma, chronic stress, and environmental factors.
Understanding the typical symptom patterns and phases of anxiety disorders in children and
adolescents is essential for early identification, intervention, and support. Clinicians should
consider developmental factors, individual differences, and environmental influences when
assessing and treating anxiety disorders in these populations. Early intervention and targeted
interventions can help mitigate the impact of anxiety and promote resilience in children and
adolescents.
Children (Ages 6-12):
Symptom Patterns:
Children in this age group may struggle to articulate their emotions and may express anxiety
through physical complaints (such as stomachaches, headaches), behavioral changes, or
avoidance behaviors.
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Symptoms of anxiety disorders in children may include excessive worry about everyday events,
separation anxiety, fear of specific objects or situations (e.g., animals, darkness), and social
anxiety in peer interactions or school settings.
Children may exhibit clinginess, tearfulness, irritability, difficulty sleeping, restlessness, and
difficulty concentrating due to anxiety.
Phases:
Early Childhood (Ages 6-8): Children may exhibit separation anxiety, fear of strangers, and
reluctance to attend school. They may also experience specific phobias related to animals, the
dark, or other common fears.
Middle Childhood (Ages 9-12): Anxiety symptoms may become more complex and include
worries about academic performance, social acceptance, family relationships, and future events.
Children in this age group may experience stress related to school transitions or peer dynamics.
Adolescents (Ages 13-18):
Symptom Patterns:
Adolescents often have a more sophisticated understanding of their emotions and may articulate
their anxiety more clearly than younger children.
Symptoms of anxiety disorders in adolescents may include excessive worry about school
performance, social interactions, appearance, relationships, and future goals.
Adolescents may experience symptoms of generalized anxiety disorder (GAD), social anxiety
disorder (SAD), panic disorder, specific phobias, and obsessive-compulsive disorder (OCD).
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Physical symptoms such as headaches, stomachaches, muscle tension, fatigue, and sleep
disturbances are common manifestations of anxiety in adolescents.
Phases:
Early Adolescence (Ages 13-15): Adolescents may experience heightened self-consciousness,
social anxiety, and body image concerns. They may also navigate the challenges of transitioning
to middle or high school, forming new friendships, and exploring romantic relationships.
Mid-Adolescence (Ages 16-18): Anxiety symptoms may intensify as adolescents face academic
pressures, college or career decisions, increased autonomy, and peer influences. They may also
grapple with existential concerns and identity formation.
Cross-cutting Issues:
Comorbidity: Anxiety disorders commonly coexist with other mental health conditions such as
depression, attention-deficit/hyperactivity disorder (ADHD), and substance use disorders in both
children and adolescents.
Coping Strategies: Children and adolescents may employ various coping strategies to manage
their anxiety, including avoidance behaviors, seeking reassurance, engaging in relaxation
techniques, and seeking social support from peers or adults.
Family Dynamics: Family factors such as parental modeling of anxiety, overprotectiveness,
family conflict, and stressful life events can contribute to the development or exacerbation of
anxiety disorders in children and adolescents.
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Cultural Factors: Cultural norms, beliefs, and values may influence the expression and
interpretation of anxiety symptoms in children and adolescents, as well as attitudes toward
seeking help and accessing mental health services.
Understanding the nuanced presentation of anxiety disorders in children and adolescents is
essential for accurate assessment, diagnosis, and intervention. It allows clinicians, educators, and
caregivers to provide targeted support and interventions that address the unique needs and
challenges faced by young individuals experiencing anxiety. Early identification and intervention
can promote resilience, reduce impairment, and improve overall well-being in children and
adolescents with anxiety disorders.
Children (Ages 6-12):
Symptom Patterns:
Children in this age group often exhibit physical symptoms of anxiety, such as stomachaches,
headaches, muscle tension, fatigue, and restlessness.
Behavioral manifestations may include clinginess, avoidance of certain activities or situations,
temper tantrums, irritability, and difficulty concentrating.
Children may express their worries indirectly or through play, drawing, or storytelling rather
than explicitly verbalizing their concerns.
Phases:
Early Childhood (Ages 6-8): Separation anxiety is common during this phase, characterized by
distress when separated from caregivers. Children may also develop specific phobias, such as
fear of animals or the dark.
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Middle Childhood (Ages 9-12): Anxiety symptoms may become more complex and include
worries about academic performance, social acceptance, family relationships, and future events.
Children may experience stress related to transitions, such as starting a new school or moving to
a new neighborhood.
Adolescents (Ages 13-18):
Symptom Patterns:
Adolescents often experience a broader range of anxiety symptoms that resemble those seen in
adults, including excessive worry, rumination, intrusive thoughts, and physical discomfort.
Social anxiety becomes more prominent during adolescence, with concerns about peer
acceptance, public speaking, performance, and social interactions.
Adolescents may experience panic attacks characterized by sudden onset of intense fear or
discomfort, accompanied by physical symptoms such as palpitations, sweating, trembling, and
shortness of breath.
Phases:
Early Adolescence (Ages 13-15): Adolescents may struggle with identity formation, body image
issues, and social comparison. Anxiety about fitting in, making friends, and navigating peer
relationships is common.
Mid-Adolescence (Ages 16-18): Anxiety symptoms may intensify as adolescents face academic
pressures, college or career decisions, romantic relationships, and family conflicts. Existential
concerns about the future and personal identity may arise.
Cross-cutting Issues:
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Comorbidity: Anxiety disorders frequently coexist with other mental health conditions such as
depression, ADHD, obsessive-compulsive disorder (OCD), and substance use disorders in both
children and adolescents.
Environmental Stressors: Stressful life events, trauma, family conflict, peer pressure, academic
demands, and societal expectations can exacerbate anxiety symptoms in children and
adolescents.
Resilience Factors: Protective factors such as supportive relationships, effective coping skills,
healthy lifestyle habits, access to mental health services, and positive school environments can
enhance resilience and buffer against the impact of anxiety.
Developmental Context: Understanding the developmental stage and cultural context is essential
for assessing anxiety symptoms in children and adolescents. Cultural beliefs, values, and family
dynamics influence the expression and interpretation of anxiety symptoms.
By recognizing the nuanced presentation of anxiety disorders across different developmental
stages, clinicians, educators, and caregivers can provide tailored interventions that address the
unique needs and challenges of children and adolescents. Early identification and intervention,
along with a supportive environment, promote resilience and well-being in young individuals
experiencing anxiety.
Children (Ages 6-12):
Symptom Patterns:
Children in this age group often exhibit physical symptoms of anxiety, such as stomachaches,
headaches, muscle tension, fatigue, sweating, and restlessness.
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Behavioral manifestations may include avoidance of certain activities or situations, excessive
reassurance seeking, clinging to caregivers, temper tantrums, withdrawal from social
interactions, and difficulty concentrating in school.
Cognitive symptoms may include excessive worry about separation from caregivers, fear of
harm or danger, perfectionism, and catastrophic thinking about potential negative outcomes.
Phases:
Early Childhood (Ages 6-8): Separation anxiety is common during this phase, characterized by
distress when separated from primary caregivers or reluctance to attend school. Children may
also develop specific phobias related to animals, the dark, or medical procedures.
Middle Childhood (Ages 9-12): Anxiety symptoms become more complex and may include
worries about academic performance, social acceptance, peer relationships, family dynamics, and
future events. Children may experience stress related to transitions such as moving to a new
school, parental divorce, or changes in family structure.
Adolescents (Ages 13-18):
Symptom Patterns:
Adolescents often experience a wider range of anxiety symptoms, which may resemble those
seen in adults. These include excessive worry, nervousness, irritability, difficulty concentrating,
sleep disturbances, muscle tension, and restlessness.
Social anxiety becomes more pronounced during adolescence, with concerns about peer
rejection, public speaking, performance anxiety, dating, and social interactions both in person
and online.
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Adolescents may also experience panic attacks characterized by sudden onset of intense fear or
discomfort, accompanied by physical symptoms such as palpitations, sweating, trembling,
shortness of breath, and a sense of impending doom.
Phases:
Early Adolescence (Ages 13-15): Adolescents may struggle with identity formation, body image
concerns, and social comparison. Anxiety about fitting in, making friends, and navigating peer
relationships is common. They may also experience academic stress and pressure to succeed.
Mid-Adolescence (Ages 16-18): Anxiety symptoms may intensify as adolescents face increasing
academic demands, college or career decisions, romantic relationships, family conflicts, and
societal expectations. Existential concerns about the future, personal identity, and independence
may arise.
Cross-cutting Issues:
Comorbidity: Anxiety disorders often coexist with other mental health conditions such as
depression, ADHD, substance use disorders, and eating disorders in both children and
adolescents.
Environmental Influences: Stressful life events, trauma, family conflict, peer pressure, academic
pressure, social media, and societal stressors contribute to the development and exacerbation of
anxiety disorders in children and adolescents.
Resilience Factors: Protective factors such as supportive relationships, effective coping skills,
positive reinforcement, access to mental health resources, healthy lifestyle habits, and
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involvement in extracurricular activities can enhance resilience and mitigate the impact of
anxiety.
Developmental Considerations: Understanding the developmental context, individual
temperament, cultural factors, and family dynamics is essential for assessing and treating anxiety
disorders in children and adolescents effectively.
By recognizing the nuanced presentation of anxiety disorders and considering the developmental
stage and individual differences, clinicians, educators, and caregivers can provide appropriate
interventions and support to help children and adolescents manage their anxiety and improve
their overall well-being. Early identification and intervention play a crucial role in preventing
long-term impairment and promoting resilience in young individuals.
Typical Symptom Patterns
Children and adolescents have similar symptoms of separation anxiety disorder.
Generally, children have separation anxiety when they are separated from the people they have
developed attachment with. The fears are common between 8 and 14 months but if they become
persistent and progressive, they become separation anxiety disorder (Lavallee & Schneider,
2019). Adolescents beyond 6 years may develop SAD if the anxiety goes beyond four weeks.
Common experiences include worry about separation, death or harm of a loved person, worry
about something bad happening to the child, fear of being alone or having nightmares and lack of
sleep (Lebowitz, 2019). Other physical symptoms include nausea, fatigue, muscle aches or quick
breathing.
In the treatment intervention for Katy, medication may not be used since the condition
has not worsened beyond treatment by normal psychotherapy. If the psychotherapy processes are
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followed well, Katy will manage the anxious feelings and lead a normal life. School-based
intervention for Katy may involve the parents taking the child early to school, spending some
time with child playing in the school compound, as well as encouraging the teacher to develop a
close relationship with child in order to remove most of the fears (Lebowitz, 2019). The teacher
should be able to develop attachment with the child by spending most of the time with her as
well as training her how to manage and cope with the condition.
Implications for Family
The family and parents of Katy should play a key role in the treatment intervention in
order to ensure Katy overcomes the anxious emotions. This will entail the parents helping the
child to keep all the appointments with the psychiatrist (Lebowitz, 2019). This should be done in
a way that the child realizes the support being given by the parent. The parent should encourage
the child to become more independent in order to overcome feelings of fear (Lavallee &
Schneider, 2019). The family should be able to recognize anything that may cause fear to the
child and plan ahead in order to prepare the child to transition successfully. The parent should
work closely with the healthcare professional as well as school in order to develop effective
treatment plan. The parent should reassure the child of their support towards the healing process.
Additionally, the parents should reach out for support from local community health care
providers in order to receive relevant support (West, Wilbanks & Suveg, 2020).
The health status of Katy’s mother is one of the triggers of anxiety and fears experienced
by Katy. It is important for the mother to reassure Katy of her health and stay close to her in
order to remove the fears that Katy has (West, Wilbanks & Suveg, 2020). This kind of therapy is
known as family therapy. It is crucial that this trigger be dealt with by Katy’s mother through
offering support in her healing journey. For further support in the treatment intervention, Katy’s
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family should seek help and support from local community professionals who deal with mental
health (Lebowitz, 2019). This will help the child to integrate properly with the community
through forming helpful relationships which enable her overcome the separation anxiety. Other
treatment resources in the area include healthcare institutions that deal with mental health,
volunteers or nurses in the community who run mental health groups, as well as private hospitals
that offer mental health services.
The worries that may come about in treatment procedure touches on the fact that Katy’s
condition may be biological. Katy may have inherited this kind of condition from her mother and
therefore it may take a mix of treatment procedures to deal with Katy’s condition. If the
condition arises again, the treatment will demand a combination of psychotherapeutic and
pharmacological treatment interventions (Lebowitz, 2019). This will help in suppressing any
hormones that may cause anxiety to Katy.
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Reference
Lavallee, K. L., & Schneider, S. (2019). Separation Anxiety Disorder.HPediatric Anxiety
Disorders, 151–176. doi: 10.1016/b978-0-12-813004-9.00008-6
Lebowitz, E. R. (2019). Child with Separation Anxiety Disorder.HAddressing Parental
Accommodation When Treating Anxiety In Children, 117–126. doi: 10.1093/med-
psych/9780190869984.003.0011
West, K. B., Wilbanks, J., & Suveg, C. (2020). Exposure therapy for separation anxiety
disorder.HExposure Therapy for Children with Anxiety and OCD, 143–163. doi:
10.1016/b978-0-12-815915-6.00007-x
