Anxiety Flashcards
Prevalence
6-15%
Types of early onset anxiety?
Separation anxiety disorder and specific phobia more common
All types of anxiety Disorders?
- separation anxiety disorder (SAD)
- panic disorder (PD)
- agoraphobia
- generalized anxiety disorder (GAD)
- social phobia/social anxiety disorder
- specific phobia
- obsessive-compulsive disorder (OCD)
- Post traumatic stress disorder (PTSD)
- Acute stress disorder
Separation Anxiety Disorder
only true childhood anxiety
- essential features –> excessive anxiety and fear concerning separation from home or from those to whom the child is attached (e.g. parent/caretakers)
- must be inappropriate for child’s age (separation anxiety normal from 7mo to 6 years).
- 3/8 symptoms to qualify
- last for 4 weeks
- must have clinically significant distress or impairment
- report somatic complaints, drop out of activities
- friendships and academics may be compromised because child may want to leave class.
- prevalence rates 2 - 12.9% (more like 5%)
- more common in females
- 80% natural remission (not stable)
Generalized Anxiety Disorder (GAD)
- previously known as overanxious disorder
- Core symptoms: excessive and uncontrollable worry about multiple topics that lasts at least 6 months.
- need to differentiate between other anxiety disorders
- worry more prevalent in older children
- younger children worry more about physical well-being, whereas older children worry more about their behavioral competence, social evaluation, and psychological well-being.
- different comorbidity patterns
- younger children –> separation concerns and ADHD
- older children –> major depression and specific phobias
- disturbing dreams
- headaches, stomachaches, muscle tension, sweating, and trembling are common
- community studies 2 - 19%
- clinical studies 20-70%
- general clincial population 5-10%
Social Phobia
- Core features: persistent fear of one or more social or performance situations in which the person fears that embarrassment may occur.
- put in a social or performance situation, the person has an immediate anxiety panic attack
- higher levels of depressed mood
- lower perceptions of cognitive competence and higher trait anxiety, with higher el-reported state anxiety during an evaluative task.
- impaired social skill (oppositional about going to school)
- .5 - 2.8% of youth meet criteria
- vast majority of youth with social phobia, up to 92%, meet criteria for the generalized type.
- generalized form
1. earlier onset
2. greater impairment in functioning
3. higher risk for the development of comorbid conditions
4. greater likelihood of earlier inhibited temperament or familial adversities. - onset usually in early adolescence (age 11-12_
- clinic samples 15-25%
Obsessive-Compulsive Disorder
- core features: recurrent and intrusive obsessions and compulsions that are time consuming (Greater than 1 hour per day) and cause marked distress for the child or significant functional impairment.
- difference between child and adult condition is that DSM does not require child to realize that his or her obsessions or compulsions are excessive or unreasonable.
- obsessions are mental and compulsions are behaviors.
- comorbid anxiety and depression (more common in older) are most common
- early onset risk of ADHD, specific phobia, GAD, and separation anxiety
- higher incidence of tourettes
- 1-2% of children meet DSM
- age of onset 7 to 10
- more common in males at a younger age
Specific Phobia
core features: persistent fear of certain objects or situations; the feared stimuli cannot include social situations, fear of having a panic attack or separation concerns.
- children may not recognize that the fear is excessive or unreasonable.
- common subtypes: animals, blood, injection/injury, and natural environment
- key to diagnoses is differentiating between normal fears that are common throughout childhood and the sever and impairing fears associated with specific phobia.
- rates 3- 10%
- more common in girls and younger children
Panic Disorder
- do they have cognitions that typify panic disorder
- defined by occurrence of at least one unexpected panic attack, followed by at least 1 month of any one of the following: persistent fear of experiencing future attacks, worry about the implications of the attack or its consequences, or a significant change in behavior related to the attacks.
- may display agoraphobia
- may be avoidant of school situations
- comorbid GAD, specific phobias, SAD, and depression.
- rate 0.5 to 5.3% (as high as 63%)
- higher for females
- peak age of onset occurs in late adolescence, but 10-20% of youth with panic disorder report first panic attack before age 10.
Conceptualization of anxiety
- Negative Affectivity (NA) –> stable, highly heritable general trait dimension
- Physiological hyperactivity (PH) –> certain dimensions (e.g. panic)
- general factors (i.e., negative affect and arousal) and specific syndromes (e.g. clinical disorders) are important in terms of informing the treatment of anxious psychopathology.
Tripartite Model of Anxiety and Depression (Clark and Wilson, 1991)
The tripartite model posits that anxiety and depression share a common component of negative affect, but can be differentiated by low positive affect associated with depression and high physiological hyperarousal associated with anxiety.
NA –> Depression and Anxiety
Low positive affect –> Depression
Physiological Hyperarousal (PH) –> Anxiety
Anderson and Hope (2006)
Evidence from a number of studies suggests that low PA is not only characteristic of depressive disorders and symptoms, as predicted by the tripartite model, but also is significantly associated with social phobia symptoms and diagnoses. Numerous investigations have found that NA seems to be more highly related to GAD compared to other anxiety disorders. Results furthermore have suggested that PH may be more significantly related to panic disorder versus other anxiety disorders. Overall, evidence thus indicates that the tripartite factors may not function similarly across all anxiety and depressive disorders.
Purpose of Assessment
Southam-Gerow and Chorpita (2006)
- Identify
- Treat
- Evaluate
Type of Assessment
- Questionnaires
- Structured Diagnostic Interview
- Observational Methods
- Physiological Assessment
Questionnaires (3 Types)
- trait
- Revised Children’s Manifest Anxiety Scale (RCMAS)
- State-Trait Anxiety Inventory for Children (STAIC) - multidimensional (focus on DSM IV categ.)
- Revised Child Anxiety and Depression Scale (RCADS)
- Screen for Child Anxiety REeated Emotional Disorders (SCARED) - syndromes (ex. social anxiety, OCD, worry, phobias/fears, and school refusal)
- Child Anxiety Sensitivity Index (CASI)
- Social Anxiety Scale (SAS)
- Fear Survey Schedule for Children (FSSC)
