Anxiety Disorders Flashcards
Compare and contrast the core symptoms of 2 anxiety disorders
Similarities- SAD and SP
Excessive worry causing sig impairment across school, social and other important domains
Both marginalize them from their peers, friendship groups and other related activities however the peer is different- one of judgement or separation
Both interfere with academic performance and age requires academic level
Both have similar somatic complaints and comorbid depression
Both have exposure for tx
Different
- SAD before age 14, whereas SP more common in adolescence
Comment on the comorbidity of anxiety disorders and depression in children
Strauss et al (1988)- amongst 106 outpatient children 28%, later studies up to 50% with more severe symptoms in comorbid group.
Research shows dev progression of anxiety disorders proceeding depression in adolescence.
Perceived hopelessness and lack of control increases risk of depression
Relationship between negative affect and physiological arousal
Childhood anxiety is neurobiological- discuss
Child of anxious parent 7x more likely to be anxious
30% genetics, 20% shared environment, and 50% other
ANS- more responsive and takes longer to habituate
HPA activity from neurotransmitter studies show increased noradrenaline activity and increased serotonin action Response to medication
Temperament-biological predisposition
Assessment informs 3 decisions
- Identification
- Triage treatment planning
- Outcome assessment
Assessment methods for anxiety include…
Interviews
Observational methods eg Behavioural Avoidance Test
Physiological assessment eg HR, galvanic skin response
Case conceptualisation
Compare the psychometric properties and clinical utility of 2 questionnaires:
The State Trait Anxiety Inventory for Children (STAIC) = 20 iteams measuring state anxiety and 20 measuring trait anxiety on a 3 pt rating scale.
Internal consistency reliability = .8
Test re-test reliability only .65-.7 (mod) over 6 wks, q’s re what it’s actually measuring
Limited validity - difficult for young children to reflect and compare usual feelings to how they’re feeling now
Easy to administer and score therefore widely used
Standardisation from 1551 primary school children in grades 4-6 (limiting)
Multidimensional Anxiety Scale for children (MASC) similar length, 39 items, 8- 19 yrs
Uses a 4 pt scale to measure overall severity of anxity and to discriminate between the expression of anxiety ie in particular domains including separation anxiety/phobias, GAD, Social anxiety, OCD
Scale more complex than STAIC with four main syndrome areas- physical, harm avoidance, social anxiety and panic and subscales measuring tension and somatic symptoms, anxious coping and perfectionisms (harm avoidance) and performance anxiety/humiliation (social anxiety)
The measure is well normed with raw scores with raw scores converted to T scores for age and gender profiles
Very good internal consistency (for self report q) and easy to administer
Similar to STAIC issues with validity but is well normed- one of the better measures
Standardised norms from 2698 children and adolescents
How does a case formulation assist planning and implementing interventions w childhood anxiety
Guides assessment Explains interrelationships between symptoms and their explanatory mechanisms Links symptoms Improves collaborative work Predicts obstacles Facilitates dealing with lack of progress Draw on CB and emotional theories Basis for dev tax plan Includes 5 Ps 5th = prognostic factors
Describe the main elements of CBT of social phobia in childhood
Exposure= in vivo and imaginal= flooding or implosion (imaginal exposure with hypothetical meaning) or systematic desensitisation (includes pairing eg muscle relaxation w exposure tasks)
NB child needs to form basis that stimulus is not intrinsically dangerous
CT = identify negative self talk eg comic bubbles, then consider replacing
= attribution retraining eg. Distinguish internal vs external, global vs local, stable from unstable. Then entertain alternatives and test them
Includes self monitoring and self instructions
Psychoeducation (child and parent) + presentation of case formulation
Behaviour management- reinforcement encourages learning of new skills to confront anxieties, parents taught positive and negative consequences to encourage approach and discourage avoidance
Behaviour activation- increase pleasant events and realise their life is not full of anxiety
Modelling (live or symbolic)
Problem solving- realise problems aren’t catastrophic or unimaginable
- description, possible solutions, evaluate options, decide, evaluate and reflect
Emotion regulation = recognise, label and self monitor, awareness = first step
Relaxation training = PMR and imagery (often used to prepare for exposure)
Describe the factors assumed to contribute to traumatic stress disorders in children
Event- experienced, witnessed or learnt… Risk and resilient factors
30% fully recover, 40% mild, 20% moderate, 10% severe
- child = thoughts about self, event, works and future + physiological + avoidance (prevents fear network from being processed) + younger +temperament + female + proximity of trauma, predictability, post event separation, parent response
- child’s family, biological hx
- child’s environment = minimal social support, minimal coping, exposure to previous trauma,
What are the five components of CBT for a child with PTSD?
Psychoeducation Anxiety reduction techniques Cognitive therapy Exposure Relapse prevention
Critically evaluate the TSCC
Strong reliability and validity
2 validity scales- under responsiveness (.85) and hyper responsiveness (.66)
Norms for large pop (3008 children)
Internal consistence (range from .77 to .89)
Reasonable convergent, discriminate and predictive validity
Scores are tx responsive, increase with more severe trauma and higher in samples of children with traumatic histories
