Child Anxiety

Question 1

How many children are estimated to have a serious mental health problem?

Answer 1

1 in 5.

Question 2

How many children meet the criteria for diagnosis of a specific illness?

Answer 2

1 in 10.

Question 3

Of those children who meet the criteria for diagnosis of a mental illness, what percentage of parents understand they have a problem?

Answer 3

40%.

Question 4

Of those children who meet the criteria for diagnosis of a specific illness, how many receive help from proper services?

Answer 4

10%.

Question 5

Why is it important to identify children living with mental illness?

Answer 5

Because understanding their mental illness helps predict future mental health problems.

Question 6

When did child psychopathology emerge? What was is like before?

Answer 6

Child psychopathology emerged in the 80’s. Beforehand, clinicians just applied adult psychology to children.

Question 7

Why is it important to differentiate between adult and child psychology?

Answer 7

Because what is normal/maladaptive behaviour differs between children and adults.

Question 8

What is considered ‘normative’ behaviour for children?

Answer 8

It changes as children mature. Need to look at milestones and sequences of development.

Question 9

What are some normal achievements, common behavioural problems and clinical disorders of 0-2 year olds?

Answer 9

Normal achievements: eating, sleeping, attachments.
Behavioural problems: stubbornness, temper, toileting difficulties.
Clinical disorders: mental retardation, feeding disorders, autistic disorder.

Question 10

What are some normal achievements, common behavioural problems and clinical disorders of 2-5 year olds?

Answer 10

Normal achievements: language, toileting, self-care skills, self-control, peer relationships.
Behavioural problems: arguing, demanding attention, disobedience, fears, overactivity, resisting bedtime.
Clinical disorders: speech & language disorders, problems from child abuse/neglect, anxiety disorders (phobias).

Question 11

What are some normal achievements, common behavioural problems and clinical disorders of 6-11 year olds?

Answer 11

Normal achievements: academic skills & rules, rule-governed games, simple responsibilities.
Behavioural problems: arguing, inability to concentrate, self-consciousness, showing off.
Clinical disorders: ADHD, learning disorders, school refusal behaviour, conduct problems.

Question 12

What are some normal achievements, common behavioural problems and clinical disorders of 12-20 year olds?

Answer 12

Normal achievements: relations w/ opposite sex, personal identity, separation from family, increased responsibilities.
Behavioural problems: arguing, bragging.
Clinical disorders: anorexia, bulimia, delinquency, suicide attempts, drug & alcohol abuse, schizophrenia, depression.

Question 13

What are the three types of diagnoses in children? (some examples)

Answer 13

• ‘internalising’ disorders (anxiety & mood/depressive disorders).
• ‘externalising’ disorders (ODD, CD & ADHD).
• developmental disorders (autism & learning disorders).

Question 14

What is ODD, CD and ADHD?

Answer 14

ODD: oppositional defiant disorder.
CD: conduct disorder.
ADHD: attention deficit hyperactivity disorder.

Question 15

Give two reasons why ‘externalising’ disorders are easier to treat?

Answer 15

1. Easier to see than ‘internalising’ disorders.
2. Children with ‘internalising’ disorders often don’t cause trouble and are good students. Sometimes it is hard to see that they need help.

Question 16

What is a diagnostic issue when it comes to diagnosing an Anxiety disorder?

Answer 16

Anxiety disorders (within children) are hard to differentiate, it is difficult to know which disorder a child has, and what treatment they need.

Question 17

What do some experts believe about the prevalence of different Anxiety disorders within children?

Answer 17

That there are no finely-tuned, individual disorders - not even a differentiation between anxiety and depression.

Question 18

It is hard to diagnose a specific anxiety disorder within children, what are two reasons why this is?

Answer 18

1. There is no differentiation between anxiety disorders.

2. We don’t understand/see the differentiation.

Question 19

What is Separation Anxiety Disorder?

Answer 19

It is developmentally inappropriate and excessive fear or anxiety concerning separation from the attachment figures (involving three symptoms).

Question 20

Give a brief overview of the 8 symptoms listed for Separation Anxiety Disorder.

Answer 20

1. Distress when anticipating or experiencing separation.
2. Worry about losing major attachment figure (or harm).
3. Worry about experiencing an untoward event that causes separation.
4. Refusal to go out because of fear of separation.
5. Fear of being alone or without attachment figure in the home (or other settings).
6. Refusal to sleep away from home or without attachment figure.
7. Repeated nightmares involving separation.
8. Complaints of physical symptoms when anticipating separation.

Question 21

In Separation Anxiety Disorder, how long must the symptoms occur in children vs. adults?

Answer 21

Children: at least 4 weeks.
Adults: 6 months or more.

Question 22

What other disorders might present similar symptoms to Separation Anxiety Disorder?

Answer 22

Autism, psychosis, GAD.

Question 23

When are symptoms of Separation Anxiety Disorder normal?

Answer 23

In a child from 6/7 months to a child of 5 years or so.

Question 24

What is the 12-month/adolescent/adult prevalence of Separation Anxiety Disorder?

Answer 24

12-month: 4%.
Adolescent: 1.5%.
Adult: 1-2%.

Question 25

What is the main difference for diagnosis of Separation Anxiety Disorder in DSM-4 and DSM-5?

Answer 25

DSM-4, diagnosis could not be made after 18.

Question 26

It is possible (albeit rare) for adults to be diagnosed with Separation Anxiety Disorder. What is the common focus of anxiety?

Answer 26

On children or spouse.

Question 27

What are the gender differences in Separation Anxiety Disorder in community samples vs. clinical samples? Why the difference?

Answer 27

Community: more girls.
Clinical: equal, if not more boys.
This could be because boys will be taken for treatment for often as it is less socially acceptable for them to have separation anxiety.

Question 28

Why does Separation Anxiety Disorder often develop?

Answer 28

Due to stress, particularly if the child has behavioural inhibition.

Question 29

What plays a major role in the maintenance of Separation Anxiety Disorder?

Answer 29

Overprotective parents. If a child is scared of a novel situation and the parent tries to protect them from their fear, they are creating AVOIDANCE.

Question 30

What is behavioural inhibition? What factor makes behaviourally inhibited children more likely to develop Separation Anxiety Disorder?

Answer 30

It is the tendency to experience stress and withdraw from unfamiliar situations. Behaviourally inhibited children are more likely to develop SAD if they have overprotective parents.

Question 31

What is the difference between diagnosing children with Generalised Anxiety Disorder compared to adults?

Answer 31

Children only need one symptom, whereas adults need three (of six).

Question 32

What is the criteria for Generalised Anxiety Disorder? What are the 6 symptoms?

Answer 32

Excessive worry that the individual finds difficult to control. Symptoms are; restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance.

Question 33

GAD tends to be diagnosed later in life but those who are diagnosed say they have ‘always been worriers’. What does this mean about the diagnosis of childhood GAD?

Answer 33

It is either rare in children OR there is something wrong with the DSM criteria that means it is does not cover childhood GAD.

Question 34

What is one reason why is it so hard to understand Generalised Anxiety Disorder in children?

Answer 34

Because the child may not even know they are suffering and might not be able to verbalise it.

Question 35

What do adults tend to worry about compared with children?

Answer 35

Adults worry about events that are likely to happen, regardless of cost (social outcomes).
Children tend to worry about any event that has a high COST, regardless of likelihood (physical outcomes).

Question 36

In what ways do children and adults differentiate between ‘worries’ and ‘fears’?

Answer 36

Adults think more about their worries (not so much their fears).
Children tend to think about their fears AND their worries.
They don’t differentiate between the two (between what is realistic and what is unlikely to happen).

Question 37

Why are children more likely to overestimate ‘likelihood’?

Answer 37

Because they can’t emotionally regulate properly. When they fear something, instead of problem solving, or thinking rationally about the issue, their emotions get the better of them and they fear the event (even if it is extremely unlikely).

Question 38

What are some biological treatments for children with anxiety disorders?

Answer 38

SSRIs are predominantly used (mainly for OCD). However, in general medications tend to be avoided.

Question 39

What is the main psychological treatment for children with anxiety disorders? What are some components?

Answer 39

Cognitive Behavioural Therapy, that involves;

• psychoeducation, relaxation.
• cognitive restructuring (usually as a fun game).
• exposure (with a bribe to reduce unpleasantness).
• behavioural elements (positive reinforcement of coping behaviours).

Question 40

What plays a huge role when psychologically treating children with anxiety disorders?

Answer 40

Parental involvement (they learn to stop reinforcing the child’s avoidance behaviours).