Child Anxiety & Depressive disorders Flashcards
Classification of childhood anxiety disorders and DSM-5
- DSM tends to use the same diagnostic categories and criteria for children as adults rarely uses seperate diagnoses for children
- Many diagnoses have low validity in children
- Limited validity of differentiation among anxiety disorers in children
- DSM no longer has a chapter called “Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence.”
- Instead the organisational structure of disorders in DSM-5 is organised by life-span development
When do we diagnose?
- Anxiety Continuum
- Not qualitatively different from normal anxiety
- Similar physical/cognitive/behavioural experience
Anxiety disorder is likely only if the fear is
- Developmentally inappropriate (e.g., seperation anxiety typically seen in 1-2 yrs of age is seen in Early primary)
- Intense or pervasive
- Causes substantial impairment in functioning
Why do we need to understand normative child behaviour?
- To understand maladaptive behaviour, we need to understand normative behaviour
- Needs to be placed in context of milestones and sequences in development
- What is “normal” changes with time
Infant: loss of support/falling; Height; Sudden and unexpected stimuli (e.g., loud sounds, bright lights)
1-2 years: Seperation from parents; Strangers; Toileting activities; Being injured
Preschool: The dark; Imaginary creatures; Animals
Early primary: Physical safety; The dark, Small animals; Natural events (e.g., storms, earthquakes)
Late primary:
Concrete/Physical fears: Physical injury; Medical procedures; Performance (e.g., public speaking, exams); economic, political and environmental disasters
Adolescence:
Social fears: Being disliked, rejected or criticised by peers
17-21:
Personal fears: Loss of close relationships; Isolation; Failing to achieve personal goals
Outline the risk factors for the development of childhood anxiety
Temperament/Genetic component:
Heritability (tend to aggregate in families across generations, studies suggest a role for genetic transmission).
- Genes may confer general predisposition to anxiety and mood disorders
- Specific vulnerabilities,
- Some argue anxiety is broad and genetics link to more specific biological traits (e.g. information processing style, temperament).
- Temperament is the fundamental way the child interacts with the world, largely genetically determined (some temperemental styles confer greater risk of developing anxiety disorders)
Behavioural inhibition (Inhibited temperament)
- Tendency to withdraw, avoid or respond fearfully to new situations
- Most widely described risk factor for development of anxiety
- Predictor in development of GAD, separation anxiety disorder, social anxiety disorder, panic disorder
- Social anxiety disorder- BI increase risk more than sevenfold (Clauss & Blackford, 2012)
Learning:
- Early experiences
- Adversity
Family Processes:
Parenting: Certain parenting styles linked to increase risk of developing anxiety disorder
- Overprotection/Over control: child never exposed to experiences to learn that the world is mostly safe and that they can cope
- Reinforcement of anxious behaviours: attention/special treatment, allowing/encouraging avoidance, over provision of reassurance
- Listening to parents, watching and modelling their behaviours
- Underscores the importance of involving parents in treatment
- Negative/critical (low warmth, rejection), insecure parent-child attachment styles
Social learning
Learning > conditioning of fear
- Negative early experiences
- Negative interaction with dog > dog is unsafe > fear of dogs > may generalise
Dental experiment showed that child’s fears were more associated with subjective ratings of distress rather than objective distress (pain level)
Coercive process/attachment styles
Learning- Adversity
Acute and chronic stressful life events/adversity >risk factors development of anxiety
Particularly events involving threat (peer victimisation, dangerous living conditions, death of loved one, physical/sexual abuse)
- Early adversity predicts anxiety more than depression
- Formation of beliefs about the world > perception of threats
Disorders specifically relevant to childhood?
Separation Anxiety Disorder
Selective Mutism: Consistent failue to speak in specific social situations in which there is an expectation for speaking
- May include excessive shyness, fear of social embarrassment, clinging, compulsive traits, negativism, temper tantrums, or mild oppositional behaviour
- May result in social impairment
- As children with selective mutism mature -> may face increasing social isolation
- May suffer academic impairment
- Severe impairment in school and social functioning
Treatment of childhood anxiety
Seperation Anxiety Disorder
- CBT treatment of choice
- Doesn’t tend to be investigated alone
- Inclusion of parents in treatment is emphasised
- Psychoeducation: especially for parents - need to learn about the impact of own behaviour on child’s anxiety
- Coping-skills training for children
- Graded exposure
- Reinforcement
Selective mutism
- Main treatment goal is to help children speak in situations they previously did not
- Behavioural treatments commonly used
- Treatments need to resolve anxiety in social situations through graded exposure and increase experience of speaking in social situations
Treating anxiety in general
CBT most empirically supported treatment
- Psycho-education
- Cognitive restructuring
- Exposure
- Importance of parent involvement
For parents:
- Reward brave behaviours
- Promote independence
- Avoid reassurance
- Control emotions
- Model coping skills
Research indicates we can prevent anxiety in children
- 136 families where parent met criteria for anxiety disorder
- Intervention targeted modifiable parent and child risk factors, CBT, recognising signs of anxiety, parenting strategies
- Incidence child anxiety = 31% control vs 5% intervention
- Effects sustained over 12 months
Child & Adolescent Depression- Features
- Spike in depression from child to adolescent years (12-17)
Period of substantial change (average age of puberty for girls @10, 12 for boys) - Physical
- Cognitive
- Emotional
- Social
MDD is the same classification for adolescents, exepct it can be irritable mood.
- Young children cannot describe how they feel
- May be harbinger of other conditions (bipolar disorder, alcohol, drugs, trauma).
Prevalence of MDD in child/adolescents?
Preschoolers: 1%
Primary school age children <13 years): 2%
Gender differences in MDD across children/adolescents?
Why?
Girls 2-3 times more likely to be depressed than boys during early-to-middle adolescence.
- Coping styles?
Specific vulnerability factors may become more prevalent in adolescence for girls.
- Higher stress exposure in young women
Influencers of MDD in children/adolescents?
- Heritability of depression
- Emerging evidence - contribution of genes
- Onset of puberty
- Neurodevelopmental remodeling
Temperament
- Heritable, stable, evident by childhood
- Emotionality
- Impacts depressive cognitive and memory biases
- Predicts first onset of MDD
Family factors
* Parental expectations
* Family problem solving
* Parent-adolescent relationship
* Maternal depression
Cognitive and interpersonal factors
Higher levels of depression in adolescence have been
associated with:
* Automatic thoughts
* Poor self esteem
* Hopelessness
* Helpless attribution style
* Ego-centrism and self-consciousness (e.g., Garber, Weiss &
Shanley, 1993)
Peer relationships
* Middle childhood and adolescence- peer relationships assume increasing importance
* Depressive symptoms may increase risk of peer victimisation and reduce peer acceptance
* Cognitive and biological factors are believed to interact with interpersonal factors
* 20% youth report being bullied at school
* Inflicting + receiving bullying
* Much higher rates among LGBTQIA+ groups
* Higher risk of depression and suicidal ideation
* Considered negative life event
Cyber bullying
* 20-40% adolescents experience cyber bullying
* Linked to depressive symptoms
Relationship between social media use and depression
Social media use and depression
* Higher depression associated with:
* time spent
* number of accounts,
* frequency of checking
* Problematic/addictive SM use
* Reciprocal relationship between SM use and depression
(Frison & Eggermont, 2017).
- Not only quantity, but quality
- Different types of SM use
- Public vs Private; Active vs Passive
- SM use linked to both adverse and positive mental health
effects - Depressed adolescents can successfully shift their use of
SM from negative to positive (Radovic et al., 2017). - Part of the problem….. part of the solution?
Psychological treatment for MDD
CBT
- Identifying mood > thoughts > behaviours
- Cognitive restructuring
- Challenging automatic thoughts/beliefs
- Psychoeducation/emotional regulation skills
- Family communication
IPT
- Related to loss, role conflict and interpersonal discord
- Focus is on interpersonal issues in significant relationships
1. Grief,
2. Interpersonal role disputes
3. Role transitions
4. Interpersonal deficits, and
5. Other family and relational problems
The main techniques used in IPT are (1) psychoeducation; (2) communication analysis; (3) encouragement of emotional expression; (4) role-playing; and (5) interpersonal problem
solving.
Exercise - lots of evidence on this now
RCTs demonstrate efficacy of IPT-A as a treatment for adolescent depression
