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Psych Week 2 > ICL 9.4: Child Anxiety Disorders > Flashcards

ICL 9.4: Child Anxiety Disorders Flashcards

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1
Q

what is the difference between child vs. adult anxiety disorders?

A

anxiety disorders which occur in adults also occur in children and adolescents

many adults treated for anxiety disorders describe symptoms dating back to childhood

high comorbidity & overlap in anxiety disorders

DSM Criteria are same, clinical presentations vary; kids have more somatic symptoms like headache and stomachache

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2
Q

how prevalent are anxiety disorders in children?

A

lifetime prevalence in children & adolescents: 10-27 %

preschool children also commonly have anxiety disorders

the most prevalent overall in children & adolescents is specific phobias

most prevalent in children younger than 12 years is social phobia

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3
Q

what are the biological causes of anxiety disorders?

A
  1. 20-25% are children of parents with anxiety
  2. temperamental predisposition to anxiety is highly heritable
  3. behavioral inhibition
  4. physiological hyperarousal
  5. ss allele of serotonin transporter is thought to lead to decreased function and therefore increase predisposition for anxiety
  6. increased activation of amygdala and prolonged activation after exposure to anxiety trigger
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4
Q

what are the psychological causes of anxiety disorders?

A
  1. disorder attachment; neglectful and abusive caregivers

2. temperament; behavioral inhibition

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5
Q

what are the sociological causes of anxiety disorders?

A
  1. parental behaviors promoting anxiety

2. modeling, encouragement, etc.

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6
Q

what is the biological treatment for anxiety?

A
  1. Selective Serotonin Reuptake Inhibitors (SSRIs): Fluoxetine, Sertraline, Fluvoxamine
  2. Selective Norepinephrine Reuptake Inhibitor (SNRI): Duloxetine
  3. Serotonin 5-HT1A agonist: buspirone
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7
Q

what is the psychological treatment for anxiety?

A

cognitive behavioral therapy (CBT)

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8
Q

what are the social interventions that can be done to treat anxiety?

A
  1. school
  2. community
  3. parent
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9
Q

how do you chose the therapy for anxiety in a kid?

A

if it’s mild = psychotherapy

if it’s moderate = psychotherapy +/- medications

severe = psychotherapy + medications

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10
Q

what is the DSM5 criteria for separation anxiety disorder?

A

developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached; usually more one parent than the other

onset before age 18, duration at least 4 weeks

  1. anticipated or actual separation
  2. harm/losing of attachment figure
  3. untoward events (kidnapping/getting lost)
  4. being alone
  5. sleeping away from home
  6. nightmares
  7. physical complaints
  8. persistent reluctance or refusal to go to school or elsewhere because of fear of separation
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11
Q

how prevalent is separation anxiety disorder?

A

it’s the most prevalent anxiety disorder in kids under 12!

peak age is 7-9 years old

girls > boys

Heritability estimated at 73%

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12
Q

how do you treat separation anxiety disorder?

A
  1. CBT: Individual, parent, family therapy
  2. social interventions: return to school, education of parents & school staff
  3. medication: SSRI
  4. combined treatment (med + CBT): 80% response
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13
Q

what is the CAMS study?

A

looked at kids with anxiety and they used sertraline as an SSRI and they saw than sertraline with CBT was 80% response while mediation alone only had 55% response

so combination is the best

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14
Q

how prevalent is school refusal?

A

school refusal alone isn’t an anxiety condition

prevalence: 5% and common around academic transitions

most common in 5- 7 y.o. & 11 -14 y.o.

the longer the child is out of school, the more difficult to treat

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15
Q

what anxiety conditions can lead to school refusal?

A
  1. separation anxiety
  2. social phobia
  3. panic
  4. OCD
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16
Q

what non-anxiety factors can result in school refusal?

A

it’s usually multi factored:

  1. social, academic aspects
  2. overstimulation
    access to media/parents/supports
17
Q

how do you treat school refusal?

A

multimodal approach best: CBT+ SSRI+ School support

TCA, benzodiazepines not useful

must get child back to school, EMERGENTLY; home schooling is contraindicated

18
Q

what is the DSM5 criteria for selective mutism?

A

consistent failure to speak in specific social situations despite speaking in other situations that lasts for at least 1 month (NOT limited to the first month of school)

it interferes with educational/occupational/social

NOT due to a lack of knowledge of/or comfort with the spoken language (i.e. second language)

NOT due to communication disorder (e.g., stuttering) / other

19
Q

what is the prevalence of selective mutism?

A

0.03%- 1% depending upon setting and age

most common in 3-6 y/o (onset before 5 y/o)

Subgroup of social phobia (co-morbid dx*

20
Q

what are the contributing factors to selective mutism?

A
  1. speech delay
  2. trauma
  3. maternal anxiety/overprotection

complications from selective mutism can lead to learning and social problems

21
Q

how do you treat selective mutism?

A

CBT: Behavior modification by Graded Exposure, Rewards, family/school involvement

social intervention: others NOT to speak for patient

medication: SSRI (fluoxetine) treatment

22
Q

what does PANS stand for?

A

Pediatric Acute-Onset Neuropsychiatric Syndrome

23
Q

what is PANS?

A

PANS = Pediatric Acute-Onset Neuropsychiatric Syndrome

dramatic acute onset of neuropsychiatric symptoms like:
1. obsessions, compulsions, food restrictions

  1. depression, irritability, anxiety, difficulty with school work
  2. personality changes, emotional lability, sleep disturbance

it’s difficult to identify cause, but it’s important to treat underlying medical issue

24
Q

what is the cause of PANS?

A

cause unknown in most cases

can be due to:
1. infections: borrelia burgdorferi (Lyme disease), mycoplasma pneumonia, herpes simplex, common cold, influenza and other viruses

  1. metabolic disturbances
  2. other inflammatory reactions
25
Q

what does PANDAS stand for?

A

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection

it’s a subset of PANS

26
Q

what is PANDAS?

A

Pediatric Autoimmune Neuropsychiatric Disorder Associated with Streptococcal Infection, specifically GABHS

Strep throat, peri-anal strep, scarlet fever

Abrupt (2-3 days) onset OCD +/- Tic symptoms

27
Q

how do you treat PANDAS?

A

Antibiotics (5 to 21 days)

if Symptoms persist or are very distressing: SSRI + CBT

severe/chronic: Immunological therapy treatment (under research), specialized dietary restrictions

28
Q

is PANDAS real?

A

PANDAS is a controversial hypothesis. One prospective study over 2 years did not find any association between strep infection and OCD exacerbation in cases with PANDAS

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