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developmental year 2 > Lecture 8 - Atypical Development 1 - Childhood Anxiety > Flashcards

Lecture 8 - Atypical Development 1 - Childhood Anxiety Flashcards

1
Q

Define Atypical development

A

Child progresses through patterns of developmental milestones, when these are not met = atypical development

  • delay in the appearance of a specific behaviour
  • behaviour that is qualitatively different (e.g. not following gaze of CG)
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2
Q

What are the 6 categories we look for in atypical development?

A
  1. Motor
  2. Cognitive
  3. Language
  4. Social
  5. Emotional
  6. Behavioural
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3
Q

What are the 3 general types of development disorders

A
  1. Neurodevelopmental disorders (Autism, ASD etc)
  2. Depressive and anxiety disorders - depression, phobias, OCD
  3. Disruptive, impulse-control and conduct disorders: e.g oppositional defiant disorder, conduct disorder
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4
Q

Whats the distinction between internalising and externalising problems

A

Internalising - inward behaviour, internal psychological environment, harmful to oneself

  • e.g. anxiety dsorders
  • difficult to detect - often seen as less of an issue by teachers/ parents

Externalising - outward behaviour, acting on external environment, harmful and disruptive towards others
- E.g. conduct disorders - difficulty following rules, behaving in socially acceptable way

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5
Q

Give some examples of developmentally appropriate fears

A
  • some levels of anxiety are normsl
  • Infancy: stranger, loud noises
  • Early Childhood: Seperation, monsters, darkness
  • Middle Childhood: natural disasters, school
  • Adolescence: social factors, peers
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6
Q

Outline when anxiety and fear becomes atypical

A
  • Object/ content: not devlopmentally appropriate - do others their age show same thing?
  • Intensity: Disproprotionate to the threat
  • Frequency and Persistence: repeated not easily overcome
  • Impairment: avoidant behaviour, interfers with daily lfie
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7
Q

Give examples of Anxiety disorders

A
  • GAD
  • Specific phobias
  • Social anxiety
  • Seperation Anxiety
  • Panic disorder
  • PTSD
  • OCD
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8
Q

Outline Symptoms of GAD

A
  • excessive worrying = worrying about something that is either not present, or at a disproprotionate level
  • More days than not for 6 months
  • Most of waking hours are spent worrying
  • Difficulty to control the worry
  • Feelings are ever present, but content of worry may switch throughout day
DSM Symptoms:
• Restlesness/ on edge
• Easily fatigued
• Difficulty concentrating/ mind going blank
• irritability
•Muscle tension
• Sleep distrubance
  • the anxiety, worry or physical sumptoms cause distress or impairment in functioning
  • not caused by substance or other medical condition
  • Not better explained by another mental disorder
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9
Q

Outline the prevalence rates of Childhood anxiety

A

One of the most common in childhood

  • prevalence 2-5%
  • More common in girls
  • High co-morbidity (depression, anxiety, OCD)

1 in 10 may experience an anxiety disorder before the age of 18 and many more have subclinical anxiety

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10
Q

What is childhood anxiety associated with later in life?

A

Associated with poorer educational outcomes and mental health/ wellbeing in adulthood
- Adjustment, family relationships, life satisfaction, coping, stress, anxiety, substance abuse
- Anxiety/ depression as an adult
- Impacts on:
• Peer/ family relations
• Social/ emotional competence
•Education

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11
Q

Outline vulnerability factors and environmental factors for getting anxiety

A

Murray et al (2009), 2 broad categories of factors:

1. Vulnerability factors
• familial/ genetics
• Temperement
• Information processing
• Behavioural dispositions and information processing styles
  1. Environmental influences
    • Life events
    • Learning
    •Parenting factors (bidrectional)
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12
Q

Outline family aggregation and genetics as a vulnerability factor

A

Clustering of anxiety disorders within families

  • some limited evidence for heritability
  • Child with a parent whos got an anxiety disorder are more likely to develop an anxiety disorder

Interaction with env factors

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13
Q

Outline temperement: behavioural inhibition as a vulnerability factor

A
  • temperament = basic nature, how you respond to situations
  • behavioural inhibition = temperemental pattern that characterises how children behave in certain situations - avoidance, inhibitions of urges.
  • may be withdrawn in new situations/ avoid interactions
  • Fear, reticence and withdrawal in novel situations
  • Stable, doesnt really change over time
  • Association between behaviourally inhibited children and anxious parents
  • Bi predicts anxiety
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14
Q

Outline information processing as a vulnerability factor

A

There may be bias’ in informational processing that is causing anxiety. Two types of bias:
1. Attentional bias: more likely to attend to something that is threatening them in their environment

  1. Interpretation bias = more likely to assess situations as unrealistically threatening

Field & Lester (2010) - its normal to be fearful of things, but this should change during development, so it isnt feared, but in anxious people this may not happen so carry on being fearful. Levels of anxiety may interact with other factors - to create exaggerated fear

Anxious people more sensitive to fear, better at fear recognition

  • Can learn to control it
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15
Q

Outline life events and difficulties as an environmental influence on developing anxiety

A
  • Association - anxiety responses are classically conditioning
    •pairing a neutral stimulus with a traumatic event
  • Negative, uncontrollable events that can happen - traumatic
  • Risk factors:
    • Trauma, dodgy neighbourhoods, parental psychopathology (interactions are bad), parental drug use

Could be bi-directional - being anxious leads to more negative events

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16
Q

outline Goodyear et al (in murray) about truama and anxiety

A
  • Anxious children had experienced significantly more traumatic events in the 12 months before getting diagnosed
17
Q

Outline modelling and information transfer as an environmental influence on developing anxiety

A

Observing other person displaying anxiety

  • we learn from their reactions to stimuli
  • How mums express fearfulness has been linked to child anxiety
  • Phobias
  • They learn by getting information about threats
  • How information is presented to the child impacts on how a child responds to that stimuli
  • Vicarious acquisition (through observation)
  • Informational Acquisition (Communication) how information is discussed - how it is transmitted and who is transmitting it
  • Parents teach child about threats in environment - careful, that pan is hot
  • Catastrophising comments, fewer positive emotions
18
Q

Outline parental warmth and control as an environmental influence on developing anxiety

A
  1. lack of warmth - perceive environment and situation as hostile and threatening -leads to low self-worth and competence
    - shaping their environment through your parenting style
    X - self-report is worse than observations
  2. Overcontrol - fewer opportunities for exploration, being overprotective - limited competencey, mastery of skills, knowledge of their environment - tend to avoid challenges
    - lack of opportunity to develop their own autonomy/ independence
19
Q

Outline bi-directional effects as an environmental influence on developing anxiety

A

Behaviourally inhibited children + anxious mother = parenting styles that contribute to child anxiety

  • Mother more likely to be critical
  • Does the child develop anxiety because parents are more anxious? or is it because parents react in a certain way because they have an anxious child? or combination of the two
  • Anxious mums with BI children more likely to be critical of their child
  • these two things co-occuring likely to cause anxiety
20
Q

What did Weems (2008) argue?

A

Anxiety is a multi-component process

  • with each component being functional at healthy levels
  • But when dysregulated cause anxiety. They are experienced at out of proportion levels, and this causes anxiety:
  • Affective (e.g. being upset)
  • Behavioural (e.g. avoidance/ escaping)
  • Physiological (e.g. racing heart, dizziness)
  • Cognitive (e.g. rumination/ concentration difficulties)
21
Q

What are the biological and behavioural predispositions to emotion dysregulation associated with anxiety disorders (3 things)

A
  1. Difficulty controlling and understanding emotion
  2. Different physiological responses (linked to B.i)
  3. Different Sensitivity to distress

these 3 things are not at normal levels, and when they interact, they can cause various anxiety disorders

22
Q

Outline Matthews et al (2016) meta-analysis into emotional competence

A
  • 185 studies that looked at aspects of emotional competences (recognition, expression, regulation, understanding etc)
    Found:
    •Less effective at expressing and understanding emotions
    • Less aware and accepting of own emotions
    •Less emotional self-efficacy

•Anxious children more likely to use coping strategies - avoidance, externalising (outward explosion of behaviour), maladaptive cognitive coping

23
Q

Outline Hurrell et al (2015) - parental reactions to negative emotions

A
  • Parental reactions to childrens emotion has a role in development of childs emotional regulation
  • anxious children have deficits in emotion functioning - expression
  • mothers offered less problem-solving and emotional help
  • maternal support and help associated with better emotional regulation
24
Q

Outline UNiversal Prevention programmes

A

Aim to improve mental health and wellbeing of all children in a setting (usually school)
- easy way of implementing programes to large number of children

  • Prmary prevention: promoting wellbeing and reducing problems developing
  • Secondary prevention: stop mild or moderate problems getting worse
  • Tertiary problems: minimise negative consequences of established disorders (treatment)

As you go up a tier, the problem becomes worse, and the trainer becomes more specialised

25
Q

Outline the FRIENDS programme

A
  • School based anxiety prevention and resilient programmes
  • Delivered by educational psychs, school nurses, teachers etc
  • Whole class (universal) or smaller groups (selective)
  • Group work, exercises, role plays, games, quizzes
  • Based on CBT
26
Q

Outline the different age range things for FRIENDS

A

Contents for these programmes need to be developmentally appropriate to suit developmental occurances going on at that age

  1. Fun Friends (4-7 years)
  2. Friends for Life (8-11) - only evidence proven effective one
  3. My friends youth (12-16)
  4. Resilience for life (16+)

All based on CBT

27
Q

Outline CBT, what does it address?

A

CBT addressed the relationships between thoughts, feelings and behaviours
Situation -> thought -> emotion -> behaviour

Children with anxiety are more likely to:
• Think negative events will occur
• make negative assessments of their own behaviour
•Identity situation as threatening
• feel they cant cope with frightening event

  • CBT gives childrens skills to control their thinking and manage these situations
  • Normal fears become anxiety if thoughts, feelings and behaviours are exaggerated and beyond what would be deemed appropriate for that situation
  • they are out of proportion to a possible threat
28
Q

What can CBT teach children strategies for managing/

A
  1. thoughts: the noise is just the cat
  2. Emotions: Take slow breaths to manage physiological fear response
  3. Behaviour - Turn the light off
  • Teaches new ways of thinking about the situation
  • How we can emotionally manage these physiological symptoms
  • Gradually exposing them to challenge the unwanted behaviour
29
Q

How is CBT used for childhood anxiety?

A
  • Teach relationships between thoughts, feelings, behaviour
  • Teach emotion recognition and management
  • Help identity cognitions and how these are distorder
  • Encourage them to challenge negative self-talk and replace with positive coping
  • Apply and practice new coping skills
  • Self-monitoring skills - recognise and reward positive coping skills
  • Prep for future
30
Q

Outline FRIENDS for life

A

10 session programme for 8-11 year olds

  • Recognised by the WHO as most effective
  • Key cognitions and behaviours associated with anxiety are targeted and challenged
  • In group context , children larn to acknowledge and accept differences, and to support and help each other cope with their worries
  • PRovides tools to deal with anxious encounters
  • About promoting understanding and acceptance of differences
  • Give everyone emotional awareness
  • Manage emotions they experience by themselves
31
Q

What are the aims of FRIENDS for life?

A
  • Replace anxiety increasing cognitions with helpful and balanced ones
  • Become aware anxious children are more likely to attend to fear stimulus and see themselves as less able to cope - replace these thoughts
  • Understanding anxiety response and physiological reaction
  • learn anxiety management techniques - emotional toolbox to manage emotions
  • Targets avoidance tendencies - gradually expose them to it with management techniques
32
Q

What was the order of Stallard (2010) Friends For Life Model?

A
  1. education and introduction

Emotional:

  1. emotional recognition
  2. Emotional management

Cognitions:

  1. Cogntions - helpful and unhelpful
  2. Helpful coping plans

Behavioural:

  1. Problem solving
  2. self-reinforcement
  3. practice this plan
  4. pracctice this plan
  5. Maintence in the future, plan for setbacks
33
Q

What is the acronym that the friends programme centres around?

A

F-eelings - all feelings are okay, how you view them
and deal with them

R-emeber to relax. Have Quiet time

I-can do it! - positive cognitions

E-xplore solutions and coping step plans

N-ow reward yourself - should do these daily - TV time

D-on’t forget to practice

S-mile! Stay calm, strong and talk to your support networks - how can role models help us?

34
Q

Outline Parent Psychoeducational sessions

A
  • Parents helped to understand anxiety and emotions
  • Develop strategies to cope with own anxiety
  • to improve child management and problem-solving skills
  • Parents taught: Contingency management and reinforcement - reward coping behaviors, rather than their anxious talk and problem avoidance
35
Q

Does FRIENDS work? what are some evaluations?

A
  • reduces anxiety and provides tools for coping with stressful situations
  • Improves social and emotional skills and regulation
  • Useful on a school wide level - all children are taught regulation of thoughts, emotions and behaviours - not just anxious children
36
Q

Outline Uk evaluations for the FRIENDS programme

A

Stallard (2010) and Stallard et al (2014)

  • Reduced anxiety and improved SE
  • High risk children were no longer high risk
  • DID NOT impace on depression and general well being
  • may be better when delivered by a professional
  • important who is delivering, because not always effective

developmental year 2 (9 decks)

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