Lecture 8 Child Anxiety

Question 1

DSM-IV most common diagnoses for children

Answer 1

internalising disorders

• anxiety disorders
• mood/depressive disorders

externalising disorders

• oppositional defiant disorder
• conduct disorder
• attention deficit hyperactivity disorder

developmental disorders

• autism
• learning disorders

Question 2

DSM-IV child anxiety disorders

Answer 2

same diagnostic categories as in adults:
specific phobia, social phobia, panic disorder, GAD, OCD, PTSD

one category specific to childhood onset:
separation anxiety disorder (before 18)

diagnostic issues:
limited validity of differentiation among anxiety disorders

Question 3

DSM-5 SAD diagnostic criteria A (3 out of 8)

Answer 3

Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached

1. Recurrent excessive distress when anticipating or experiencing separation from home or from major attachment figures.
2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill)that causes separation from a major attachment figure.
4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings.
6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
7. Repeated nightmares involving the theme of separation.
8. Repeated complaints of physical symptoms (e.g., headaches, stomach aches, nausea, vomiting) when separation from major attachment figures occurs or is anticipated.

Question 4

Diagnostic criteria B,C,D for SAD

Answer 4

B. The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks in children and adolescents and typically 6 months or more in adults.

C. The disturbance causes clinically significant distress or impairment

D . The disturbance is not better explained by another mental disorder, such as ASD, psychotic disorder, agoraphobia, or generalised anxiety disorder

Question 5

development of SAD

Answer 5

from 6-7 months: strong separation fear normative, increase chance of survival

school-age: interferes with normal developmental milestones

develops in response to stress esp in vulnerable children

genetic component: neuroticism, behavioural inhibition, shyness

overprotective parents

maintained by avoidance, severity associated with parents’ response

Question 6

Difference between adult and child diagnosis of GAD

Answer 6

Only 1 out of 6 symptoms required for children vs 3 for adults

Question 7

GAD developmental analysis of Vasey (1993)

Answer 7

Children need to be able to:

• imagine chains of catastrophic outcomes
• switch to verbal thinking from imagery
• develops by age 7-8 years

Cognitive avoidance theory of worry (Borkovec, 1994)

Question 8

Worry topics in young people

Answer 8

Young adults:
-worry more about social outcomes, compared to physical outcomes

Children (Age 7-9 and 10-12 years)
-worry more about physical outcomes (compared to social)

Question 9

Threat perception

Answer 9

Both young adults and children rate social outcomes as less aversive and more likely to occur

Older group (10-12 yo) : Likelihood and cost explain worry equally

Younger group (7-9 yo): 
Only cost has unique association with worry

Question 10

Treatment of anxiety in children

Answer 10

Biological treatments:

• SSRIs: Zoloft, Prozac
• effective for OCD, used also for other disorders

Psychological Treatments:

• CBT derived from adult approaches
• Psychoeducation, relaxation,
• Cognitive restructuring (e.g., detective game)
• Exposure (with bribe)
• Increased behavioural component
• Positive reinforcement of coping behaviours

Parent involvement