Mood and Anxiety Disorders in Children

Question 1

Developmental Considerations

Answer 1

Cognitive level

Language ability

Level insight

Reliance on caregiver / teacher reports

Limited emotional vocabulary

Physical development (pre/post puberty)

Question 2

Major Depressive Disorder

Answer 2

Irritable mood may substitute for depressed mood

Failure to gain weight substitutes weight gain/loss

Uncommon in pre-pubertal children, and increases in adulthood

The main stressor in MDD is parent child-conflict

Tx: for mild cases 1st line is CBT, and for moderate-severe cases 1st line is CBT + fluoxetine (Prozac) for 6-12 months

Question 3

Persistent Depressive Disorder

Answer 3

Duration only needs to be 1 year instead of 2 years like in adults.

Question 4

Disruptive Mood Dysregulation Disorder

Answer 4

Exclusively pediatric

Severe, recurrent temper outburts inconsistent with developmental level on average > 3x/week

Baseline mood is angry/irritible

Age of onset is <10 and >12 months (symptoms cannot be absent for any period of time)

Cannot make diagnosis before age 6 or after age 18

Question 5

Selective Mutism

Answer 5

Failure to speak in situations in which there is an expectation to speak despite speaking in other settings and situations.

Interferes with education/occupational achievement or with social communications.

Duration >1 month but not ever the first month of school.

Not attributable to lack of language.

Question 6

Seperation Anxiety Disorder

Answer 6

More common in younger children.

Need to have 3/8 of the following…

1. Distress when separating from home or major attachment figures
2. Worry about losing major attachment figure / harm befalling them
3. Worry that an untoward event will lead to seperation (ie. earthquake)
4. Refusal to go to school / work if away from a major attachment figure
5. Fear of being alone without major attachment figure
6. Refusal to sleep away from major attachment figure
7. Nightmares with themes of separation
8. Complaints of physical symptoms when separation is anticipated or occurs

Need to happen for at least 4 weeks in children or at least 6 months in older adolescents / adults.

Tx: CBT + fluoxetine (Prozac) + family therapy + school-based interventions

Question 7

Bipolar Disorders

Answer 7

No criteria modifications that are different in children.

Causes a high level of functional impairment.

Can look similar to ADHD but the onset is often later (>10 years), more abruptly, or with exaggerated manic episodes.

Question 8

Social Phobia

Answer 8

Symptoms must occur in a peer setting

Fear may be represented by crying, trantrums, freezing, clinging, shrinking, or failing to speak.