Week 2

Question 1

What differentiates normal vs. clinical anxiety for children?

Answer 1

• normal fears differ from clinical anxiety in SEVERITY not quality

Question 2

What are the guiding principles for understanding the assessment of normal vs. clinical anxiety?

Answer 2

• is the anxiety CAUSING MARKED DISTRESS and/or interference in major areas of functioning
• is the behaviour and distress EXCESSIVE compared to other children their age?

Question 3

How do we identify differential diagnosis?

Answer 3

• need to obtain specific information about severity, duration, key automatic thoughts and frequency to tease apart various anxiety disorders

Question 4

What are common comorbidities to anxiety in children?

Answer 4

• unusal to see only one diagnosis, kids will often have 2/3 anxiety disorders
• secondary anxiety in ODD and ADHD is common
• severe anxiety is often associated with depression, particularly in social phobia
• 85% of depressed adolescents have a history of anxiety.

Question 5

What are biological factors relating to child anxiety?

Answer 5

• brain structures (anxious children differ from non-anxious children in size and volume of specific brain structures)
• brain activity (neuroanatomical and functional differences in AMYGDALA AND PREFRONTAL COREXT
• NEUROTRANSMITTERS
• GENETICS (clear genetic pathways to anxiety/depression- differential impact on treatment outcomes)

Question 6

What are child factors relating to child anxiety?

Answer 6

• AVOIDANCE (lack of experiences with a fear event leads to increased anxiety about a future negative outcome)
• NEGATIVE LIFE EVENTS (anxious children experience more negative life events and interpret neutral events as negative)
• MONITORING/ATTENTION BIAS: anxious children are hypervigilant to negative events–> constantly scan the environment during positive and neutral activities for possible threats
• PERCEPTION BIAS: interact with a negative bias, i.e. they view neutral events as threatening and see threats faster than peers
• COGNITIVE ERRORS: i.e. generalize, catastrophize, mind-read, overestimate probabilities

Question 7

What are family factors related to child anxiety?

Answer 7

• overprotection and family accomodation (parents and teachers try to protect the child from feeling anxious by completing tasks for them or by providing constant reassurance that they will be fine. The child never learns that they are capable and never trust their ability to decide if there is danger)
• FAMILY MODELING (anxious children are likely to have an anxious parents who also avoid situations, therefore as a family there is poor modeling of how to cope in a situation e.g. if a parent is socially anxious their child is unlikely to have participated in a lot social activities)
• FAMILY INTERACTIONS (PARENTS ENCOURAGE AVOIDANT STRATEGIES AND DO NOT ENCOURAGE POSITIVE PROBLEM SOLVING FOR THEMSELVES)

Question 8

What is the best approach to child anxiety assessment?

Answer 8

• MULTIMODAL: observation, functional analysis, clinical interview, questionnaires, behavioural assessment
• MULTI-INFORMANT (collaborative): parents, child, teacher

Question 9

How do we use behavioural assessments?

Answer 9

• observing in a contrived situation designed to elicit suspected fears in the absence of safety behaviours
• particularly useful when maintaining factors are not clear
• conduct tasks with and without parents present
• direct observation of behaviour in natural settings
• particularly on separation and in playground/classroom
• ask for video/audio evidence if helpful

Question 10

Why is school refusal important to understand in an adolescent?

Answer 10

• symptom of many disorders
• why are they avoiding school?
• possibilities include:
  (fear of separation from parents, dysfunctional patterns of family behaviour, fear or social situations at school, behaviour management problems, depression and other mental health problems)