Anxiety Disorders in Children

Anxiety Disorders in Children

Summary:
– anxiety disorders in children are extremely similar to the way they appear in adults
– the chief difference is with respect to the content of the worries
– the “big 3” anxiety disorders for children are:
1) separation anxiety – where the child is afraid of separating from a significant other (most commonly their mother) – what the child is worried about is that something awful will happen when they separate from their mother – for e.g. That their mother will be killed in a car accident; that for some reason they will never see their mother again; that they themselves may be kidnapped & never see their mother again – as a result, they tend to want to stay with their mother – they hate separating from her – they try to not let her go out at night – they may not like to go to school – in extreme cases they may even shadow or follow their mother from room to room in the house
2) social phobia – this is very similar to social phobia in adults – essentially they are highly shy children who experience a great deal of difficulty interacting with others – they also worry a great deal about social interactions & their main underlying fear is what others will think of them – that they are incompetent in some way, inferior, unattractive, stupid etc., compared with others | they tend to have fewer friends – & often experience difficulty making friends | they tend to be not very assertive | experience difficult answering questions in class & joining sports groups etc.,
3) generalised anxiety disorder – they are essentially what Ronald Rappee describes as “the worry warts” – such children worry about all sorts of things – school & sports performance, the news they see on television, health anxiety, finances etc., – on top of this children with GAD can have a lot of physical symptoms such as stomach aches, difficulty going to sleep, irritability, appetite loss, etc.m

– many epidemiological studies suggest anxiety disorders occur in approximately 1 in 10 children
– the gender differences for prevalence are much the same as for adults – 2 girls to 1 boy
– he notes often that in society that anxiety is often seen as a “worse problem than it is for girls”, with parents more likely to see help for boys

Diagnosis issues
– the major characteristic issue of any anxiety disorder is avoidance
– a clear behavioural focus on what the child does or does not do, with a clear focus on patterns of avoidant behaviour – for e.g.:
– all different social situations
– the next step – to ask parents “why” it is – that they think – the child is avoiding
– differential diagnosis is about trying to separate the truly frightened child – who is truly afraid of some danger or something bad happening – from the child who is naughty & being difficult
– in many cases, the child is able to tell you themselves
– if not, the psychologist may come up with a hypothesis – based on history
– it should also be noted that a lot of anxiety can occur in a temporary fashion, influenced by adverse childhood events & other occurrences in their environment such as bullying at school – in such cases, the child would not be diagnosed with an anxiety disorder
– history of those children with a anxiety disorder often goes right back to birth

Aetiology – there are very few risk factors
– genetics (twin studies show there is a strong heritable component to anxiety)
– research also seems to suggest that something in the child’s environment seems to influence the child’s anxiety
– parents of anxious children often become over-involved in assisting their child (over-protective parenting to mitigate threats/possible harm & often leap in quickly to solve problems when e child is anxious/upset)
– longitudinal research suggests over-protection at one time seems to be linked with anxious later, while noting the two way interaction of cause & effect (I.e. a temperamentally anxious child will elicit parental over-protective behaviours & at the same over-protectiveness in the parent will foster & increase anxiety in the child)
– research does not show a strong link between stressful life events & anxiety (whereas there is a strong link for depression & Oppositional Defiant Disorder (ODD))
– most anxious children do have one or both parents who are anxious – I.e. not just genetic influences on the child, but also behavioural/modelling of anxious type behaviours

Treatment
– Very similar to that used for adults
– Cognitive behavioural treatment – This involves:
– Teaching kids to think differently
– Teaching kids not to perceive events as dangerous or overwhelming
– Systematically face situations they are afraid of (Exposure response prevention)
– Such treatment works in up to 60% of cases
– There is far less research with respect to the effectiveness of medication (except for OCD)
– SSRIs appear to be effective
– clinicians need to watch for situations where it would be reasonable to be anxious – for e.g. Where a learning difficulty exists (where a child is failing at school because of a very real cognitive deficit) – treating for anxiety in such a case would be ineffective

Source: CPD Online | podcast date: 29 May 2008

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