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CHILD ANXIETY - Coggle Diagram
CHILD ANXIETY
Specific Phobia
Symptoms
Anxiety/fear about particular situations or objects
Children will avoid situations or things that they fear, or endure them with anxious feelings, which can manifest as crying, tantrums, clinging, avoidance, headaches, and stomach aches.
Cognitive ideation is not prevalent: unlike adults, they do not usually recognize that their fear is irrational
Rather, anxiety response is immediately induced by the phobic situation. The response is persistent and out of proportion to the posed risk
The fear, anxiety, or avoidance is persistent
Typically lasting 6 months or more
Common Phobias
Animals (e.g. spiders, insects, dogs)
Natural environment (e.g. heights, storms, water)
Blood-injection-injury (needles, medical procedures, fear of blood, fear of injury)
Situational (e.g. airplanes, elevators, enclosed places)
Other (e.g. clowns)
Prevalence
Children: 5%
13 to 17 yrs: 16%
Adults: 3%-5%
Onset is usually between 7 and 11 years
Girls are more frequently affected than boys (rate of 2:1)
How it Develops
A traumatic event (e.g. being attacked by an animal or stuck in an elevator)
An unexpected panic attack in the to-be feared situation (e.g. a panic attack while on a train)
Informational transmission (e.g. extensive media coverage of a plane crash)
Assessment
How to distinguish between normal developmental fear or worry vs. a clinically significant phobia/disorder
Intensity
Frequency
Content
Spontaneity
Avoidance
Stage of development
Nonadaptive and persistent nature
Interference
Four Pillars of Assessment
Those who know the child
Different measures of assessment
The characteristics of this child
The environment of the child
Topics in Parent Interviews
Behaviour: define the problem behaviour & specific manifestations of the fear of anxiety. Onset & development of the symptoms.
Developmental and medical history: history of temperamental problems, stranger and separation responses, and early fears. A review of the child’s general pattern of coping with sleep, toileting, eating & childcare. A medical history should include information about visits to the Doctor for anxiety symptoms, medications and any medical conditions
Family & environment: changes in the environment or the child's attachment figures (e.g. death of a grandparent) can precipitate problems with anxiety; recent changes in the family situation or changes at the time of symptom onset should be explored. Environmental stressors such as a disorganized home, neglect 7 exposure to danger or violence can also precipitate anxiety symptoms.
Efforts to help the child: what has been done so far to help the child and how the child has responded to these efforts
Family & community resources: who in the family is best suited to help the child through the treatment process
Family history: what is the medical and psychiatric history of the parents and family members
Child functioning: the child's academic, athletic, social and behavioural functioning should be explored
Formal Assessment Tools
Multidimensional Anxiety Scale for Children
Screen for Child Anxiety Related Emotional Disorders
Spence Children's Anxiety Scale
Aetiology
Genetic Factors
rate of anxiety disorders has been found to be higher in children of adults with anxiety disorders
children of parent with an anxiety disorder are two to five times more likely to have an anxiety disorder
Behavioural inhibition (a genetically based, temperamental trait) is associated with anxiety and it refers to the child's reaction to novel & unfamiliar stimuli. Children with behavioural inhibition have a tendency to respond to novel situations with restraint, distress & avoidance
Cognitive Factors
Maladaptive cognitions are thought to play a significant role in the aetiology and maintenance of fears and anxieties
Schemata/core Beliefs
Associations between observation, interpretation, attention and memory
Schemata contain chronically overactive themes of threat and danger
Misrepresentations, exaggerations, or over-attending to environmental threats are more common in anxious children than in other youngsters
Parental Impact
Insecure Attachment
Low sensitivity and responsivity to the child
The parent does not provide a secure base from which to explore the world
A diminished sense of control results for the child
Over-anxious, intrusive, and protective parenting
Wrapping the child in cotton wool hinders autonomy
Can lead to the child’s under-developed competence in handling the external environment
Separation Anxiety Disorder
Symptoms
Distress when separated (or anticipating separation) from home or major attachment figures
Worry about potential harm to attachment figures (e.g. illness, injury, death)
Worry about something bad happening to them (e.g. getting lost, being kidnapped, having an accident)
Reluctance or refusal to go out away from home
Fear of being alone
Reluctance or refusal to sleep away from home or to sleep alone
Repeated nightmares
Physical distress symptoms (e.g. headaches, stomach-aches, nausea)
Symptoms must last at least 4 weeks in children and adolescents and 6 months+ in adults
Prevalence
Children: 4%
Adolescents: 1.6%
Adults: 0.9%
The most common anxiety disorder in children under 12 years of age, with a gradual decrease in frequency as children mature into adolescence and adulthood.
Onset peaks with entry into Kindergarten, between ages 7-9, and again with entry into HS
Boys and girls are equally affected by separation anxiety
Selective Mutism
Symptoms
Consistent failure to speak in social situations in which the child is expected to speak but can speak in other situations
May stand motionless and expressionless, turn their heads, chew or twirl hair, avoid eye contact, or withdraw into a corner to avoid talking
Can be very talkative and display normal behaviours at home or in another place where they feel comfortable
Failure to speak interferes with educational achievement and/or and normal social settings (e.g. making friends)
The duration of the disturbance needs to be at least 1 month (not limited to the first month of school)
The failure to speak is not attributed to a lack of knowledge of, or comfort with, the spoken language required in the situation
The disturbance is not better explained by a communication disorder
Prevalence
a relatively rare disorder that is more likely to manifest in young children than in adolescents and adults
Prevalence ranges between 0.03% and 1% depending on setting and age
Onset is usually before age 5 years, but the disturbance may not come to attention until entry into school, where there is an increase in social interaction & performance tasks (eg reading aloud)
Boys and girls are equally affected
Social Phobia
Symptoms
Fear of negative evaluation: i.e. will be humiliating or embarrassing; will lead to rejection; or offend others
The anxiety is persistent, typically lasting 6 months or more
Fear or anxiety about social situations in which the individual is exposed to possible scrutiny by others
Prevalence
7%
Prevalence rates decrease with age
Median age of onset is 13 years old
75% of individuals have age of onset between 8 and 15 yrs
Onset may follow a stressful or humiliating experience (e.g. being bullied) or it may be insidious, developing slowly.
Higher rates found in females than males