WEEK 4-1 Introduction to childhood disorders

What is anxiety?

  • anxiety is anormal emotion

    • fear, stress, worry, emotion

  • problem when danger is imagined or out of proportion to real threat

  • three parts

    • body (physiology): heart racing, sweaty, butterflies

    • thoughts (cognition): something bad is going to happen

    • actions (bhv): fight or flight

When is anxiety a disorder?

  • there is a fear or worry about a particular event or multiple areas of life

  • the fear/worry is excessive compared to that experienced by peers is age-inappropriate

  • the fear/ worry leads to avoidance of events

  • the fear/worry causes significant distress and/or significant interference in daily activities.

Why do we care sbout anxiety in children?

  • most common mental health problem in children - 6.5% prevelance

  • can affect academic performance

  • anxiety disorientated school children

    • less likely to have satisfying social relationships

    • have higher ongoing usage of health facilities

    • live a life (in their own words) of “missed opportunity”

Types of Disorders - DSM 5

  • disorders are recognized by ‘classification systems’

  • there are two main classification system: DSM and ICD

  • criteria dont hugeky vary for children/adults so we need to think about how symptoms present in children

Separation anxiety

  • Developmentally inappropriate, recurrent, excessive anxiety concerning separation either from a) home or b) attachment figures

  • Excessive worry about possible separation, including losing caregivers or harm coming to caregivers.

  • Experience physical symptoms on separation or anticipation of separation

  • May be reluctant to attend school, may fear being alone, may have nightmares about separation

  • For diagnosis:

    • Must last at least 4 weeks

    • Must cause clinically significant distress or interference.

generalised anxiety disorder

  • Excessive anxiety and worry occurring more days than not

  • Worry is difficult to control

  • Causes significant distress and impairs functioning

  • Must exist for at least 6 months

  • Worry accompanied by at least 3 somatic symptoms:

    • stomach or head aches, problems sleeping, irritability, poor concentration or fatigue

  • seek out reassurance constantly

  • overly compliant/ perfectionist

Specific phobia

  • Intense and persistent fear of specific object or situation

  • Avoidance and distress caused when confronted

  • Children may cry, freeze or cling to express fear

  • Common fears are animals/insects, storms, dark, heights, blood/injection/injury, vomiting & small spaces

  • For diagnosis:

    • Must last at least 6 months

    • Must cause clinically significant distress or

Panic disorder

  • Recurrent, unexpected panic attacks for no apparent reason

  • Attacks involve intense fear, accompanied by somatic symptoms (heart pounding, sweating etc.) and catastrophic cognitions (e.g I can’t breathe, I’m going to die).

  • Associated with agoraphobia (next slide).

  • At least one attack must have been followed with:

    • Persistent concern or worry that

Agoraphobia

  • Persistent fear of certain environments, typically crowded places of open spaces.

  • Must exist in at least two environments.  

  • Fear must be out of proportion to realistic threat posed.

  • Presence or anticipated presence of feared environment results in significant distress.

  • Feared environment is avoided or endured with extreme distress.

Major Depression in DSM-5

Additional symptoms include:

 

  • Significant weight loss/weight gain or changes in appetite

  • Insomnia or hypersomnia

  • Unable to sit still or lethargy

  • Loss of energy or fatigue

  • Feelings of worthlessness or excessive, inappropriate guilt

  • Impaired concentration/slowed down thinking/indecisiveness

  • Recurring thoughts of death/suicide

Comorbidity

Comorbidity refers to the presence of more than one disorders occurring together.

  • Children with anxiety disorders are 8 – 29 times more likely to be diagnosed with depression (Angold et al., 1999; Costello et al., 2003; Ford et al., 2003).

  • Anxiety is strongly associated with subsequent depression (Cole et al., 1998; Costello et al., 2003) .

  • Clark & Watson (1991) tripartite model – negative affect (associated with both anxiety and depression), low positive affect is associated with depression, high physiological arousal associated with anxiety.

Measuring depression and anxiety

  • Typically use questionnaire measures of symptomatology or diagnostic interviews

  • Widely used questionnaire: Revised Child Anxiety and Depression Scale (RCADS)

    • ‘Gold-standard’ for diagnosing:

    • Anxiety: Anxiety Disorder Interview Schedule (ADIS)

    • Depression: Schedule for Affective Disorders and Schizophrenia in School Age Children (Kiddie-SADS)

Problems with the diagnostic approach

  1. Categorical (all or nothing) approach to diagnosis

    • What about people who are just below the threshold?

    • Would a dimensional approach be more suitable

  2. High comorbidity between diagnoses

  3. Results in labeling

  4. Tells us nothing about cause