Wee 6 L11 Anx.

Question 0

Internalizing Spectrum

Answer 0

 Cluster of interrelated problems  anxiety disorders
 mood disorders
 cross-sectional and lifetime comorbidity extremely high
 Developmental psychopathology framework
 Remember that we evaluate what is abnormal in the context of
what is typical for children of that age
 fear and sadness are important emotions
 “normal” fears come and GO over development

Question 1

Shift of focus from externalizimg is orders to

Answer 1

Internalizing.

Anx disorders, and epidemiology today.

Question 2

Anxiety Disorders are:

Though we often discount or forget about them…

Answer 2

 Associated with significant impairment

Social impairment
 Excluded, unliked
 Academic impairment

Question 3

Service Utilization for anx,

Good help from psych, what they are probably best at, but?

Answer 3

 Anxiety problems often go untreated
 Most youth with mental health problems do not receive treatment
 This gap is very pronounced for anxiety
 National Comorbidity Survey – Adolescent (Merikangas et al.)
 10, 123 adolescents aged 13 to 18 years
 Nationally representative (US) sample
 Interviewed about psychiatric diagnoses
 Asked whether they had ever received services for each disorder
depression was just 50% only 14% to 30 %

Percentage of Adolescents Who Report Using Mental Health Services
ADHD
ODD
CD
Nonsevere
Depression 39% 41%
55%
35%
26%
Severe
78%
54%
82%
v

Look at table again!

Question 4

Who is more likely to receive services for anxiety?

Answer 4

 Girls
 Older youth

Question 5

Reason no treat anx.
1) Some Fear and Anxiety is Normal

Answer 5

 Nearly all 1-year-olds become distressed when separated from Mom
 Most children have very short lived specific fears  About half of children aged 6 to 12 have 7 or more fears
 Is it causing disability, distress, or risk?
 Only 5% of children report excessive fear in response to a given fear stimulus (e.g., needles, dogs)

Question 6

Reason no treat anx.
2) Some Anxiety is Adaptive

Answer 6

 Stranger anxiety in young children

 Test anxiety
 Excessive checking of homework

Question 7

Reason not treat anx.
3) It may not be as upsetting to adults

Answer 7

 Remember that children and adolescents do not generally refer themselves for treatment
 Anxiety may not be causing disruption

May be associated with favourable characteristics
 Less aggression

But saw videos of impairing anx,

Question 8

Core Features of anx

Answer 8

 Focus on threat or danger
 Anxiety is future oriented
 “anxious apprehension”
 Note that this differs from fear, which is present-oriented
 Strong negative emotion or tension, displayed as: cognitive shifts, keeps worrying.
Behavioural pattern, phobia (avoid object)
 physical sensations

Focus on threat or danger
 Anxiety is future oriented  “anxious apprehension”
 Note that this differs from fear, which is present-oriented
 Strong negative emotion or tension, displayed as:  physical sensations
 Cognitive shifts
 Images
 Worry
 behavioral patterns
 Avoidance  Crying
 Clinging

Question 9

Diagnoses of anx

Answer 9

 Many specific diagnoses
 vary on content of threat
 vary on balance of symptoms (e.g., worry versus physical)

Question 10

Specific phobia
(Content of anx disorder)

Answer 10

 Specific situations or things
 Needles, dogs, water

Question 11

Separation anxiety

Not limited to children, can see in adults.

Answer 11

 Separation from or harm coming to loved ones
 Do not want to be separated from parents
 Worrying about events that might separate them from paren

Question 12

Social anxiety

Answer 12

 Fear of negative evaluation by others
 Fear of social situations in which person will be evaluated
 For children, must occur in peer settings (not just with adults)

Question 13

Generalized anxiety disorder

Answer 13

 Worry about multiple threats
 School, friends, sports, bad things happening

Question 14

Post-traumatic stress disorder

Answer 14

 Fear of trauma cues

Question 15

Panic Disorder
and dsm criteria

Answer 15

 Fear of panic attacks
 Panic attack: period of intense fear or discomfort that develops abruptly and is accompanied by at least four symptoms (e.g., sweating, shortness of breath, feeling like you are choking, chest pain, nausea)
 DSM-5 Criteria for Panic Disorder
 Recurrent, unexpected panic attacks
 At least one of the attacks has been followed by one month (or more) of one of the following
 (a) persistent concern about having additional attacks
 (b) worry about the implications of the attack or its consequences (e.g., losing
control, having a heart attack, “going crazy”)
 (c) a significant change in behavior related to the attacks
 Panic attacks are not better explained by another disorder, including another anxiety disorder

Question 16

Obsessive-Compulsive Disorder (OCD)
obsessions

Answer 16

 Obsessions
 Recurrent, persistent thoughts, impulses, or images that are experienced as intrusive, inappropriate, and that cause marked anxiety or distress
 These thoughts are not simply excessive worries about real life problems
 The person attempts to ignore or suppress the thoughts or to neutralize them with another thought or action
 The person recognizes that the thoughts are a product of their own mind
Common obsessions
 Contamination
 Harm to self or others
 Symmetry

Question 17

OCD
 Compulsions

Answer 17

 Repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession, or according to rules that must be applied rigidly
 The behaviors or mental acts are aimed at preventing or reducing distress or preventing some dreaded events or situations; however, these behaviors or mental acts either are not connected in a realistic way with what they are designed to neutralize or prevent or they are clearly excessive

Common compulsions
 Counting
 Checking
 Washing

Question 18

To meet criteria for OCD, note odd has been taken out of anxiety section of dsm-v different biological mechanisms.

Answer 18

a person must be experiencing either obsessions or compulsions
 Obsessions or compulsions are time consuming or causing clinically significant distress or impairment

Question 19

Prevalence of anxiety disorder

Answer 19

 NCS-A
 Lower levels of parental education associated with
increased rates of anxiety disorder
 Also higher rates of anxiety disorders among youth whose parents were divorced or separated, and among minority youth

Lifetime prevalence of any anxiety disorder during childhood and adolescence is 32%
 Specific phobia: 19% (most do not get treatment)
 Separation anxiety: 8%
 Social Phobia: 9%
 Generalized anxiety disorder: 2%
 Panic Disorder: 2%
 OCD 1%-2% (data from a different survey)

Gender differences
 2:1 female to male ratio
 Except for OCD, which is 2:1 male to female
-Present across development

Question 20

Course of anx disorder.

Answer 20

 Some fears, worries, and rituals developmentally
appropriate, shoes, desert, cute things… But trying in the moment.
 Different “typical” age of onset for each fear
 2 years of age: Loud noises, animals, the dark, separation from
parents
 5 years of age: Animals, dark, separation from parents, bodily injuries, “bad” people
 7 to 8 years of age: Dark, supernatural beings, staying alone, bodily injuries
 Worries more complex as youth age
 Young children may not realize that their fears or behaviors are excessive or abnormal

Young children may not realize that their fears or behaviors are excessive or abnormal
 As children become older, they may become more embarrassed  Young children may not be able to tell you how they are feeling
 Defiance, acting out

Question 21

Ages of onset of anxiety disorders?

Answer 21

Anxiety disorders typically show earlier age of onset than other disorders
 Different Anxiety Disorders Show Different Ages of Onset
 Separation Anxiety Disorder (7 to 8 years)
 OCD (9 to 12 years) prognosis worse younger you are at onset.
 Some children will show it very early – 6 to 10 years
 Generalized Anxiety Disorder (10 to 14 years)  Social Phobia – adolescence
 Panic Disorder – adolescence

Question 22

Prognosis of anx dis.

Answer 22

 Research is ongoing to determine what the long-term outcomes of anxiety disorders are
 Homotypic continuity: have same anx. In the future
-Anxiety disorders predict subsequent anxiety disorders
 Heterotypic continuity
–An anxiety disorder predicts other types of disorders

There was a table looking at this, a proxy
Showed that accounting for many variables,
Homotypic, 17.4 , 41,
Strong homotypic continuity.
Strong hetero topic continutioy esp. With depression. 60% had.

More anx, less likely to go to uni.

Question 23

Clinical Correlates of anx.

Answer 23

 Academic difficulties
 Anxious children typically have IQs in the normal range
 BUT . ..
 Impact of worry on concentration
 School refusal
 Refusal to go to school
 Difficulty remaining in school
 Separation anxiety
 Social anxiety
 Selective mutism:
–Will not talk in specific social settings

Question 24

Clinical Correlates of anx. Dis.

 Social Difficulties

Answer 24

 Shy/withdrawn children become increasingly rejected by the
peer group with age
 More likely to experience peer victimization
 Shy/withdrawn children are as likely as peers to have friends, but they perceive these relationships to be of lower quality

Question 25

Anxiety and Mood Disorders link?

Answer 25

 Links between anxiety and depression
 Anxiety and depression are highly co-morbid
 Diagnostic co-morbidity rates can be as high as 75% in some clinical samples

Symptom overlap
 GAD and MDD – fatigue, sleep disturbance, irritability,
concentration difficulties

 Negativity affectivity
 Underlying dimension
 Extent to which person feels distress
 Occurs in both anxiety and depression

Anxiety symptoms/disorders often precede depression
 Anxiety as a risk factor
 Dysfunctional social behaviors (avoidance)
 Social-cognitive processing