Anxiety

Question 1

Prevalence of anxiety

Answer 1

o 10 – 20% of children diagnosed with anxiety

o Girls report more stress than boys

Question 2

Name four methods of distinguishing normal from pathological

Answer 2

o	Object:  
o	Intensity: 
o	Impairment:  
	(Social functioning, Academic functioning, Family functioning)
o	Ability to Recover/Coping Skills

Question 3

General fears of: 
Infants
Toddlers
School age
Adolescents

Answer 3

o Infants; loud, strangers
o Toddlers; darkness, seperation
o School-age; injury, natural events, attribution bias
o Adolescents; school, social competence, health

Question 4

Confidence of predictors at age 5

Answer 4

Being confident age 5 = less likely to develop anxiety disorders
 Children who are passive, shy, fearful, and avoid new situations at 3 and 5 years = more likely to exhibit anxiety later in life

Question 5

Three most common anxiety disorders?

Answer 5

The most common anxiety disorders
• Separation Anxiety
• Generalized Anxiety
• Specific Phobias

Question 6

What are the clinical presentations of anxiety?

Answer 6

o	Unable to recognize their fears as unreasonable 
o	often cannot articulate their feelings
o	often see physical symptoms 
	Headaches 
	nausea 
	increased heart rate 
	diarrhoea or constipation 
	sleep disturbance 
	colds
	appetite change 
	fatigue & exhaustion

Question 7

What is separation anxiety?
What are the symptoms?
Age of development?

Answer 7

o Excessive fear when separated from home or attachment figures
o Gender ratios are generally equal
 Symptoms
• difficulty sleeping alone, nightmares
• somatic complaints
• school refusal
o earliest age of onset among anxiety disorders
 may develop after a stressor
o precursor to of adult psychiatric conditions like depression /anxiety

Question 8

What are specific phobia?
Key criteria?
Age?

Answer 8

o Fear of a particular object or situation which is avoided or endured with great distress
o Avoidance is key: if it is a true phobia, will avoid at all costs
o Specific phobias often dissipate with age
 phobias that persist into adulthood remit only infrequently (20%)

Question 9

What is GAD?
What symptoms do children exhibit?
Lifetime?

Answer 9

o chronic, excessive worry in multiple areas with at least one associated somatic symptom (schoolwork, social interactions, family, health/safety, world events, natural disasters)
o Affected children:
 perfectionistic
 seek reassurance
 struggle is evident to parents and teachers
o Worry is not limited to a specific situation or object
o GAD often report they’ve felt anxious their entire life
 Over half presenting for treatment report onset in childhood or adolescence but after 20 is not uncommon

Question 10

What is social anxiety?
What are presenting symptoms?
What could be a new type of social phobia?

Answer 10

o Feeling scared or uncomfortable in one or more social or performance situations (Fear of scrutiny, Fear of doing something embarrassing)
o Struggle to answer questions in class, reading aloud, initiate conversation, talking with unfamiliar people, and attend parties and social events
o The anxiety dissipates when away from a social situation (unlike GAD)
o 90% of children with Selective Mutism meet criteria for Social Phobia
 Selective Mutism = specific type of Social Phobia?
o Social Phobia begins in childhood and is usually both lifelong and continuous

Question 11

What is panic disorder?
What are the symptoms?
Age of onset?

Answer 11

o Recurrent episodes of intense fear that occur unexpectedly
o attacks become less severe if they occur more often
o Somatic symptoms: (Heart pounding and/or racing, Sweating, Cold hands/painful extremities,Can feel so extreme that one feels (s)he is dying)
o Uncommon before puberty period

Question 12

What is OCD?
What do O and C stand for?
How do symptoms change over time?

Answer 12

o Most patients experience both obsessions and compulsions
 Obsessions are intrusive, continuous, unmanageable thoughts/worries –
 Compulsions are “ritualistic” actions performed in response to obsessive thoughts
• Performing compulsive actions relieves anxiety
o Symptoms worse with stress or trauma
o Changes in symptoms and in intensity over time
o Symptoms commonly exist for years before reaching clinical attention
o Usually improves with time

Question 13

Three main features of anxiety disorders?

Answer 13

o Increased behavioural inhibition (the tendency to be unusually withdrawn/timid and to show fear/withdrawal in novel/ unfamiliar social and nonsocial situations)
o Increased attention to threat
o Increased response to any arousal
 people with anxiety disorders can find anything exciting unpleasant, regardless of valence

Question 14

Genetics of anxiety?

Heritability factors?

Answer 14

o No clear data support specific genes for specific anxiety disorders
o Anxiety is heritable
 Panic Disorder (48%)
 Generalized Anxiety Disorder (32%)
o Genes account for some but not all of risk increase
 Environmental factors must play a major role

Question 15

What is the Reticular Activating System?

Answer 15

 network of ascending, arousal-related neural systems
 Locus coeruleus mobilizes in response to real or perceived threat –
• Dorsal raphe mediates the locus coeruleus

Question 16

Serotonin and anxiety

Answer 16

 High levels of serotonin in the brain during development can lead to permanent changes in the response to stress
 Serotonin is strongly implicated in emotion
• Serotonergic drugs are often prescribed for anxiety disorders
• SSRIs are effective against panic, anxiety and depression

Question 17

When the Serotonin receptor and transporter is knocked out mice exhibit…

Carrying the short form is associated with…

Answer 17

increased fear and anxiety
• Transporter protein has Two Alleles – short and long

 Higher levels of anxiety
 Increased amgydala reactivitiy
Less habituation of amygdala response is associated with Trait Anxiety

Question 18

Three Interactions between gene and environment

Answer 18

• People with short form are less resilient
• Gene dosage matters (two copies worse than one)
• Long form is “protective”?

Question 19

Where does cortisol release occur and what does it do?

Answer 19

HIppocampus during stress

results in cell death

Question 20

Where do Cognitive distortions (seeing threat where there isn’t real threat) occur?

Answer 20

o Hypothalamus and prefrontal cortex

Question 21

ASD and anxiety
Prevalence?
Which two symptoms are associated with both?

Answer 21

o Prevalence 40 –84%
 Impairments in social functioning
 Impairments in Theory of Mind
heightened “Intolerance of uncertainty” (All ambiguous stimuli interpreted as negative )
Sensory atypicalities
Presence and severity of repetitive behaviours

Question 22

Why does ASD symptom severity increase vulnerability to anxiety disorders?

Answer 22

• Less cognitive reserve/ability to cope
• Increased likelihood of negative response from others
• Increased likelihood of stress and negative life events

Question 23

Anxiety and Williams
Prevalence?
Main type?
What protects against anxiety in Williams?
What does it present like?

Answer 23

o	50% 
o	Mainly specific phobia (childhood) 
o	IQ and anxiety are negatively correlated 
	Higher intelligence may be protective 
o	ASD

Question 24

Fragile X and anxiety
Anxiety is high prevalence because?
In social situations, anxiety presents like?
There is an association between anxiety and…?

Answer 24

o Anxiety is part of the diagnosis
• “ASD-like” behaviours in social situations
 Association between anxiety and repetitive behaviours

Question 25

What are some triggers to anxiety?

Answer 25

o Changes in schedule, routines
o Anticipation of upcoming events
o Sensory overload
o Worry about upcoming social situations
o Taking away or being away from a preferred interest (e.g., music)
o Not being allowed to engage in repetitive behaviors

Question 26

Name four difficulties assessing anxiety?

Answer 26

o Anxiety measures designed for typical children may not be sensitive to characteristics specific to a syndrome
o Often difficult to distinguish between core symptoms of a developmental disorder and anxiety disorders
o Can result in overdiagnosis of anxiety in children with neurodevelopmental disorders
o Can result in all symptoms of anxiety being attributed to the core syndrome and not treated