Lecture 6- Childhood Anxiety

Question 1

What is SADD?

Answer 1

• Excessive anxiety concerning separation.
• Preoccupation with returning home to attachment figures.
• Inability to remain in a room alone or displaying “clinging” behavior.

Question 2

What is the SADD diagnostic criteria under the DSM-5?

Answer 2

Developmentally inappropriate and excessive fear or anxiety concerning separation from those to whom the individual is attached, as evidenced by at least 3 of the following:

1. Recurrent or excessive distress when anticipating or experiencing
   separation from home or from major attachment figures.
2. Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death.
3. Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes separation from a major attachment figure.
4. Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of separation.
5. Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings
6. Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure.
7. Repeated nightmares involving the theme of separation.
8. Repeated complaints of physical symptoms (e.g., headaches,
   stomach aches, nausea, vomiting) when separation from major
   attachment figures occurs or is anticipated.

The disturbance causes clinically significant distress or impairment in social, academic, occupational, or other important areas of
functioning

Question 3

Under the DSM-5 how long do symptoms have to last in order to be classified with SADD?

Answer 3

The fear, anxiety, or avoidance is persistent, lasting at least 4 weeks
in children and adolescents and typically six months or more in
adults

Question 4

What is the disclaimer for practically all disorders in the DSM-5 but is particularly important here?

Answer 4

The disturbance is not better explained by another mental disorder,
such as refusing to leave home because of excessive resistance to
change in autism spectrum disorder; delusions or hallucinations
concerning separation in psychotic disorders; refusal to go outside
without a trusted companion in agoraphobia; worries about ill health
or other harm befalling others in generalized anxiety disorder; or
concerns about having an illness in illness anxiety disorder.

Lots of anxiety disorders overlap. They differ in how the present but overall all come down a feeling of incompetence.

Question 5

How does SAD differ across development?

Answer 5

Presents differently at differ ages (three categories as such):

Children aged 5-8 years: Lots of kids are sad about leaving parents/ safety but beyond age 2 it is no longer developmentally normal to be extreme about it or throw tantrums. At this kind of age it usually manifests as emotional out bursts. The parent often reports never being able to do anything without the child.

Children aged 9-12 years: for children of this age and above expression of the disorder becomes less about strong emotional outbursts. Generally, becomes a lot more cognitive, they have an overwhelming sense that they can’t do things on their own. They tend to avoid a lot e.g. get homeschooled. Also worry about what others think and try in hide that their true feelings are they don’t want to separate from parents. Often they have somatic complaints: headache, tummy ache which may very well be real but can also sometimes just be used as an excuse to leave school/avoid.

Adolescents aged 13-16 years

Question 6

What are some causes of SAD?

Answer 6

• Genes: tends to run in families, people have strong genetic predisposition.
• Neurotransmitters: Naturally born with abnormalities or environmental factors can cause you to produce more e.g. in lots of stressful situations body may produce lots of cortisol.

Family Environment: Often come from close knit families with not a lot of outside support. This lack of support means children have less exposure to others and then all of sudden when they have to go to school freak out. Parenting styles can also play a role. Many parents infantize their children i.e. Do too much for children meaning children are very reliant at an abnormal age . To overcome this we need to build confidence that the child can do things on their own. The paranoia for parents safety generally progresses after initially feelings of inadequacy.

Question 7

What is school refusal?

Answer 7

This is not a DSM-V diagnosis but is very common

School refusal can occur for a number of reasons:

• Separation Anxiety Disorder
• School Phobia (fearful of something at school, can start from one bad experience and snowball)
• Social Phobia (school is a very judgy place and especially as you are going to school in a time when you are heavily reliant on peer relationships)

Question 8

What are some interventions for anxiety?

Answer 8

• Cognitive Behavioural therapy: challenging automatic thought processes
• Family therapy
• Medications (tends to be more a last resort)

Question 9

How are children often taught to recognize and manage

their emotions?

Answer 9

• Anxiety is normalized (Explaining what anxiety is and why we need it to a certain extent: think Yerkes Dodson curve)
• Body alarm (your body alarm is going off in times when it is not mean to be going off, lead into the idea that the situation isn’t scary it’s just your perception of the event that is causing anxiety)
• Relaxation training
• Thought-response connection
• Coping self-talk

Question 10

What acronym is often used to facilitate recall of the steps for
coping successfully with anxiety?

Answer 10

F = feeling frightened?
E = expecting bad things to happen?
A = attitudes and actions that will help?
R = results and rewards?

Question 11

What is exposure therapy?

Answer 11

• Hierarchy of anxiety provoking situations is developed
• Hierarchy is worked through gradually and systematically
• Exposure is done in therapist’s office and in natural environment

Flooding is an extreme of exposure therapy and is seen as too overwhelming

Question 12

What is often done in family therapy?

Answer 12

• Behavior management strategies such as planned ignoring of anxious behavior
• Parental awareness of their own emotional responses
• Training in problem solving skills

Question 13

What are some medication options for anxiety?

Answer 13

• SSRIs (long term)
• Benzodiazepines (short term: this is for when there is a very stressful situation that you want to deal with immediately)
• Beta Blockers