Psychology 2320A/B Lecture Notes - Lecture 7: Separation Anxiety Disorder, Generalized Anxiety Disorder, Selective Mutism
29 Apr 2018
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Lecture 7: Anxiety in Childhood and Adolescent
NORMATIVE EXPERIENCES OF ANXIETY
• Anxiety has physical, cognitive, and behavioral manifestations (See table in text)
• Anxiety is normal
– Common in childhood (and later on)
– Often adaptive
• To diagnose in children, fears need to be persistent, excessive when compared to same-age children,
cause harm or impairment
ANXIETY IN YOUTH: RECENT CLASSIFICATION
• DSM-III & III-R had multiple anxiety disorders specific to children
• DSM-IV: child-specific diagnoses reduced to one, criteria applicable to children and adults developed
• DSM-5 goes even further with SAD
– Other major changes made
• Current: All 7 major DSM-5 anxiety disorders concern a fearful/anxious response of some kind
– Focus of the anxious fear and its expression differs across diagnostic categories
– Must cause impairment, fear/anxious response disproportionate to potential for harm
One take home message on this slide: the general trend for diagnosis in kids is to increasingly conceptualize in terms that
apply ACROSS DEVELOPMENT
- OCD: look at it in the exam she says
DSM-5 ANXIETY DISORDERS
• In DSM-5, there are seven major ADs:
– *Separation anxiety disorder (SAD) C
– *Generalized anxiety disorder (GAD) C & A
– *Panic disorder (PD) ?? A
– *Social phobia A
– *Specific phobia C
– Agoraphobia w/o panic disorder A
– Selective mutism C
C = predominantly child onset; A = predominantly adol/adult onset
- Get used to these abbreviations (makes note taking easier)
- Do ot see agrophoia /o PD is’t oo in children
- Selective mutism: not talk about it so much.. Not much research
- So focus on first 5
ANXIETY IN YOUTH: SAD
• Recurrent, excessive distress over separating from home or attachment figure (e.g., parent)
- Worry re: caregiver or self during separation
- Physical symptoms
- Onset usually age 7-8
• Fear is excessive for developmental stage
– Separation anxiety is common between 7 months to age 6
- Refusal to go to school, sleep alone, stomach aches, headaches
- Diagnosis has to affect developmental stage of 7/8
find more resources at oneclass.com
find more resources at oneclass.com
ANXIETY IN YOUTH: GAD
• GAD: prolonged, uncontrollable, excessive worry about mult. domains, more days than not
• + one other symptom of anxiety (restlessness, fatigue, muscle tension, sleep disturbance)
– Onset usually bt 10-14 yrs of age
• GAD has low inter-rater reliability, rarely occurs without another comorbid disorder (esp depression)
- Worry about getting good grades, sports, peers w/ physical symptoms
ANXIETY IN YOUTH: SPECIFIC PHOBIA
• Specific phobia: marked fear of circumscribed objects or situations
– Animal, blood, environmental phobias all common in childhood
– Onset of most phobias around ages 7-9
ANXIETY IN YOUTH: SOCIAL ANXIETY DISORDER
• Social anxiety disorder: persistent fear of social/performance situations that would expose them to
possible scrutiny
– Fear of acting in embarrassing/humiliating manner, or fear they will show anxious symptoms
– Usually onsets after puberty; rare prior to age 10
ANXIETY IN YOUTH: PD
• Panic attacks: sudden, discrete episodes of intense fear + physical & cognitive symptoms
– Heart palpitations, sweating, trembling, nausea, shortness of breath
– Feelings of detachment, fear of losing control, going crazy, dying
• Pai attaks ≠ pai disorder
– Common in other anxiety disorders
• Panic disorder: recurrent, spontaneous panic attacks accompanied by:
– Fear of consequences of attacks
– Concern about future attacks
– Or significant behavior change due to attacks (e.g., avoidance)
• Panic disorder = fear of anxious symptoms
• Usually diagnosed bt ages 15-19
ANXIETY IN YOUTH: PREVALENCE & ASSOCIATED FEATURES
• Prevalence of youth ADs: 8-27% (1/3)
– SAD appears to be the most common: 4-13%
– Specific phobia: 4-10%
– GAD: 3-6%
– Social anxiety disorder: 6-12%
– PD less common (PD: 1%)
– NCS replication: 30% lifetime AD prevalence
– Overall, these are common disorders
• The most common category of disorder
SAD, specific phobia and social anxiety most common and GAD, PD lesson common
ANXIETY IN YOUTH: ASSOCIATED FEATURES
• Obvious Gender differences
– From a young age, girls are more fearful than boys
– Literature somewhat mixed for youth, but many studies show at least slight F preponderance
– In adulthood, all ADs F>M
– Overall, AD F>M, appx 1.5 or 2:1
find more resources at oneclass.com
find more resources at oneclass.com
Document Summary
Lecture 7: anxiety in childhood and adolescent: anxiety has physical, cognitive, and behavioral manifestations (see table in text, anxiety is normal. Often adaptive: to diagnose in children, fears need to be persistent, excessive when compared to same-age children, cause harm or impairment. Anxiety in youth: recent classification: dsm-iii & iii-r had multiple anxiety disorders specific to children, dsm-iv: child-specific diagnoses reduced to one, criteria applicable to children and adults developed, dsm-5 goes even further with sad. Other major changes made: current: all 7 major dsm-5 anxiety disorders concern a fearful/anxious response of some kind. Focus of the anxious fear and its expression differs across diagnostic categories. Must cause impairment, fear/anxious response disproportionate to potential for harm. One take home message on this slide: the general trend for diagnosis in kids is to increasingly conceptualize in terms that apply across development. Ocd: look at it in the exam she says. *generalized anxiety disorder (gad) c & a.
