Abnormal Psychology 3018 Child Anxiety

1 in 5.

1 in 10.

40%.

10%.

Because understanding their mental illness helps predict future mental health problems.

Child psychopathology emerged in the 80’s. Beforehand, clinicians just applied adult psychology to children.

Because what is normal/maladaptive behaviour differs between children and adults.

It changes as children mature. Need to look at milestones and sequences of development.

Normal achievements: eating, sleeping, attachments.
Behavioural problems: stubbornness, temper, toileting difficulties.
Clinical disorders: mental retardation, feeding disorders, autistic disorder.

Normal achievements: language, toileting, self-care skills, self-control, peer relationships.
Behavioural problems: arguing, demanding attention, disobedience, fears, overactivity, resisting bedtime.
Clinical disorders: speech & language disorders, problems from child abuse/neglect, anxiety disorders (phobias).

Normal achievements: academic skills & rules, rule-governed games, simple responsibilities.
Behavioural problems: arguing, inability to concentrate, self-consciousness, showing off.
Clinical disorders: ADHD, learning disorders, school refusal behaviour, conduct problems.

Normal achievements: relations w/ opposite sex, personal identity, separation from family, increased responsibilities.
Behavioural problems: arguing, bragging.
Clinical disorders: anorexia, bulimia, delinquency, suicide attempts, drug & alcohol abuse, schizophrenia, depression.

• ‘internalising’ disorders (anxiety & mood/depressive disorders).

• ‘externalising’ disorders (ODD, CD & ADHD).

• developmental disorders (autism & learning disorders).

ODD: oppositional defiant disorder.
CD: conduct disorder.
ADHD: attention deficit hyperactivity disorder.

1. Easier to see than ‘internalising’ disorders.

2. Children with ‘internalising’ disorders often don’t cause trouble and are good students. Sometimes it is hard to see that they need help.

Anxiety disorders (within children) are hard to differentiate, it is difficult to know which disorder a child has, and what treatment they need.

That there are no finely-tuned, individual disorders - not even a differentiation between anxiety and depression.

1. 1. There is no differentiation between anxiety disorders.

2. We don’t understand/see the differentiation.

It is developmentally inappropriate and excessive fear or anxiety concerning separation from the attachment figures (involving three symptoms).

1. Distress when anticipating or experiencing separation. 2. Worry about losing major attachment figure (or harm). 3. Worry about experiencing an untoward event that causes separation. 4. Refusal to go out because of fear of separation. 5. Fear of being alone or without attachment figure in the home (or other settings). 6. Refusal to sleep away from home or without attachment figure. 7. Repeated nightmares involving separation. 8. Complaints of physical symptoms when anticipating separation.

Children: at least 4 weeks.
Adults: 6 months or more.

Autism, psychosis, GAD.

In a child from 6/7 months to a child of 5 years or so.

12-month: 4%.
Adolescent: 1.5%.
Adult: 1-2%.

DSM-4, diagnosis could not be made after 18.

On children or spouse.

Community: more girls.
Clinical: equal, if not more boys.
This could be because boys will be taken for treatment for often as it is less socially acceptable for them to have separation anxiety.

Due to stress, particularly if the child has behavioural inhibition.

Overprotective parents. If a child is scared of a novel situation and the parent tries to protect them from their fear, they are creating AVOIDANCE.

It is the tendency to experience stress and withdraw from unfamiliar situations. Behaviourally inhibited children are more likely to develop SAD if they have overprotective parents.

Children only need one symptom, whereas adults need three (of six).

Excessive worry that the individual finds difficult to control. Symptoms are; restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep disturbance.

It is either rare in children OR there is something wrong with the DSM criteria that means it is does not cover childhood GAD.

Because the child may not even know they are suffering and might not be able to verbalise it.

Adults worry about events that are likely to happen, regardless of cost (social outcomes).
Children tend to worry about any event that has a high COST, regardless of likelihood (physical outcomes).

Adults think more about their worries (not so much their fears).
Children tend to think about their fears AND their worries.
They don't differentiate between the two (between what is realistic and what is unlikely to happen).

Because they can't emotionally regulate properly. When they fear something, instead of problem solving, or thinking rationally about the issue, their emotions get the better of them and they fear the event (even if it is extremely unlikely).

SSRIs are predominantly used (mainly for OCD). However, in general medications tend to be avoided.

Cognitive Behavioural Therapy, that involves;

• psychoeducation, relaxation.

• cognitive restructuring (usually as a fun game).

• exposure (with a bribe to reduce unpleasantness).

• behavioural elements (positive reinforcement of coping behaviours).

Parental involvement (they learn to stop reinforcing the child's avoidance behaviours).