Anxiety & Mood Disorders In Children

Anxiety Disorders Common among children – 9.7% in a community-based school sample More girls than boys Fears are normal, but the disorders are more extreme Children tend to cope by becoming overly dependent on others for support Often co-morbid with depressive disorders or may be influential in the later development of depression

Separation Anxiety Disorder The most common anxiety disorder for children (2 – 41%); may have other anxiety-based disorders Characterized by unrealistic fears, oversensitivity, self- consciousness, nightmares, chronic anxiety, low self-confidence, apprehensive in new situations Described as shy, sensitive, nervous, submissive, easily discouraged, worried; frequently cry, overly-dependent Key feature: excessive anxiety about separation from major attachment figures and from familiar home surroundings A psychosocial stressor may be identified (e.g. a death) More common in girls Not stable – 44% recovered at 4-year follow-up; some exhibit school refusal and continue to have adjustment problems

Criteria for Separation Anxiety Disorder Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidenced by 3 or more of the following: 1.Recurrent excessive distress about being separated from home or major attachment figures 2.Persistent and excessive worry about losing or about harm occurring to family members 3.Persistent and excessive worry that an untoward event will lead to separation from a major attachment figure 4.Persistent reluctance or refusal to go to school or elsewhere because of fear of separation 5.Persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings 6.Persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home 7.Repeated nightmares involving the theme of separation 8.Repeated complaints of physical symptoms when separation from major attachment figures occurs or is anticipated

Etiology Parental behavior (over-anxious, over-protective & indifferent or rejecting) Cultural factors (those that favor inhibition, compliance & obedience) Constitutional sensitivity to conditioning by aversive stimuli (e.g. easily upset, difficulty calming down) Traumatic events (illness, hospitalizations, accidents, losses) Sense of diminished control over negative environmental factors

Treatment Successful experiences Medication – fluoxetine Behavior therapy - assertiveness training - desensitization (in vivo methods) Cognitive-behavior therapy – group sessions for recognizing anxiety and coping more effectively with parent training in behavioral management

Mood Disorders Characteristic behaviors: withdrawal, crying, avoidance of eye contact, physical complaints, poor appetite, aggressive behavior, suicide Same criteria as used with adults, except irritability Transparency 25 – Influences on Self-Concept Copyright © 2006 by Pearson Education, Inc. All rights reserved.

Prevalence Depression: Under 13: 2.8% 13–18: 5.6% (girls 5.9%, boys 4.6%) Bipolar Disorder: Diagnosis has increased dramatically, at least in part due to increased recognition that the disorder does occur in children A high percentage also receive a comorbid diagnosis, often ADHD Equal prevalence in males & females

Disruptive Mood Dysregulation Disorder Criteria – p. 156 DSM-5 Key features: chronic, non-episodic irritability (differentiates from bipolar) & temper outbursts (supercedes ODD) At risk for unipolar depressive disorders and anxiety in adulthood

Etiology Parental mood disorders, which also influence interactions (negative emotional states & negative parental behavior, less attuned to the child’s needs, modeling of irritability & affect) Prenatal exposure to alcohol Exposure to early traumatic events (hyperreactivity of the nervous system & alteration of neurotransmitter system) Divorce Attributing positive events to external, specific & unstable causes and negative events to internal, global & stable causes Fatalistic thinking & feelings of helplessness

Treatment Medication – research is contradictory & some shows only moderate helpfulness & an increased risk of suicide The predominant approach has been a combination of medication and psychotherapy Therapy should provide a supportive emotional environment with the opportunity to learn more adaptive coping strategies & more effective emotional expression; play therapy – younger children; discussing feelings openly for older children; cognitive-behavioral therapy has been shown to reduce symptoms Short-term residential treatment can be effective Effective treatment can reduce the recurrence of depression