Anxiety Disorders in Children and Adolescents

Various Forms of Anxiety Generalized Anxiety Separation Anxiety Specific Phobia Panic Disorder Selective Mutism Social Anxiety Somatization Obsessive Compulsive Disorder Post-Traumatic Stress

Fear is, I think, the greatest suffering for children George Sand (1854-1855)

Basics of Anxiety Anxiety is a feeling state consisting of physical, emotional and behavioral response to a perceived threat Often undetected or under treated Fear and worry are common in normally developing children Need to distinguish normal from abnormal

Basics of Anxiety Worries and fears can be protective in moderation

Basics of Anxiety Cognitive distortions Anxious children tend to have negative distorted thoughts and perceive events in a negative way (attribution bias) Anxiety becomes a disorder when… Increased intensity/duration than expected Impairment or disability Disruption of daily activities Clinically significant unexplained physical symptoms or intrusive thoughts

Basics of Anxiety Overestimated Underestimated Likelihood x Harm Ability to cope Underestimated Beck et al. 1985

School refusal

Management of Anxiety Recognize that it is there: develop insight, give it a name, make it less of a mystery. Teach healthy coping: relaxation, distractions Exposures: Do not recommending avoiding stimuli that cause anxiety. Rather learn to adapt. Formal treatment: therapy or medication.