UNDERSTANDING OCD AND ANXIETY DISORDERS Amy Drahota, Ph.D. RCHSD-Autism Discovery Institute Child & Adolescent Services Research Center San Diego State University, Dept. of Psychology 4/26/2016

Understanding Anxiety: Conclusions  OCD and anxiety disorders are common in children.  OCD and anxiety disorders commonly occur together with Tourette syndrome.  These disorders may interfere with the daily lives of children who experience them.  Children suspected of having anxiety disorders should be referred to mental health professionals.

OCD, Anxiety and Tourette Syndrome  OCD and anxiety disorders are common comorbidities in children with Tourette syndrome  OCD affects 30-66% of individuals with a diagnosis of Tourette syndrome (American Psychiatric Association, 2013; Hirschtritt et al., 2015)  Anxiety disorders affect 36% of individuals with a diagnosis of Tourette syndrome (Hirschtritt et al., 2015)

Understanding Anxiety  Fear and anxiety is linked with threat  Anxiety is brain-based: Studies show that the limbic system and especially the amygdala are sensitive to cues of danger in the world  Once triggered by perception or worry about danger (even just being laughed at in a social situation) these brain structures set off the “ fight/flight/freeze reflex ”  Anxiety is experienced by everyone, but becomes are problem when interferes with one or more areas of life

Understanding Childhood Anxiety  OCD and Anxiety disorders are among the most common psychiatric disorders affecting children and adolescents (Albano et al., 2003)  Estimated collective prevalence rate: 6 to 15% (Benjamin et al., 1990; Briggs-Gowan, 2000; Costello, 1989)  Anxiety disorders involve:  Behavior: Avoidance of feared things  Cognitions: Fearful beliefs and attributions  Affect: Negative affect and physiological arousal  Anxiety disorders: Separation anxiety, Selective mutism, Social phobia, Generalized anxiety, Specific phobia and Panic disorders.  OCD is its own diagnosis category

Core Features Age of Onset Common Behaviors Obsessive-Compulsive and Related Disorders

Obsessive-Compulsive Disorder  Core features  Obsessions are recurrent and persistent intrusive and unwanted thoughts, urges, or images  Compulsions are repetitive behaviors or mental acts that an individual feels driven to perform in response to an obsession or according to rules that must be applied rigidly  Average age of onset is 19½ years; 25% of cases start by age 14 years old. Boys typically have earlier onset than girls  Common behaviors  Time-consuming  Causing clinically significant distress or impairment

Core Features Age of Onset Common Behaviors Specific Anxiety Disorders

Separation Anxiety Disorder  Core features  Overwhelming fear of losing or being separated from parents or caregivers through catastrophic means  Most prevalent anxiety disorder in kids younger than 12 years; can occur at any age & into adulthood  Common behaviors  Difficulty transitioning from home to other places or refusal to leave home or separate from caregiver May consistently feel sick upon arrival to appointment  Multiple requests to leave the appointment  Avoidance of activities with peers or others  Difficulty concentrating due to worry for self or caregiver  Distress and preoccupation with separation

Selective Mutism  Core features  Children do not initiate speech or reciprocally respond when spoken to by others in specific social situations  Yet, children generally have normal language skills  Development & Course  Prevalence: 0.03% to 1%, depending on study settings & ages  Onset often before 5 years old but interference noticed at school  Clinical observations suggest that kids may “outgrow” SM but empirical data is lacking  Common behaviors  Refuse to speak in social situations  Clingy behavior to caregivers or trusted adults  Mild oppositional behavior and temper tantrums

Social Phobia / Social Anxiety  Core features  Marked fear and panic while in or anticipatory anxiety about 1+ social situations in which there could be embarrassment, rejection, or scrutiny For children, must occur in peer setting & not just with adults  Social situations are avoided or endured with intense fear  Most often diagnosed in adolescents but does occur in earlier childhood  Common behaviors  Crying and/or temper tantrums  Freezing or shrinking in social situations  Clinging

Generalized Anxiety  Core features  Excessive worry about a number of events or activities, which is difficult to control and has associated physical symptoms (restlessness, fatigue, difficulty concentrating, irritability, muscle tension, sleep problems)  Common behaviors  Repeated or “out-of-the-blue” questions/comments about the worried event/activity  Distraction and interference with the task at hand  Refusal to try tasks; perfectionism  Trembling, twitching, shaking, muscle aches and soreness  Somatic symptoms & exaggerated startle response

Understanding Anxiety: Conclusions  OCD and anxiety disorders are common in children.  OCD, anxiety disorders and mood disorders commonly occur together.  These disorders may interfere with the daily lives of children who experience them.  Children suspected of having anxiety disorders should be referred to mental health professionals.

THANK YOU! Any questions or discussion?