1. Anxiety Disorders

2. Anxiety Disorders - Terms Fear = emotional rxn to danger Fear = emotional rxn to danger Anxiety Anxiety –Future orientation –Feelings of apprehension –No danger may be present Panic – physiological rxn; fight or flight Panic – physiological rxn; fight or flight Phobias = pathological fears Phobias = pathological fears

3. Fears vs. Phobias 1. Out of proportion 2. Cannot be explained away 3. Leads to avoidance 4. Not adaptive 5. Persists over time 6. Not age or stage specific

4. Fears Common and normal Common and normal 90% of children have at least one specific fear 90% of children have at least one specific fear 50% have numerous fears 50% have numerous fears Generally decline with age; peak around 11 Generally decline with age; peak around 11 Phobias only 1% Phobias only 1%

5. Common fears Fears of physical injury or personal loss Fears of physical injury or personal loss Fears of natural or supernatural danger Fears of natural or supernatural danger Fears reflecting psychic distress Fears reflecting psychic distress animals animals

6. Developmental changes in fears 1 st year: loud noises, separation from parent 1 st year: loud noises, separation from parent Preschoolers – animals, the dark, imaginary creatures Preschoolers – animals, the dark, imaginary creatures school age – school, injury, social fears school age – school, injury, social fears Adolescence – interpersonal fears, appearance, school, safety Adolescence – interpersonal fears, appearance, school, safety

7. Difficulties in assessment of anxiety disorders in children 1. Differentiate normal fears from pathological anxiety impairmentimpairment 2. domains may not correspond VerbalVerbal BehavioralBehavioral PhysiologicalPhysiological 3. Problems operationalizing behavioral manifestations of anxiety Physiological measures limitedPhysiological measures limited Verbal report - ??Verbal report - ?? Rating scales good but don’t distinguishRating scales good but don’t distinguish

8. DSM-IV Anxiety Disorders 9 disorders 9 disorders –Same as adult except for separation anxiety disorder –OCD, PTSD, GAD, Panic Disorder, phobia, social phobia, agoraphobia, acute stress disorder

9. Separation Anxiety Disorder Excessive anxiety concerning separation from home or caregivers beyond that expected for developmental level Excessive anxiety concerning separation from home or caregivers beyond that expected for developmental level Lasts 4 weeks or more Lasts 4 weeks or more Often early age of onset Often early age of onset Often precipitated by major stressor Often precipitated by major stressor

10. Social Phobia Extreme shyness Extreme shyness Children may not recognize why they feel anxious Children may not recognize why they feel anxious Must have capacity for social relationships with familiar people Must have capacity for social relationships with familiar people Must occur in peer setting, not just with adults Must occur in peer setting, not just with adults

11. Components of Treatment 1. Avoidance/escape – exposure 2. Physiological reactions – relaxation training and/or meds 3. Cognitive – alter distorted thinking 4. Cognitive – sense of control, self-efficacy