Anxiety
(3-26-15)
346 Exceptional Children
Anxiety Disorders of Childhood & Adolescence
Anxiety as a concept I: elements/facets/dimensions
physiological arousal: activation of sympathetic aspects of autonomic nervous system
measures based on this perspective assess biological activation: Galvanic Skin Response (GSR), heart rate, respiration, muscle tension (EMG), perspiration
behavioral escape & avoidance: anxiety is noxious and motivates the organism to get away from anxiety provoking stimuli
measures based on this perspective assess avoidance (or approach) behavior: Behavioral Avoidance Test (BAT)
cognitive disruption: anxiety interferes with attention, problem solving, recall
measures based on this perspective assess errors in intellectual activities judged within the subject's ability range
phenomenological dread: our private sense of tension, worry, nervousness
measures based on this perspective provide a means to report on our internal experience: Subjective Units of Disturbance (SUD) ratings, ratings scales, 100 mm lines, fear thermometer
Anxiety as a concept II: level/scope of interest
symptom: a characteristic response (e.g., hands trembling or feeling "scared")
syndrome: a group of symptoms (e.g., tremor, and shaky voice, and feeling scared, and avoiding the situation)
internalizing symptoms; anxious-inhibited cluster
disorder: core symptoms of sufficient severity & duration to cause distress &/or maladjustment
Phobic Disorder, Generalized Anxiety Disorder, Panic Disorder, PTSD, OCD
Anxiety as a concept III: normal/functional/appropriate vs. . . .
Adaptive: ............................Maladaptive:
fear ...................................... phobia
worry ................................... rumination
tension ................................. overanxious
self-soothing ............. .......compulsion
Patterns (diagnoses) of anxiety disorders in children
Phobias: "a special form of fear"
Mark's 1969 definition of a phobia: A phobia is a special form of fear which, is out of proportion to demands of the situation, cannot be explained or reasoned away, is beyond voluntary control, leads to avoidance of the feared situation, persists over an extended period of time, and is unadaptive.
Miller, Barrett, & Hample (1974) offered a slight modification/addition to this definition for children: Is not age or stage specific.
AGE TYPICAL FEARS
birth - 6 months ......... (Moro reflex)....... loud noise, loss of support
.5 - .75 years ..................... ...................................... Strangers
(1) 2 - 4 years .......................................................... Separation
1.25 - 4 years ........................................................... Creatures, Bad people,
............................................................................................ Death, Being alone
2 years ........................................................................... Toilet
3 years ............................................................................ Animals
4 years ............................................................................ Dark
5 - 6 years ................................................................... School
11 years ......................................................................... Injury, Natural events
............................................................................................. Social, All fears
12 years ......................................................................... Social, Sexual
19+ years ....................................................................... Natural events
Generalized Anxiety Disorder (GAD) (also known in children as: Overanxious Disorder of Childhood)
worry, threat sensitivity, chronic tension
Separation Anxiety Disorder
Obsessive-Compulsive Disorder (OCD)
obsessions: intrusive, repetitive thoughts, anxiety generating or anxiety reducing
compulsions: repetitive rituals and nonpurposeful behavior associated with anxiety reduction
PANDAS (Pediatric onset, Neuropsychiatric Disorder), group A streptococcal infections, and OCD behavior
Panic Disorder
Without Agoraphobia (avoidance of situations believed linked with probability of anxiety attacks)
With Agoraphobia
acute episodes (attacks) of fear, anxiety, panic; may lead to attempts to control future episodes by avoidance (agoraphobia)
Posttraumatic Stress Disorder (PTSD)
traumatic event (threat + fear/helplessness/horror)
leading to:
1. over arousal
2. avoidance / numbing of emotional responses
3. re-experiencing (serial dreams, flashbacks, repetitive toy play)may represent a failure of the General Adaptation Syndrome (GAS)
Acute Stress Disorder
time limited disorder
dissociative symptoms
Adjustment Disorder With Anxiety
other problems in which anxiety may play a role:
Hypochondriasis
Body Dysmorphic Disorder
Conversion Disorder
Dissociative DisorderDissociative Identity Disorder (DID) -- formerly known as multiple personality disorder (MPA)
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