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Questions and Answers
What is one of the primary symptoms of Generalized Anxiety Disorder in children?
Which anxiety disorder is less commonly found in adults compared to children?
How many symptoms are required for a diagnosis of Generalized Anxiety Disorder in children?
Which somatic symptoms might indicate Generalized Anxiety Disorder?
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What is a significant risk factor associated with anxiety disorders?
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What characterizes specific phobia?
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Which symptom is NOT commonly associated with panic disorder?
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How does avoidance manifest in specific phobia?
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What triggers panic attacks according to the information?
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Which of the following is a feature of agoraphobia?
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What duration is required for a diagnosis of specific phobia?
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Which statement best describes the impact of panic disorder on daily life?
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What is a common manifestation of anxiety in children with specific phobia?
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Which anxiety disorder typically manifests between the ages of 10 and 16?
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What is a common consequence of untreated anxiety disorders in childhood?
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What parenting style is associated with the development of anxiety disorders?
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At what developmental stage do normative fears include loss of control and going crazy?
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Which of the following is a potential risk factor for developing anxiety disorders?
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Which anxiety disorder in childhood is likely to predict social anxiety in later adolescence?
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What aspect of anxiety disorders is characterized as polymorphic?
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What is an essential component of assessment for anxiety disorders in children?
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What characterizes separation anxiety disorder in children?
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Which of the following is NOT a common symptom of selective mutism?
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What defines social anxiety disorder in children compared to adults?
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What outcome is likely if anxiety disorders remain untreated in youth?
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How long must symptoms be present to diagnose separation anxiety disorder?
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What behavioral signs might indicate social anxiety disorder in a child?
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Which of the following describes a symptom of selective mutism?
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What is a common misconception regarding children with social anxiety disorder?
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What is considered an essential aspect of therapeutic lifestyle changes for managing anxiety?
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Which type of therapy is recommended as the first-line treatment for children aged 6 to 18 with anxiety disorders?
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In which situations are antidepressants typically used in treating anxiety in children?
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What is a common characteristic of anxiety disorders in children and adolescents?
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Which of the following statements is true regarding medication for anxiety in children?
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Study Notes
Anxiety Disorders in Children and Adolescents
- Anxiety disorders are the most common psychiatric disorders in children and adolescents
- Less than half of youth needing treatment receive it
- Untreated anxiety disorders often lead to depression
Separation Anxiety Disorder
- A common condition in youth and adolescents
- Characterized by excessive fear and anxiety when separated from parents or parental figures
- Symptoms include:
- Refusal to stay alone
- Irrational fears
- Nightmares
- School refusal, refusal to go to camp or sleep at a friend's house
- Tears, pleading, tantrums, physical resistance, panic reactions when separation is attempted
- Misery, withdrawal, apathy, sadness, difficulty concentrating, homesickness when separated
- Fear, anxiety, or avoidance persists at least 4 weeks in children and adolescents
Selective Mutism
- Normal communication with close family members but failure to speak in specific situations expecting judgment
- Symptoms include:
- Shyness, social anxiety, and social withdrawal
- Academic difficulties
- Clinging, negativism, opposition, tantrums
- Use of non-verbal communication
- Willingness to participate in activities that don't require speaking
- Often comorbid with other anxiety disorders, such as separation anxiety and social anxiety disorder
- Should be present for 1 month where the patient is failing to speak in specific social situations, yet normal in other familiar situations.
Social Anxiety Disorder
- A continuum of Selective Mutism and SAD
- Characterized by fear and anxiety in social situations where the individual is exposed to judgment by others
- In children, anxiety must occur in peer settings, not just during interactions with adults
- Symptoms include:
- Crying, tantrums, freezing, shrinking, or failing to speak in social situations
- Phobic situations: observation, performance, assertiveness, self-revelation, mundane interactions
- Fear before and during the situation, and shame after the situation
- Postural rigidity, avoidant eye contact, verbal inhibition, low speaking voice
- Shy bladder syndrome: avoiding public toilets
- Social anxiety disorder is often accompanied by alcohol abuse to manage anxiety
- Specify if the fear is restricted to speaking or performing in public performance only
Specific Phobia
- Marked fear or anxiety to a specific object, idea, or place
- Phobias can be limited (e.g., spiders but not worms), generalized (e.g., needles and by extension hospitals), by proxy (i.e., for themselves and their family), and associated (e.g., heights and snakes).
- Anxiety may occur in the presence of the phobic object or in anticipation
- Degree of expressed anxiety can vary according to exposure, duration, and presence of others
- Symptoms include:
- Hypervigilance
- Sympathetic hyperactivity (tachycardia, increased BP) except in the blood-injection-injury subtype where there's vagal discharge (bradycardia, decreased BP, syncope)
- Avoidance: overt or covert
- Counterphobic attitude: seeking out and confronting phobic objects
- In children, fear or anxiety may be expressed by crying, tantrums, freezing, or clinging
- Duration of diagnosis is 1 month
Panic Disorder
- Panic attacks can occur in any anxiety disorder
- Diagnosis requires recurrent, unexpected panic attacks, plus worry about additional attacks occurring
- Panic attacks can occur at night, waking the patient
- Patients may experience anxiety related to physical health (e.g., fear of cardiac problems, brain tumor) or mental health (e.g., fear of going crazy)
- Becomes a disorder when attacks increase to daily or weekly for a month
- Fear of panic attacks and inability to cope leads to avoidance of everyday life and activities
- Stressful situations and caffeine are triggering factors
- Symptoms include:
- Palpitations, accelerated heart rate
- Shaking
- Shortness of breath, choking
- Chest pain, discomfort
- Abdominal distress
- Dizziness, fainting, heat sensations
- Feeling numb
- Derealization
- Fear of going crazy, losing control, dying
Agoraphobia
- Similar to a phobia but related to situations where escape is difficult, such as heights, malls, cinemas, theaters, busy places, etc.
- Extreme cases can lead to total home reclusion
- Children are particularly worried when outside their home, often with fear of getting lost
Generalized Anxiety Disorder
- Not frequent in children
- Marked by uncontrollable, excessive worry and fear about everything
- Symptoms include:
- Always on edge
- Easily fatigued
- Problems concentrating
- Increased irritability
- Muscle tension
- Sleep difficulties
- Perfectionism
- Constant need for reassurance
- Somatic symptoms: tremor, fasciculations, muscle pain, sweating, nausea, diarrhea
- Increased startle response
- Irritable bowel syndrome, migraines
- Infrequent in children, look for separation anxiety, social anxiety, or OCD
Additional Notes
- SAD and selective mutism are more prevalent in children and rare in adults
- To differentiate between social phobia and specific phobia, the location of the symptoms is crucial
- Separation anxiety, selective mutism, panic disorder (panic attacks alone are not problematic) can have severe effects on a person's life.
- Anxiety disorders are highly comorbid with other psychiatric disorders, including sleep disorders
- Suicidal risk is universally increased in anxiety disorders, both with or without comorbid depression
- The risk is particularly elevated in cases of anxious raptus: sudden and acute panic reactions that can lead to impulsive acts
- Prevalence for all anxiety disorders is 7%
- More prevalent in girls
- Median age of onset is 11, but each disorder has its own age of onset:
- 0-6: separation anxiety, selective mutism
- 5-11: specific phobias
- 10-16: social anxiety
- 15-21: panic disorder, agoraphobia, GAD
Pathophysiology
- Genetic predisposition combined with life course events can contribute to anxiety disorders
- Early emotional deprivation
- Parenting style
- Poor social integration
- Stressful and traumatic life events
Natural History
- Onset is usually acute during childhood
- Course is chronic, often waxing and waning
- Anxiety can manifest in different forms, and the anxiety-provoking agents can vary with age
- Diagnostic stability can be high for some individuals, retaining the same diagnosis throughout life
- Others experience evolving anxiety with different categories of diagnosis at different stages of life.
| Developmental Stage | Normative Fears | Anxiety Disorders |
|---|---|---|
| Preschool/Early School Age | Separation, stranger shyness | Separation anxiety, selective mutism |
| School-Age | Thunder, fire, darkness, animals, blood, etc. | Specific phobias |
| Late School Age/Early Adolescence | Peer rejection, school performance | Social anxiety |
| Adolescence/Early Adulthood | Loss of control, going crazy, empty places, illness, etc. | Panic disorder, agoraphobia, generalized anxiety disorder |
- Childhood separation anxiety often predicts panic disorder, agoraphobia, and depression in adolescence and adulthood
- Childhood selective mutism often predicts social anxiety in adolescence and adulthood
Consequences of Untreated Anxiety Disorders
- Depression, suicidal thoughts and attempts
- Alcohol, substance, or medication abuse
- Social, educational, and occupational impairment
Assessment
- Done with the family and the child
Management
- Treatment is not always medication
- Psychoeducation: explaining the symptoms, the disorder, and the risks of untreated anxiety
-
Therapeutic Lifestyle Changes:
- Reducing exciting products (nicotine, alcohol, caffeine, etc.)
- Reducing and stopping anxiolytic medications (benzodiazepines, antihistamines)
- Adopting a healthy diet
- Maintaining good sleep hygiene
- Maintaining regular physical activity
- Relaxation and meditation
- Psychotherapy: Cognitive behavioral therapy (CBT) is the first-line for children between 6 and 18
-
Medication: In moderate to severe cases, antidepressants are used alongside CBT, or from the start for high severity in children aged 6 and above
- Antidepressants have independent anti-anxiety effects from their anti-depressive effects
Conclusion and Key Messages
- Anxiety disorders are one of the most common mental disorders in children and adolescents
- Presentation can vary with age for the same individual
- High prevalence of comorbidity with other anxiety disorders, mental disorders, and neurodevelopmental disorders
- Increased suicidal risk regardless of comorbid depression
- Treatment consists of psychoeducation, therapeutic lifestyle changes, CBT, and sometimes antidepressant medication.
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Description
Explore the impact of anxiety disorders in youth, including Separation Anxiety Disorder and Selective Mutism. This quiz delves into symptoms, prevalence, and the importance of treatment. Understand how these disorders affect children's daily lives and communication.
