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Questions and Answers
Which statement best describes the function of normal worries in children?
Which statement best describes the function of normal worries in children?
What distinguishes Separation Anxiety Disorder (SAD) from normal separation anxiety in children?
What distinguishes Separation Anxiety Disorder (SAD) from normal separation anxiety in children?
Which of the following is a common outcome for children diagnosed with Separation Anxiety Disorder in adulthood?
Which of the following is a common outcome for children diagnosed with Separation Anxiety Disorder in adulthood?
Which anxiety disorder is characterized by intense worry rather than a greater frequency of worry compared to other children?
Which anxiety disorder is characterized by intense worry rather than a greater frequency of worry compared to other children?
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What is a characteristic feature of normal rituals and repetitive behavior in children?
What is a characteristic feature of normal rituals and repetitive behavior in children?
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In what percentage of children does Separation Anxiety Disorder occur?
In what percentage of children does Separation Anxiety Disorder occur?
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What initial influence can lead to the progression of Separation Anxiety Disorder?
What initial influence can lead to the progression of Separation Anxiety Disorder?
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Which of the following categories is NOT one of the seven anxiety disorders listed?
Which of the following categories is NOT one of the seven anxiety disorders listed?
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What characterizes anxiety as a mood state?
What characterizes anxiety as a mood state?
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Which response system is activated in anticipation of danger?
Which response system is activated in anticipation of danger?
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What distinguishes anxiety from fear?
What distinguishes anxiety from fear?
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What is an example of a common anxiety in children?
What is an example of a common anxiety in children?
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How can moderate amounts of anxiety be beneficial?
How can moderate amounts of anxiety be beneficial?
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Which of the following is NOT a symptom of anxiety?
Which of the following is NOT a symptom of anxiety?
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What is the neurotic paradox?
What is the neurotic paradox?
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What causes normal fears to become debilitating over time?
What causes normal fears to become debilitating over time?
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What is the average age of onset for obsessive-compulsive disorder in children?
What is the average age of onset for obsessive-compulsive disorder in children?
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Which comorbidity is most commonly associated with obsessive-compulsive disorder?
Which comorbidity is most commonly associated with obsessive-compulsive disorder?
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What percentage of children diagnosed with OCD are likely to continue having the disorder 2-14 years after diagnosis?
What percentage of children diagnosed with OCD are likely to continue having the disorder 2-14 years after diagnosis?
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Which characteristic is associated with children displaying anxiety disorders?
Which characteristic is associated with children displaying anxiety disorders?
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What cognitive disturbance is typical of children with anxiety disorders?
What cognitive disturbance is typical of children with anxiety disorders?
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How do children with anxiety disorders typically perceive threats?
How do children with anxiety disorders typically perceive threats?
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Which physical symptom is commonly reported by children with generalized anxiety disorder?
Which physical symptom is commonly reported by children with generalized anxiety disorder?
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What is a common effect of high levels of anxiety on a child's academic performance?
What is a common effect of high levels of anxiety on a child's academic performance?
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What emotional issues do children with social anxiety typically report?
What emotional issues do children with social anxiety typically report?
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Which factor is most likely to be independently correlated with depression?
Which factor is most likely to be independently correlated with depression?
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According to early theories, what leads to the development of anxiety and avoidance behaviors?
According to early theories, what leads to the development of anxiety and avoidance behaviors?
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What is the main role of the amygdala in anxiety reactions?
What is the main role of the amygdala in anxiety reactions?
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How does the incidence of anxiety disorders differ between genders?
How does the incidence of anxiety disorders differ between genders?
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Which theories propose that fears and anxieties are learned behaviors?
Which theories propose that fears and anxieties are learned behaviors?
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Which of the following aspects do cultural influences affect regarding anxiety?
Which of the following aspects do cultural influences affect regarding anxiety?
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What symptom may be unique to anxious children compared to others?
What symptom may be unique to anxious children compared to others?
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What age range is most commonly affected by school refusal?
What age range is most commonly affected by school refusal?
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Which of the following is NOT a characteristic of specific phobia?
Which of the following is NOT a characteristic of specific phobia?
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What percentage of children are estimated to be affected by social anxiety disorder at some point in their lives?
What percentage of children are estimated to be affected by social anxiety disorder at some point in their lives?
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What is the most common fear associated with social anxiety disorder?
What is the most common fear associated with social anxiety disorder?
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Selective mutism is characterized by a failure to speak in which of the following settings?
Selective mutism is characterized by a failure to speak in which of the following settings?
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At what average age does selective mutism typically onset?
At what average age does selective mutism typically onset?
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What is a common result of untreated specific phobia in children?
What is a common result of untreated specific phobia in children?
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Which disorder is characterized by intense fear or discomfort accompanied by physical and cognitive symptoms?
Which disorder is characterized by intense fear or discomfort accompanied by physical and cognitive symptoms?
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Study Notes
Description of Anxiety Disorders
- Anxiety is a mood state characterized by strong negative emotion and bodily symptoms of tension in anticipation of future danger or misfortune.
- Anxiety disorders involve experiencing excessive and debilitating anxieties.
- Many children with anxiety disorders suffer from more than one type.
Experiencing Anxiety
- Moderate amounts of anxiety helps us think and act more effectively.
- Excessive, uncontrollable anxiety can be debilitating.
- The neurotic paradox is a self-defeating behavior pattern – fear with no threat.
- Fight/flight response is an immediate reaction to perceived danger or threat aimed at escaping potential harm.
Three Interrelated Anxiety Response Systems
- Physical system: The brain sends messages to the sympathetic nervous system, fight/flight response.
- Cognitive system: Activation leads to feelings of apprehension, nervousness, difficulty concentrating, and panic.
- Behavioral system: Aggression is coupled with a desire to escape the threatening situation.
Anxiety Versus Fear and Panic
- Anxiety is a future-oriented mood state that may occur in absence of realistic danger.
- Fear is a present-oriented emotional reaction that occurs in the face of a current danger and marked by a strong escape tendency.
- Panic is a group of physical symptoms of fight/flight response that unexpectedly occur in the absence of obvious danger or threat.
Normal Fears, Anxieties, Worries, and Rituals
- Moderate fear and anxiety are adaptive.
- Emotions and rituals that increase feelings of control are common in children and teens.
- Normal fears: Fears that are normal at one age can be debilitating a few years later. A fear defined as normal depends on its effect on the child and how long it lasts. The number and types of fears change over time.
Seven Categories of Anxiety Disorders
- Separation Anxiety Disorder (SAD)
- Generalized anxiety disorder (GAD)
- Specific phobia
- Social anxiety disorder
- Panic disorder (PD)
- Agoraphobia
- Selective mutism
Prevalence and Comorbidity
- SAD is one of the two most common childhood anxiety disorders.
- It occurs in 4-10% of children.
- It is more prevalent in girls than in boys.
- More than 2/3 of children with SAD have another anxiety disorder and about half develop a depressive disorder.
Onset, Course, and Outcome
- SAD has the earliest reported age of onset of anxiety disorders (7-8 years of age) and the youngest age at referral.
- It progresses from mild to severe.
- It is associated with major stress.
- It persists into adulthood for more than 1/3 of those diagnosed.
Outcome as Adults
- As adults, individuals with SAD are more likely to experience relationship difficulties, other anxiety disorders and mental health problems, and functional impairment in social and personal life.
School Reluctance and Refusal
- School refusal behavior is a refusal to attend classes or difficulty remaining in school for an entire day.
- It occurs most often in ages 5-11.
- Fear of school may be fear of leaving parents (separation anxiety), but can occur for many other reasons.
- Serious long-term consequences result if it remains untreated.
Specific Phobia
- It is an age-inappropriate persistent, irrational, or exaggerated fear that leads to avoidance of the feared object or event and causes impairment in normal routine.
- It lasts at least 6 months.
- It is an extreme and disabling fear of objects or situations that in reality pose little or no danger or threat.
- The child/adolescent goes to great lengths to avoid the object/situation.
Prevalence and Comorbidity
- About 20% of children are affected at some point in their lives, although few are referred for treatment.
- It is more common in girls.
Onset, Course, and Outcome
- Onset at 7-9 years - phobias involving animals, darkness, insects, blood, and injury.
Social Anxiety Disorder (Social Phobia)
- It is a marked, persistent fear of social or performance requirements that expose the child to scrutiny and possible embarrassment.
- It often involves anxiety over mundane activities.
- The most common fear is doing something in front of others.
- Children with Social Anxiety Disorder are more likely than other children to be highly emotional, socially fearful; and inhibited, sad, and lonely.
Prevalence, Comorbidity, and Course
- Lifetime prevalence of 6-12% of children.
- Twice as common in girls.
- Two-thirds also have another anxiety disorder.
- 20% also suffer from major depression and may self-medicate with alcohol and other drugs.
- Most common age of onset is early to mid-adolescence, and is rare under age 10.
Selective Mutism
- It is the failure to talk in specific social situations, even though they may speak loudly and frequently at home or other settings.
- It is estimated to occur in 0.7% of children.
- Average age of onset is 3-4 years.
- It may be an extreme type of social phobia, but there are differences between the two disorders.
Panic
- Panic Attacks: Sudden, overwhelming period of intense fear or discomfort accompanied by four or more physical and cognitive symptoms characteristic of the fight/flight response.
- Rare in young children; common in adolescence and adulthood.
Diagnostic Criteria for Obsessive-Compulsive Disorder
- Obsessions are recurrent and persistent thoughts, impulses, or images that are experienced as intrusive and unwanted.
- Compulsions are repetitive behaviors or mental acts that the person feels driven to perform in response to an obsession.
- The obsessions or compulsions are time-consuming (e.g., take more than 1 hour per day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
Prevalence and Comorbidity
- Lifetime prevalence in children and adolescents is 1-2.5%.
- Clinic-based studies find it twice as common in boys.
- Comorbidities most common are other anxiety disorders, depressive disorders, disruptive behavior disorders.
Onset, Course, and Outcome
- Average age of onset 9-12 years with peaks in early childhood and early adolescence.
- Chronic disorder - as many as two-thirds continue to have OCD 2-14 years after initial diagnosis.
Associated Characteristics
- Children with anxiety disorders display a number of associated characteristics: cognitive disturbances, physical symptoms, social and emotional deficits, anxiety and depression.
Cognitive Disturbances
- Disturbance in how information is perceived and processed.
- Intelligence and academic achievement: Despite normal intelligence, deficits are seen in memory, attention, and speech or language. High levels of anxiety can interfere with academic performance. Those with generalized social anxiety may drop out of school.
- Threat-related attentional biases: Selective attention is given to potentially threatening information. Anxious vigilance or hypervigilance permits the child to avoid potentially threatening events.
- Cognitive errors and biases: Perceptions of threats activate danger-confirming thoughts. Children with conduct problems select aggressive solutions in response to a perceived threat. Children with anxiety disorders see themselves as having less control over anxiety-related events than other children.
Physical Symptoms
- Somatic complaints, such as stomachaches or headaches, are more common in children with GAD, PD and SAD than in those with a specific phobia.
- 90% with anxiety disorders have sleep-related problems, e.g., nocturnal panic.
- High rates of anxiety in adolescence are related to reduced accidents and accidental deaths in early adulthood.
Social and Emotional Deficits
- Anxious children display low social performance and high social anxiety.
- They see themselves as shy and socially withdrawn, and report low self-esteem, loneliness, and difficulty initiating and maintaining friendships.
- They have deficits in understanding emotion and in differentiating between thoughts and feelings.
Anxiety and Depression
- A child’s risk for accompanying disorders will vary with the type of anxiety disorder.
- Depression is diagnosed more often in children with multiple anxiety disorders.
- Negative affectivity: persistent negative mood.
- Positive affectivity: persistent positive mood. Negatively correlated with depression, but is independent of anxiety symptoms and diagnoses.
Gender, Ethnicity, and Culture
- Higher incidence of anxiety disorders in girls suggests genetic influences and related neurobiological differences.
- The experience of anxiety is pervasive across cultures.
- Ethnicity and culture may affect the expression, developmental course, and interpretation of anxiety symptoms.
Theories and Causes – Early Theories
- Classical psychoanalytic theory: Anxieties and phobias seen as defenses against unconscious conflicts rooted in the child’s early upbringing.
- Behavioral and learning theories: Fears and anxieties learned through classical conditioning and maintained through operant conditioning.
- Bowlby’s theory of attachment: Fearfulness is biologically rooted in the emotional attachment needed for survival. Early insecure attachments lead children to view the environment as undependable, unavailable, hostile, and threatening.
- No single theory is sufficient.
Temperament
- Variations in behavioral reactions to novelty result, in part, from inherited differences in the neurochemistry of brain structures.
- Amygdala: Primary function is to react to unfamiliar or unexpected events.
- Projections of the amygdala to the motor system, anterior cingulate and frontal cortex, hypothalamus, and brainstem play a key role in the fight-or-flight response.
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Description
This quiz explores the nature of anxiety disorders, highlighting their characteristics, impacts, and response systems. It covers how anxiety can be both beneficial and debilitating, as well as the interplay between physical, cognitive, and behavioral responses. Understand the complexities of anxiety in both children and adults.
