Anxiety Disorder

Separation Anxiety Disorder

• Separation anxiety disorder is a fear of separation from attached people that is greater than normal and persists beyond the usual preschool period.
• Onset is before the age of 6 years.
• Diagnosis is not made when there is a generalized disturbance of personality development.
• Children with this disorder are excessively anxious when separated from parents or other attachment figures and are unrealistically concerned about harm befalling them or leaving the child.
• Symptoms include:
  • Refusing to sleep away from attachment figures
  • Disturbed sleep with nightmares
  • Clinging to attachment figures by day, demanding attention
  • Anxiety manifested as physical symptoms (stomach ache, headache)

Treatment Options

• Cognitive behavioral methods, medication, or a combination of both can be used to treat separation anxiety disorder.
• Exposure and response prevention (ERP) is a cornerstone of psychological therapies for children with OCD.
• Involving the family in treatment is important, and about 30% of children will not respond to treatment.

Separation Anxiety Disorder: Epidemiology, Aetiology, and Prognosis

• Epidemiology: 5% of 7-11 year old children experience separation anxiety disorder.
• Aetiology: May be triggered by a frightening experience, family conflicts, or overprotective parents.
• Prognosis: The disorder often improves over time, but may worsen if there is a change in the child's routine.
• Some children may go on to develop generalized or other anxiety disorders in adulthood.

Phobic Anxiety Disorder

• Phobic anxiety disorder is similar to specific phobia in adults.
• Phobias are common in childhood and most commonly involve animals, insects, darkness, school, and death.
• Prevalence of severe, persistent phobias decreases as children grow older.
• Most childhood phobias improve with a firm and supportive approach from parents.
• Behavioral treatment can be helpful if the phobia does not improve on its own.

Social Anxiety Disorder of Childhood

• Begins before the age of 6, involving anxiety with strangers that is greater or more prolonged than the typical fear of strangers seen in the second half of the first year of life.
• Children with this condition often have an inhibited temperament from infancy.
• Fear is centered primarily on adults or other children, interfering with social interaction.
• Treatment is similar to that used for other childhood anxiety disorders.

Sibling Rivalry Disorder

• Diagnosis is made in children who exhibit extreme jealousy or rivalry in response to a new sibling, starting soon after the sibling's birth.
• Symptoms are more pronounced than typical rivalry seen in siblings.
• Children with this condition may show hostility, violence, and regressive behavior, including tantrums to gain attention.
• Treatment involves dividing parental attention fairly, setting clear boundaries, and supporting each child's feeling of being valued.

Post-Traumatic Stress Disorder (PTSD)

• Can occur in children who experience trauma, leading to symptoms similar to those seen in adults.
• Symptoms include:
  • Disturbed sleep
  • Nightmares
  • Flashbacks
  • Avoidance of trauma-related stimuli
  • Behavioral problems
  • Developmental regression
  • Physical symptoms
  • Generalized anxiety
• Aetiology: Encounter with an exceptionally severe stressor, such as natural disasters, war, physical or sexual abuse, violence, or serious injury.
• Prognosis: Exposure to trauma in childhood is associated with a broad range of adverse psychiatric outcomes in adulthood.
• Management: Treatment resembles that for adults, including trauma-focused cognitive behavior therapy (TF-CBT), eye-movement desensitization and reprocessing (EMDR), narrative exposure therapy (NET), and supportive counseling.

Obsessive-Compulsive Disorder (OCD)

• OCD is a complex disorder characterized by the presence of obsessions (unwanted, repetitive, or intrusive thoughts) and compulsions (unnecessary repetitive behaviors or mental activities).
• OCD is common in childhood and adolescence, and is a common cause of distress for children and adolescents.
• Clinical features:
  • Typically develops in late childhood and early adolescence
  • Obsessions and compulsions resemble those in adults
  • Most common obsessions concern contamination, accidents, or illness affecting the patient or another person
  • Symptoms often change as the child grows older
• Epidemiology:
  • Overall prevalence of OCD in young people up to 18 years of age is around 1-3%
  • Males have an earlier age of onset
• Associated disorders:
  • Tic disorders (30%)
  • Major depression (26%)
  • Specific developmental disabilities (17%)
  • Simple phobias, ADHD, conduct disorder, and separation anxiety disorders
• Prognosis:
  • OCD in childhood has a generally poor prognosis, persisting in almost half of cases
  • 50% of adults with OCD report that their symptoms started in childhood
  • Poor outcomes are predicted by earlier age of onset, comorbid psychiatric illness, and poor initial response to treatment
• Management:
  • Inform the child, parents, and teachers about the disorder
  • When obsessional symptoms occur as part of an anxiety or depressive disorder, treatment is directed to the primary disorder
  • True obsessional disorders of later childhood are treated along similar lines to adults