Understanding Anxiety Disorders

Anxiety Disorders Overview

• Anxiety disorders are commonly diagnosed in children, adolescents, and adults.
• These disorders can be internalizing, featuring exaggerated fears, worries, and avoidance.
• Many cases are untreated because anxiety is seen as typical in childhood.

Types of Anxiety Disorders

• Separation Anxiety Disorder involves fear of being apart from attachment figures, leading to distress.
• Generalized Anxiety Disorder includes persistent worry about life aspects, causing distress.
• Social Anxiety Disorder features intense fear of social situations, due to fear of judgment.
• Panic Disorder involves sudden fear episodes with physical symptoms like palpitations and dizziness.
• Selective Mutism is when a child doesn't speak in social situations due to anxiety, despite speaking in others.

Anxiety's Time Course

• Anxiety can be either transitory or persistent.
• Persistent anxiety affects school, social interactions, and can predict future disorders.

Anxiety vs. Anxiety Disorder

• Anxiety involves negative emotions anticipating future danger.
• An anxiety disorder involves maladaptive anxiety that interferes with daily functioning due to its intensity and duration.

Experiencing Anxiety

• Anxiety is a response to perceived threats, manifesting cognitively, physically, and behaviorally.
• It is adaptive when preparing for challenges but debilitating when causing avoidance.

Physical System of Anxiety

• Physical symptoms include increased heart rate, dizziness, nausea, and muscle tension.
• These are triggered by the sympathetic nervous system activating during perceived threats.

Cognitive System of Anxiety

• Cognitive symptoms include thoughts of harm and inadequacy, leading to difficulty concentrating.
• Self-critical thoughts occur as the individual searches for threats.

Behavioral System of Anxiety

• Behavioral symptoms involve avoidance, like avoiding eye contact or anxiety-triggering situations.
• Avoidance is often reinforced by temporary relief from anxiety.

Anxiety vs. Fear and Panic

• Anxiety is future-oriented and focuses on potential threats.
• Fear is present-oriented and responds to immediate danger.
• Panic involves sudden fear episodes without an apparent threat.

Atypical and Typical Development Regarding Fears

• Typical fears and anxieties are common and adaptive, declining with age.
• Atypical development involves persistent, intense fears that disrupt functioning.

Typical Fears

• Common at every age, typical fears are adaptive.
• Typical fears can become debilitating if they persist beyond what is typical for the developmental stage.

Typical Anxieties and Worries

• Common and useful for development, excessive anxieties can indicate disorder.
• Excessive anxieties indicate an anxiety disorder if they impair one's daily functioning.

Typical Rituals

• Common in childhood, rituals provide predictability.
• Rituals can become problematic if they interfere with normal development.

Separation Anxiety Disorder Details

• Separation anxiety involves excessive fear of separation from attachment figures.
• It is prevalent in children and can co-occur with other anxiety disorders.
• It can range from mild to severe, requiring intervention to prevent long-term impairment.

School Reluctance and Refusal

• School reluctance is associated with separation anxiety.
• It can manifest as difficulty attending school due to fear, requiring specific interventions.

ADHD: "Intention Deficit"

• ADHD involves deficits in self-regulation, involving the frontal lobes.

ADHD: Chronic Neurodevelopmental Disorder

• ADHD is characterized by persistent, age-inappropriate behavior leading to impairment.
• These behaviors are linked to deficits in executive function within the frontal lobe.

ADHD: Prevalence and Gender Differences

• ADHD prevalence is higher in boys, with ratios from 3:1 to 6:1.
• This is possibly due to referral bias, where boys' behaviors are more likely seen as problematic.

ADHD: Other Diagnostic Criteria

• ADHD diagnosis considers age of onset, the setting, and the level of impairment.
• Symptoms must be present before age 12 and occur in multiple settings.

ADHD: Core Characteristics

• The two primary dimensions include inattention, and hyperactivity or impulsivity.
• Inattention involves difficulties in maintaining focus.
• Hyperactivity and impulsivity is marked by excessive activity.

ADHD: Inattention Details

• Inattention involves deficits in attentional capacity (ability to handle information).
• Selective attention involves difficulty distinguishing relevant stimuli.
• Sustained attention involves challenges in maintaining focus over time.

ADHD: Deficits in Sustained Attention

• A core feature involves deficits in sustained attention.
• Problems with alerting (initial reactions to stimuli) may also contribute.

ADHD: Hyperactivity-Impulsivity

• Hyperactivity involves excessive motor activity.
• Impulsivity includes difficulties in delaying responses.
• Impulsivity is conceptually distinct but often co-occurs with hyperactivity.

Impulsivity Types

• Cognitive impulsivity involves poor decision-making.
• Behavioral impulsivity leads to actions without forethought.
• Emotional impulsivity leads to rapid emotional responses.
• Cognitive and behavioral impulsivity predicts academic difficulties and social challenges.
• Behavioral impulsivity is linked to conduct disorders and antisocial behavior.
• Emotional impulsivity is associated with poor long-term outcomes in social and career domains.

ADHD: Diagnosis and Associated Characteristics

• ADHD diagnosis requires ruling out other causes for symptoms.
• Factors such as birth month may influence diagnosis rates.
• Associated characteristics include cognitive deficits in executive functions and distorted self-perceptions.

ADHD: Cognitive Deficits and Executive Functioning

• Executive function deficits impact control processes and academic performance.
• Executive function deficits are not unique to ADHD.

ADHD: Language Impairments

• Language impairments affect structure (grammar) and pragmatic use, impacting social interactions.

ADHD: Medical and Physical Concerns

• Concerns include sleep disturbances, accident proneness, and risk-taking.
• There is an increased risk of injuries and legal issues in adulthood.

ADHD: Social Problems

• Individuals experience negative interactions, struggle with social rules, and may not learn from social mistakes.

ADHD: Psychological Disorders

• ADHD frequently co-occurs with ODD, CD, anxiety disorders, mood disorders, developmental coordination disorder, and tic disorders.

Intellectual Developmental Disorder (IDD): Overview

• IDD is categorized as a neurodevelopmental disorder in the DSM-5-TR.
• IDD involves limitations in intellectual functioning and adaptive behavior and has an onset during development.

IDD: Essential Elements

• The first element is intellectual functioning, the cognitive abilities like reasoning. The DSM-5-TR does not specify IQ score cutoffs
• The second is adaptive behavior, the daily skills needed to live independently. This includes coping with life's demands and social relationships.
• The third element is a developmental period during which symptoms manifest, typically before adulthood.

IDD: Context of Typical Development

• Understanding IDD requires comparing an individual's development to typical milestones.

Defining Intellectual Functioning in IDD

• The DSM-5-TR emphasizes deficits in intellectual functioning without strict IQ cutoffs. This considers cognitive capabilities from clinical assessments.

The Controversial IQ: Stability

• It is debated whether IQ is stable, innate, or influenced by environment.
• While IQ can be stable, the correlation with outcomes varies.

The Controversial IQ: Influences

• Early childhood is critical as stimulation programs shape intellectual development.
• Despite genetic components, environmental factors matter from ages 0 to 5.

Defining Adaptive Behavior

• Adaptive behavior involves conceptual, social, and practical domains.
• The Conceptual domain includes skills in language, literacy, math, and managing money.
• The Social domain includes empathy, social interactions, and forming relationships.
• The Practical domain covers daily living skills, hygiene, and using transportation.

Adaptive Behavior: Developmental Appropriateness

• Assessments consider what is appropriate for an individual's developmental stage.
• Assessments tailor support to enhance independence.

Defining Developmental Period in IDD

• Symptoms must appear during early development.
• Focus is on developmental aspects rather than a specific age cutoff.

IDD: Examples

• Cases highlight ability variations and issues in communication and learning.

DSM-5-TR Levels of Impairment

• Levels are based on adaptive functioning, not IQ, scores.
• Mild (85%): People often achieve independence and are diagnosed in early elementary.
• Moderate (10%): Common in Down syndrome, diagnosed in preschool, requiring support.
• Severe (4%): Often organic, diagnosed in later infancy, and needs extensive support.
• Profound (2%): Diagnosed in early infancy, requiring pervasive support.

AAIDD Levels of Needed Support

• Intermittent Support is provided on an "as-needed" basis such as during transition.
• Limited Support is more consistent but not intensive such as regular supervision.
• Extensive Support means ongoing, regular support such as daily support in home living.
• Pervasive Support is highly intensive support across all environments such as full-time care.

AAIDD Categories of Support

• Teaching and Education Activities focus on specialized instruction.
• Home Living Activities include assistance with cooking and personal care.
• Community Living Activities support participation in community life and using public services.
• Employment Activities provide vocational training and job placement.
• Health and Safety Activities ensure medical care and safety awareness.
• Behavioral Activities involve coping skills and emotional regulation.
• Social Activities encourage interpersonal skills, and community involvement.
• Protection and Advocacy Activities safeguard individual rights.

DSM-5-TR vs. AAIDD Frameworks

• DSM-5-TR focuses on adaptive functioning.
• AAIDD emphasizes levels of support.
• Both highlight diagnostic considerations and assistive interactions.

IDD: Developmental Course

• Developmental trajectories in conditions like Down syndrome are examined.
• The developmental versus difference controversy explores if IDD follows typical sequences.

Developmental vs. Difference Controversy

• It contrasts familial influences (genetics) with organic causes (genetic disorders).

IDD: Causes

• Etiology encompasses over 1,000 genetic disorders, alongside genetic and environmental factors.
• Understanding the interplay is vital for diagnosis and intervention.

Specific Learning Disorders (SLDs)

• SLDs involve difficulties in processing information, affecting the ability to take in and express information.
• They are often not immediately apparent in young children.
• These challenges can manifest in various ways, impacting academic performance and other life areas.
• Can be specific, like reading, writing or math, or more general.

SLDs: Main Diagnostic Feature

• The key diagnostic feature of SLDs is the failure to learn key academic skills (reading, writing, math).
• The child's academic performance is substantially below what is expected for their age.

SLDs: Overlap

• There is often overlap among different types of SLDs.
• Individuals may exhibit difficulties in more than one area.

SLDs: Specification of Impairment Severity

• Reading impairment presents as issues with accuracy, fluency, and comprehension.
• Written Expression impairment presents as difficulties with spelling, grammar, and organization.
• Math impairment presents as challenges with number sense, fact recall, and reasoning.
• Severity indicates degree of compensation needed

Reading: Basics

• Proficiency in reading is generally expected by Grade 1.
• Parents play a vital role in fostering reading skills.
• Reading involves grapheme-to-phoneme correspondence or the ability to map phenomes to graphemes.
• Decoding involves recognizing phonemes from graphemes.

Reading Processes

• Reading requires the coordination of various processes (directionality, word recognition, vocabulary).
• Difficulties with phonological awareness is most common feature in SLD.
• Reading involves phoneme-based word analysis and whole-word recognition.
• Typical readers use phonological analysis while poor readers rely on memory.

SLD with Impairment in Reading: Difficulties

• Children may struggle with basic sight words. Errors involve reversals, transpositions, inversions, and omissions.

SLD with Impairment in Reading: Core Deficit

• The core deficit is often in decoding and reading single small words.
• Detecting phonological structure and achieving automaticity are crucial.

SLD with Impairment in Reading: Prevalence

• SLDs impact 5-27% of children, with reading disorders being the most common.
• Reading disorders appear during elementary school, are lifelong and affect other areas.
• Male-to-female ratio ranges from 2:1 to 3:1.
• Reading skills improve with practice and exposure.

Integrative Social Framework

• Autism is viewed through a lens that values differences as strengths.
• A mismatch between people and their environments leads to difficulties.

Proposal to Change ASD to ASR

• The shift from Autism Spectrum Disorder (ASD) to Autism Spectrum Recognition (ASR) aims to reduce stigma.
• ASR change focuses on acceptance.

Person First vs. Identity First

• Person-first language (person with autism) is traditionally recommended.
• Some advocate for identity-first language (autistic person).

Autism Spectrum Disorder (DSM-5-TR)

• ASD is a complex neurodevelopmental condition with communication and interaction challenges.
• The DSM-5-TR categorizes levels of severity for required support.

Examples of Range

• Dr. Temple Grandin is an example of the diversity and potential within the autism spectrum.

Spectrum Nature

• While repetitive behaviours and difficulty with social interaction are common, they are not unique to autism

Factors Contributing to Differences

• Level of Intellectual Ability affects how autism presents and the challenges individuals face.
• Language Differences impact communication and social interactions.
• Behavioral Changes with Age change for each individual.

Core Deficits

• Core deficits in ASD are in social communication, interaction and repetitive behaviors.
• Must be present early and cause significant impairment across multiple settings.

Social Communication and Interaction

• Autistic individuals may show inconsistencies in preverbal communication skills such as eye contact.
• There are notable differences in how autistic individuals use gestures.

Instrumental vs. Pragmatic Gestures

• A preference for solitary activities and intense focus on specific interests shapes social interactions.
• Face processing and attachment can influence play and social relationships.

Repetitive Behaviors and Interests

• Individuals with ASD often have narrow, repetitive interests and activities.
• Behaviors may serve as self-stimulatory mechanisms or ways to manage anxiety.

ASD: Intellectual Differences

• Intellectual Developmental Disorder (IDD) often accompanies autism, influencing outcomes.
• Some possess special talents in specific areas.

Cognitive and Motivational Differences

• Can be specific to problems processing social-emotional information.
• General relating to problem solving and attention.

Specific Cognitive Differences

• Individuals may struggle with understanding emotional expressions and mental states.

Pretend Play

• Non-autistic children often engage in imaginative play, while autistic children find it challenging.

General Information Processing Difference

• Individuals may have difficulties with complex problem-solving and focusing on broader contexts.

Are Differences Unique to Autism?

• Differences can be found in other conditions

Prevalence

• ASD affects approximately 1 in 36 children, with increasing rates.
• More males are being diagnosed.

Definitions

School Refusal

• Reluctance to attend school due to emotional distress or anxiety, instead of wanting to skip school.

Childhood Ritual

• Repetitive behaviors or routines done for comfort or structure.

Phoneme

• Smallest unit of sound that distinguishes words.

Central Coherence

• Ability to integrate information into a coherent whole.

Attentional Capacity

• Amount of information a person can process and hold in their attention.

Self-Stimulatory Behavior

• Repetitive input.

Distinguishing Anxiety, Fear, and Panic

• Anxiety is an emotional state with worry about threats.
• Fear is a response to an immediate threat.
• Panic is an intense onset of fear, with physical symptoms.

ADHD Associated Characteristics

• Emotional dysregulation includes impulsive reactions.
• Social difficulties can include relationship challenges.
• Behavioral issues mean bad impulse control.

Social communication Domain

• Deficits in social-emotional reciprocity.
• Deficits in non-verbal communication.
• Difficulties in developing an maintaining relationships.

Restrictive behavior Domain

• Stereotyped movements.

• Insistence on sameness.

• Highly fixated interests.

• Deficits in intellectual functioning, is a component.

• Challenges in behavior, impacting independence, is a component.

• Onset during development, and measured by IQ, is the final component.

Most difficult to operationalize:

• Adaptive functioning deficits involve subjective assessments