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Name: Class: Date: Chapter 11 1. Which of the following is NOT true of anxiety disorders? a. While prevalent in adults, they are relatively rare in children. b. There are several different types of anxiety...

Name: Class: Date: Chapter 11 1. Which of the following is NOT true of anxiety disorders? a. While prevalent in adults, they are relatively rare in children. b. There are several different types of anxiety disorders. c. Anxiety disorders can be persistent across the lifespan. d. Anxiety disorders often occur with other disorders. ANSWER: a 2. The ____ mobilizes the body for action in a fight/flight situation. a. central nervous system b. peripheral nervous system c. sympathetic nervous system d. parasympathetic nervous system ANSWER: c 3. When activated, the sympathetic nervous system causes the release of ____ from glands on the kidney. a. insulin b. adrenaline c. growth hormone d. testosterone ANSWER: b 4. ____ is an immediate alarm reaction to current danger or life-threatening emergencies. a. Anxiety b. Panic c. Fear d. Worry ANSWER: c 5. ____ is characterized by feelings of apprehension and lack of control over upcoming events that might be threatening. a. Anxiety b. Panic c. Fear d. Worry ANSWER: a 6. ____ is a group of physical symptoms of the fight/flight response that unexpectedly occur in the absence of any obvious threat or danger. a. Anxiety b. Panic c. Fear d. Worry Copyright Cengage Learning. Powered by Cognero. Page 1 Name: Class: Date: Chapter 11 ANSWER: b 7. ____ fears increase with age. a. Social b. School-related c. Nighttime d. Parental separation ANSWER: a 8. The fear of death is common among children aged ____. a. 1 to 2 b. 4 to 5 c. 6 to 8 d. 8 to 11 ANSWER: b 9. The fear of separation from parent(s) is common among children aged ____. a. 1 to 5 b. 3 to 6 c. 6 to 9 d. 8 to 11 ANSWER: a 10. Behavioral symptoms of anxiety include ____. a. fatigue b. blurred vision c. thoughts of inadequacy d. fidgeting ANSWER: d 11. Ritualistic behavior is ____ in young children. a. nonexistent b. uncommon c. common d. difficult to observe ANSWER: c 12. Anxiety disorders in the DSM-5 are divided into categories that reflect ____. a. primary dimensions of anxiety (biological/cognitive/behavioral) b. varieties of reaction and avoidance c. the response to treatment (good/poor) Copyright Cengage Learning. Powered by Cognero. Page 2 Name: Class: Date: Chapter 11 d. typical age of onset ANSWER: b 13. When would an absence of separation anxiety suggest an insecure attachment? a. at 2 months of age b. at 7 months of age c. at 10 years of age d. never ANSWER: b 14. One of the most common anxiety disorders of childhood is ____. a. obsessive–compulsive disorder (OCD) b. panic disorder c. generalized anxiety disorder d. separation anxiety disorder (SAD) ANSWER: d 15. The anxiety disorder with the earliest age of onset is ____. a. obsessive–compulsive disorder b. panic disorder c. generalized anxiety disorder d. separation anxiety disorder ANSWER: d 16. The average age of onset for separation anxiety disorder is ____. a. 2 to 3 years of age b. 4 to 6 years of age c. 7 to 8 years of age d. 9 to 10 years of age ANSWER: c 17. Excessive and unreasonable fears usually peak around _____________. a. pre-K b. kindergarten c. second grade d. fourth grade ANSWER: c 18. Which of the following is LEAST likely to lead to school refusal? a. Difficulty with academics b. Separation anxiety disorder Copyright Cengage Learning. Powered by Cognero. Page 3 Name: Class: Date: Chapter 11 c. Fear of being teased or bullied d. Fear of being socially evaluated ANSWER: a 19. Which of the following is NOT a DSM diagnosis? a. Separation anxiety disorder b. Obsessive–compulsive disorder c. Panic disorder d. Test anxiety disorder ANSWER: d 20. For many children, fear of school is really a fear of what? a. Having a difficult time socializing b. Being afraid of the teacher c. Worrying about test taking d. Leaving your parents ANSWER: d 21. School refusal is equally common in boys and girls, and it occurs most often between the ages of ____. a. 3 and 10 b. 5 and 11 c. 7 and 11 d. 8 and 12 ANSWER: b 22. Which of the following distinguishes children with generalized anxiety disorder from those with other anxiety disorders? a. Their worries are age-inappropriate. b. They experience somatic symptoms. c. They worry about minor events. d. They worry about minor events and experience somatic symptoms. ANSWER: c 23. To be diagnosed with generalized anxiety disorder, a child must exhibit ____. a. separation anxiety disorder b. worry about academic performance c. an inability to control worry d. perfectionism and self-critical behavior ANSWER: c 24. The lifetime prevalence of generalized anxiety disorder is ____. Copyright Cengage Learning. Powered by Cognero. Page 4 Name: Class: Date: Chapter 11 a. 1.2% b. 2.2% c. 3.6% d. 6.8% ANSWER: b 25. Unlike adults, children with specific phobias ____. a. avoid the feared stimuli b. do not recognize that their fears are extreme and unreasonable c. experience physiological arousal when presented with the feared stimuli d. are more easily treated ANSWER: b 26. The fact that the most common specific phobia in children is a fear of animals is believed to be due to ____. a. the high rates of exposure to animals in young childhood b. evolutionary processes c. parental overprotection when young children encounter animals d. the large size of the animals ANSWER: b 27. A situational specific phobia would most likely involve a fear of ____. a. heights b. elevators c. illnesses d. injections ANSWER: b 28. ____ is the most common secondary diagnosis for children with another anxiety disorder. a. Specific phobia b. Social anxiety disorder c. Obsessive–compulsive disorder d. General anxiety disorder ANSWER: b 29. Most social anxiety disorders first occur in ____. a. the preschool years b. the primary school years c. late childhood d. adolescence ANSWER: d Copyright Cengage Learning. Powered by Cognero. Page 5 Name: Class: Date: Chapter 11 30. Selective mutism is believed to be a type of ____. a. specific phobia b. generalized anxiety disorder c. obsessive–compulsive disorder d. social phobia ANSWER: d 31. Children who exhibit selective mutism may also ____. a. be developmentally delayed b. have higher than average intelligence c. have strong social skills d. an absence of anxiety ANSWER: d 32. Which of the following is NOT an OCD-related disorder? a. Germ avoidance disorder b. Body dysmorphic disorder c. Hoarding disorder d. Excoriation ANSWER: a 33. Compulsions and obsessions experienced by children typically last ____. a. between 30 and 60 minutes a day b. more than an hour a day c. two to three hours daily d. over three hours daily ANSWER: b 34. The most common compulsions include____________. a. touching and counting b. checking and repeating c. excessive washing and bathing d. ordering and arranging ANSWER: c 35. The rate of obsessive–compulsive disorder in children is ____ the rate of obsessive–compulsive disorder in adults. a. less than b. more than c. equal to d. more variable ANSWER: c Copyright Cengage Learning. Powered by Cognero. Page 6 Name: Class: Date: Chapter 11 36. ____ influences have a greater role in early onset cases of obsessive–compulsive disorder than late onset cases of obsessive–compulsive disorder. a. Parenting b. Learning c. Neurobiological d. Genetic ANSWER: d 37. Which of the following is NOT a characteristic of a panic attack? a. Intense fear or discomfort b. Can last for a few days c. Sense of imminent danger d. Occur several times a week or month ANSWER: b 38. The onset of first panic attack is often related to ____. a. adult stressors b. pubertal stage c. cognitive developmental stage d. the development of internalized speech ANSWER: b 39. Agoraphobia can be best described as the fear of ____. a. leaving home and not being able to get back in the house b. being separated from one’s parents c. having a panic attack in situations in which escape would be difficult or help unavailable d. spiders ANSWER: c 40. Panic attacks occur in about ____ of adolescents. a. 3 % to 4% b. 8% to 10% c. 15% to 20% d. 25% to 30% ANSWER: c 41. A marked fear or avoidance of certain situations in which the individual thinks that escape may be difficult if he or she were to experience panic-like symptoms refers to ________________.. a. ophidiophobia b. acrophobia Copyright Cengage Learning. Powered by Cognero. Page 7 Name: Class: Date: Chapter 11 c. arachnophobia d. agoraphobia ANSWER: d 42. What is one of the main features separating early onset OCD and later onset? a. Individuals in early onset are more likely to be females. b. Individuals in early onset are more likely to be males. c. Individuals in early onset are more likely to have learning disorders. d. Individuals with early onset are more likely to be from wealthy families. ANSWER: b 43. Increased functional impairment and poorer OCD outcomes are more likely when _____________. a. parents practice accommodation b. parents confront the OCD behaviors of their children head on c. children also experience trichotillomania d. children are not diagnosed with OCD until they are older ANSWER: a 44. The most common physical symptoms of anxiety disorders include a. stomachaches and nausea. b. sleep-related problems. c. headaches. d. joint pain. ANSWER: b 45. In most cases, ____. a. anxiety precedes depression b. depression precedes anxiety c. depression and anxiety occur simultaneously d. there is not a clear relationship between anxiety and depression ANSWER: a 46. In comparison to children who are anxious, children who are depressed display ____. a. more negative affectivity b. less negative affectivity c. more positive affectivity d. less positive affectivity ANSWER: d 47. Females are ____ than males to experience anxiety symptoms. a. twice as likely Copyright Cengage Learning. Powered by Cognero. Page 8 Name: Class: Date: Chapter 11 b. less likely c. slightly more likely d. equally likely ANSWER: a 48. Child psychopathology reflects a mix of actual child ____ and the ____ through which others view it in a child’s culture. a. symptoms; structure b. disorders; focus c. behavior; perspective d. behavior; lens ANSWER: d 49. The two-factor theory explains anxiety disorders as arising and persisting through a combination of ____. a. attachment and social learning b. temperament and exposure c. classical and operant conditioning d. modeling and reinforcement ANSWER: c 50. Children with a behavioral inhibition temperament may be less likely to develop a later anxiety disorder if ____. a. their parents protect them from stressful events b. their parents set firm limits that teach them how to cope with stress c. they have older siblings d. their parents ignore their bids for comfort and protection ANSWER: b 51. Findings from twin and adoption studies of anxiety in children and adolescents suggest that the genetic contribution for anxiety ____. a. decreases with age and environmental influence increases b. decreases with age, along with environmental influence c. increases with age and environmental influence decreases d. increases with age, along with environmental influence ANSWER: a 52. The brain system associated with anxiety is called ____. a. behavioral activation system b. behavioral inhibition system c. behavioral formation system d. hypothalamic system ANSWER: b Copyright Cengage Learning. Powered by Cognero. Page 9 Name: Class: Date: Chapter 11 53. The neurotransmitter system most often implicated in anxiety disorders is the ____ system. a. dopaminergic b. nondopaminergic c. GABA-ergic d. prominergic ANSWER: c 54. Prolonged exposure to ______ as a result of early stress or trauma may have neurotoxic effects on the developing brain. a. cortisol b. serotonin c. GABA d. norepinephrine ANSWER: a 55. According to __________________, fearfulness in children is biologically rooted in the need for survival.. a. the two-factor theory b. survival conditioning theory c. behavioral and learning theories d. attachment theory ANSWER: d 56. The parenting style most often associated with anxiety disorders in children is one in which parents are overly ____. a. supportive b. controlling c. permissive d. positive ANSWER: b 57. Twin studies suggest that about ______________ of the variance in childhood anxiety symptoms is accounted for by genetic influences. a. 5% b. 10% to 20% c. 20% to 30% d. 30% to 40% ANSWER: d 58. The most effective treatment of a child’s phobia of riding in a car would involve which final step? a. Playing with toy cars b. Watching tapes of other children riding in cars Copyright Cengage Learning. Powered by Cognero. Page 10 Name: Class: Date: Chapter 11 c. Imagining riding in a car d. Actually riding in a car ANSWER: d 59. The most effective procedure for treating most anxiety disorders is ____. a. behavioral therapy b. cognitive–behavioral therapy (CBT) c. family therapy d. use of medications ANSWER: b 60. To date, the strongest evidence for the effectiveness of medication to treat anxiety disorders in children and adolescents is for ____. a. generalized anxiety disorder b. panic disorder c. obsessive–compulsive disorder d. social phobia ANSWER: c 61. Discuss in detail what happens when the physical response system is activated in the face of perceived danger. ANSWER: Chemical effects. Adrenaline and nonadrenaline are released from the adrenal glands. Cardiovascular effects. Heart rate and strength of the heart beat increase, readying the body for action by speeding up blood flow and improving delivery of oxygen to the tissues. Respiratory effects. Speed and depth of breathing increase, which brings oxygen to the tissues and removes waste. This may produce feelings of breathlessness, choking or smothering, or chest pains. Sweat gland effects. Sweating increases, which cools the body and makes the skin slippery. Other physical effects. The pupils widen to let in more light, which may lead to blurred vision or spots in front of the eyes. Salivation decreases, resulting in a dry mouth. Decreased activity in the digestive system may lead to nausea and a heavy feeling in the stomach. Muscles tense in readiness for fight or flight, leading to subjective feelings of tension, aches and pains, and trembling. 62. Review the three anxiety response systems and give examples from each. ANSWER: Physical System. When a person perceives or anticipates danger, the brain sends messages to the sympathetic nervous system, which produces the fight/flight response. The activation of this system produces many important chemical and physical effects that mobilize the body for action. Cognitive System. Since the main purpose of the fight/flight system is to signal possible danger, its activation produces an immediate search for a potential threat. For children with anxiety disorders, it is difficult to focus on everyday tasks because their attention is consumed by a constant search for threat or danger. When these children can’t find proof of danger, they may turn their search inward: “If nothing is out there to make me feel anxious, then something must be wrong with me.” Behavioral System. The overwhelming urges that accompany the fight/flight response are aggression and a desire to escape the threatening situation, but social constraints may prevent fulfilling either impulse. For example, just before a final exam, you may feel like attacking your professor or not showing up at all, but fortunately, for your professor and your need to pass the course, you are likely to inhibit these urges! However, they may show up as foot tapping, fidgeting, or irritability (consider the number of teeth marks in pencils) or as escape or avoidance by getting a doctor’s note, requesting a deferral, or even faking illness. Copyright Cengage Learning. Powered by Cognero. Page 11 Name: Class: Date: Chapter 11 63. Distinguish between worry, anxiety, and panic. ANSWER: Worry, which is characterized as thinking about all possible negative outcomes, serves an extremely useful function in normal development. In moderate doses, worry can help children prepare for the future—for example, by checking their homework before they hand it in or by rehearsing for an upcoming class play. Anxiety is a mood state characterized by strong negative emotion and bodily symptoms of tension in which the child apprehensively anticipates future danger or misfortune (Barlow, 2002). Panic is a group of physical symptoms of the fight/flight response that unexpectedly occur in the absence of any obvious threat or danger. 64. What are some of the normal worries, anxieties, and rituals/routines of children? ANSWER: The most frequent symptoms in samples of children with normal anxieties are separation anxiety, test anxiety, overconcern about competence, excessive need for reassurance, and anxiety about harm to a parent (Barrios & Hartmann, 1997). In moderate doses, worry can help children prepare for the future—for example, by checking their homework before they hand it in or by rehearsing for an upcoming class play. Ritualistic, repetitive activity is extremely common in young children (Peleg-Popko & Dar, 2003). A familiar example is the bedtime ritual of saying good night—addressing people in a certain order or giving a certain number of hugs and kisses. Normal ritualistic behaviors in young children include preferences for sameness in the environment (e.g., watching the same DVD over and over again), rigid likes and dislikes, preferences for symmetry (e.g., carrying a toy in each hand), awareness of minute details or imperfections in toys or clothes (e.g., being bothered by a minuscule thread on a jacket sleeve), and arranging things so they are “just right” (e.g., insisting that different foods not touch each other on the plate). 65. Give some examples of behavior of a child with separation anxiety disorder (SAD). ANSWER: Young children with SAD may have vague feelings of anxiety or repeated nightmares about being kidnapped or killed or about the death of a parent. They frequently display excessive demands for parental attention by clinging to their parents and shadowing their every move. Often, they are reluctant to sleep separated from their parents, and they try to climb into their parents’ bed at night or sleep on the floor just outside their parents’ bedroom door (Allen et al., 2010). Older children with SAD may have difficulty being alone in a room during the day, sleeping alone even at home, running errands, going to school, or going to camp. They may also have specific fantasies of illness, accidents, kidnapping, or physical harm. 66. What are some symptoms of generalized anxiety disorder (GAD), and which symptom distinguishes GAD from other anxiety disorders? ANSWER: For children with GAD, worrying can be episodic or almost continuous. The worrier is unable to relax and may experience physical symptoms such as muscle tension, headaches, or nausea. Common symptoms of GAD include irritability, difficulty concentrating, and a lack of energy, difficulty falling asleep, and restless sleep (Comer et al., 2012; Layne et al., 2009). In other anxiety disorders, anxiety converges on specific situations or objects, such as separation, social performance, animals or insects, or bodily sensations. In contrast, the anxiety experienced by individuals with GAD is widespread and focuses on a variety of everyday life events (Andrews et al., 2010). 67. List the five subtypes of specific phobias, and give an example of the focus of fear for each one. ANSWER: As specified in DSM-5, common types of specific phobias in young people include fears of animals or insects (e.g., dogs or spiders); fears of natural events (e.g., heights or thunderstorms); fears of blood, injuries, or medical procedures (e.g., seeing blood or receiving an injection); and fears of specific situations (e.g., flying in airplanes, riding on a bus). Both similarities (e.g., age at onset, gender, treatment response) and differences (e.g., focus of fear, physiological reaction, neural response patterns, impairment, comorbidity) have been found across these types, with natural environment and animal phobias having the most in common with other types, and blood, injury, and injection phobias the least (LeBeau et al., 2010; Lueken et al., 2011). Copyright Cengage Learning. Powered by Cognero. Page 12 Name: Class: Date: Chapter 11 68. Distinguish between obsessions and compulsions, and discuss the relationship between them. ANSWER: Obsessions are persistent and intrusive thoughts, urges, or images that are experienced as intrusive and unwanted and generally cause significant anxiety or distress. Compulsions are repetitive, purposeful, and intentional behaviors (e.g., hand washing) or mental acts (e.g., repeating words silently) that are performed in response to obsessions in an attempt to suppress or neutralize them. Most children with OCD have multiple obsessions and compulsions, and certain compulsions are commonly associated with specific obsessions. For example, washing and cleaning rituals are likely to be associated with contamination obsessions, such as a concern with dirt or germs, a concern or disgust with body wastes or secretions (e.g., urine, feces, saliva), or an excessive concern about chemical or environmental contamination. 69. Why are panic attacks rare in young children? ANSWER: One explanation is that young children lack the cognitive ability to make the catastrophic misinterpretations (e.g., “my heart is beating rapidly and I’m sitting here watching TV like I always do—I must be going crazy”) that usually accompany panic attacks (Nelles & Barlow,1988). 70. What are the different symptoms for a diagnostic criteria of panic disorder? ANSWER: One common element is that an abrupt surge can occur from a calm state or from an anxious state. Symptoms include palpitations; pounding heart; accelerated heart rate; sweating; trembling or shaking; sensations or shortness of breath or smothering; feelings of choking; chest pain or discomfort; nausea or abdominal distress; feeling dizzy, unsteady, light-headed, or faint; chills or heat sensations; paresthesias; derealization or depersonalization; fear of losing control or going crazy; and fear of dying. 71. Identify the diagnostic criteria needed for a diagnosis of OCD. ANSWER: First, a child must present obsessions, compulsions, or both. Next, the obsessions or compulsions are time- consuming (at least an hour a day) or cause clinically significant distress or impairment in social, occupational, or other important areas of functioning; the symptoms are not attributable to the physiological effects of a substance abuse or use, or another medical condition; and the disturbance is not better explained by the symptoms of another mental disorder. 72. Compare and contrast positive and negative affectivity and the role of these concepts in understanding the link between anxiety and depression. ANSWER: Positive affectivity refers to a persistent positive mood that includes states such as joy, enthusiasm, and energy. Negative affectivity, in contrast, is a persistent negative mood, as reflected in nervousness, sadness, anger, and guilt. Negative affectivity is related to both anxiety and depression, whereas positive affectivity is negatively correlated with depression and is independent of anxiety symptoms and diagnoses. Children with anxiety generally do not differ from children with depression in their negative affect, suggesting that a general underlying dimension of negative affectivity is common between anxiety and depression. 73. What is the behavior lens principle? ANSWER: Perhaps the most accurate way to analyze cultural differences in anxiety is using Weisz and colleagues’ (2003, p. 384) behavior lens principle, which states that child psychopathology reflects a mix of actual child behavior and the lens through which it is viewed by others in a child’s culture. 74. What role does temperament play in the development of anxiety disorders? ANSWER: Children with a high threshold for novelty are presumed to be at low risk for developing anxiety disorders. Other children (about 15% to 20%) are born with a low threshold for becoming overexcited and to withdrawing in response to novel stimulation as infants, a tendency to be fearful and anxious as toddlers, and a tendency to be unusually shy or withdrawn in novel or unfamiliar situations as young children. This type of temperament is called behavioral inhibition (BI), an enduring trait for some and a predisposing factor for the Copyright Cengage Learning. Powered by Cognero. Page 13 Name: Class: Date: Chapter 11 development of later anxiety disorders, particularly SOC (Chronis-Tuscano et al., 2009; Kagan, 2017). 75. Discuss Kendall’s CBT treatment program Coping Cat, for treating social phobia, generalized anxiety disorder, and separation anxiety disorder. ANSWER: The CBT treatment program Coping Cat, developed by Philip Kendall and his colleagues, is one of the most carefully evaluated treatments for youngsters 7 to 13 years old who have GAD, SAD, and SOC (Kendall, Furr, & Podell, 2010). A teen version is available, as is an Australian adaptation (Coping Koala). This approach emphasizes learning processes and the influence of contingencies and models, as well as the pivotal role of information processing. Treatment is directed at decreasing negative thinking, increasing active problem solving, and providing the child with a functional coping outlook. The intervention creates behavioral experiences with emotional involvement while simultaneously addressing thought processes (Kendall et al., 2010). Copyright Cengage Learning. Powered by Cognero. Page 14