Wednesday, January 25, 2012

"What are the types of Anxiety Disorders in childhood" written by our Guest Psychologist Dr Nicole Arthur Jindalee Brisbane

Types of Anxiety Disorders in Children 

Whilst most Anxiety Disorders are generally presented across the lifespan, one exception occurs. Separation Anxiety Disorder is an anxiety disorder that is only diagnosed in childhood. 
Anxiety Disorder Specific to Childhood
Separation Anxiety Disorder (SAD)

Children with SAD experience recurrent and excessive fear regarding their separation from home or their loved ones. The fear involves dangers that may occur to these individuals or to the children themselves. This leads to their reluctance or refusal to be separated from their loved ones, to be alone, or to be away from home. Separation anxiety may also present in the form of nightmares or complains of physical symptoms when separation occurs or is pending.


Children attempt to avoid the separation (e.g., crying, clinging, exhibiting behaviour tantrums, or complaining that they are physically unwell) or to escape from the situations where separation occurs (e.g., feigning ill in order to return home from school). This behaviour can interfere with their daily activities (e.g., going to school, engaging in camping activities or sleepovers). Such behaviours and symptoms need to occur for at least 4 weeks for a diagnosis of Separation Anxiety Disorder to be warranted.

Selected Anxiety Disorders (Not-specific to Childhood)
Generalized Anxiety Disorder (GAD)
 
Children with GAD have a tendency to be overly concerned and constantly worried about a range of different things (e.g., school performance, family stability, health, past mistakes, future, environment). The worries occur most of the time for a period of at least 6 months. They also find it difficult to control the worries which are commonly accompanied by restlessness, fatigue, difficulties concentration, irritability, disturbed sleep, or muscle tension
 
Specific Phobias
 
Children with specific phobias experience persistent and excessive fears about certain objects or circumstances (e.g., animals, injection, darkness, or storm). When exposed to these, they exhibit extreme signs of distress (e.g. crying, freezing, clinging or behaviour tantrums). Also, they try to avoid and stay away from the feared objects or escape from the feared situations (e.g., a child with an injection phobia is likely to protest being in a close proximity with a doctor with a needle in his hand or a child with a height phobia is likely to exhibit behaviour tantrums so that her parents will take her out of a tall building). The avoidance, anxious anticipation, and distress in the feared situations must interfere significantly with their daily function for a period of at least 6 months before a diagnosis is warranted.

Social Anxiety Disorder
 
Children with Social Anxiety Disorder experience marked and persistent fear when being in social (e.g., initiating conversation with friends, being assertive) or performance (e.g., reading aloud to class, playing musical instrument on stage) situations. When exposed to these situations, they experience apprehension that they will embarrass themselves or will be evaluated negatively. For this reason, they generally attempt to avoid or escape from these feared situations. The avoidance, anxious anticipation, and distress in the feared situations must interfere significantly with their daily function for a period of at least 6 months before a diagnosis is warranted.

Obsessive-Compulsive Disorder (OCD)

Children with OCD experience recurrent and persistent intrusive thoughts (including impulses and images). Although they may understand that these thoughts are not rational, they become obsessed and preoccupied with them (e.g., becoming apprehensive about germs or infection). They find it exceedingly difficult to stop thinking about the preoccupation which they find anxiety-provoking. 
 
For this reason, the obsession often drives children to compulsively perform certain rituals (e.g., constantly washing hands) to prevent the negative consequences of their preoccupation. They generally establish arbitrary rules for the rituals and feel the compulsion to perform them to the point of perfection to eradicate their anxiety. The connection between the obsession and compulsion to complete the rituals is then established as a habit and maintained although the children may be informed otherwise. If the obsession and compulsion cause the children marked distress and last more than 1 hour a day, a diagnosis of OCD may be warranted.
Post-Traumatic Stress Disorder (PTSD)
For a diagnosis of PTSD a child must be exposed to at least one traumatic event, either first-handed (e.g., being in a tornado, being sexually abused) or second-handedly (e.g., witnessing a car accident, seeing their parents being hurt). In the situation, they must have experienced intense fear and helplessness. They must also within a period of 3 months after the event, re-experience the event through recollection, feelings, dreams, or physiological reactivity and become extremely anxious. Generally, they will respond to the anxiety by avoiding thoughts, feelings, or conversations associated with the trauma or its reminders. Increased arousal in the forms of difficulties sleeping, irritability, hypervigilance, or startled responses to cues of the event may also observed. If these behaviours and symptoms significantly interfere with normal functioning and daily activities for a period of at least 1 month, then a PTSD diagnosis may be warranted.
Dr Nicole Arthur
BHMS (Ed) B Arts (Psych)(Hons) D Psych Clin MAPS
Clinical Psychologist and Director