Anxiety in Children

Panic Disorders

Definition - An attack where one has a fear of dying / going crazy, doing something uncontrolled.

Epidemiology - 11.6% of 9^th graders have had at least one 4 symptom panic attack. But overall, it is less common.

Etiology - Shy children may be at risk. Parents with panic disorder have children with greater risk.

Differential Diagnosis - Separation anxiety, Hyperventilation, "Normal" anxiety

Treatment - Medication (SSRI’s, Other antidepressants), Therapy

Anxiety Disorders

everyone is "wired" differently, react to similar situations differently (i.e. some sleep during class, others wide awake)

people look at stimuli differently Þ connected to temperament

illness is linked to how your "wired"

example: no risk factors for cardiovascular disease, has a heart attack (posterior infarct), why?

it was psychologically related Þ personality factor (i.e. explosive anger, beyond type A personality)

Signs / Symptoms of Anxiety

Cardiovascular: palpitations, tachycardia

Respiratory: shortness of breath

Skin: blotching, "rash"

GI: diarrhea, nausea

Musculoskeletal: tremor, muscle tension

Other: headaches, startles easily

Some Examples of Childhood Anxiety

(1) Separation Anxiety Disorder

anxiety to separation from parents or loved ones; normal unless the response gets in the way of day-to-day functioning

Developmental Perspective: normal in late infancy; sometimes in kindergarten and 1^st grade

Epidemiology: boys = girls; peak incidence around 11 years of age

Differential Diagnosis: Depression; Truancy; GAD; Panic disorder

Course and Outcome: younger children = better outcome; older children = worse outcome

Treatment: Therapy; Medications - SSRI’s (Prozac, Zoloft)

(2) Generalized Anxiety Disorder (GAD) (a.k.a."over-anxious disorder"; can result from anger/conflict within family)

excessive and unrealistic worries about competence, approval, appropriateness, etc (i.e. parents give child feeling they are never living up to expectations - "my son is great but if he could only do ______, he would be a perfect kid")
extreme self-consciousness; trouble relaxing; somatic complaints

DSM IV criteria: include BOTH of the following for at least 6 months

persistent worrying
3 of the following: restlessness; feeling keyed up; being easily fatigued; trouble concentrating; irritability; muscle tension; sleep disturbances

Developmental Perspective: usually seen in late elementary school; worries about how one appears

Epidemiology: Childhood (males = females); Adolescence (females > males);

Higher risk = 1^st born children, achievement-oriented family

Course and Outcome: wax/wane; gradual improvement

Differential Diagnosis: medical causes; hyperthyroid, hypoglycemia; depression; ½ have another anxiety disorder

Treatment: therapy and medications

(3) Reactive Attachment Disorder

an emotional disturbance that develops in infants and very young children to the degree to grossly inadequate emotional nurturing

Developmental Perspective

affectional bonds is more of a gradual process
no intervention means failure to thrive, frequent illnesses and eventual death

Epidemiology: prevalence remains unknown; risk factors (low birth weight, sickliness, prematurity, parents with difficulties)

Etiology and Pathogenesis: little eye contact; lack of responsiveness to baby’s vocalizations; inconsistent responses

Differential Diagnosis: autism; severe mental retardation; medical problems

Treatment: establish adequate feeding and wght gain; treatment of malnutrition; provision of adequate stimulation and intervention

Course and Outcome: at risk for continued impairment

(4) Phobias

Definition: fear associated with avoidance behavior

Epidemiology: social phobias (boys > girls); simple phobias (girls > boys, 5% of population)

Etiology: genetic predisposition?; Psychoanalysis: thoughts state symbolic displacement of intolerable fears

Differential Diagnosis: increased fears; schizophrenia; avoidant personality; depression

Course and Outcome: social phobia = chronic; single phobia = usually improve

Treatment: therapy and medications

(5) PTSD

Signs and Symptoms

re-experiencing the traumatic event (i.e. abused - sexually, physically, mentally)
avoidance
increased arousal: insomnia, irritability, vigilance

Therapy: medications - antidepressants (Prozac, Zoloft)