Embedded Files
treatment for anxious children – no individual receives any income from these materials. Anxiety disorders F.1 2 IACAPAP Textbook of Child and Adolescent Mental Health I t was not very many years ago that anxiety disorders in children were thought to be relatively rare and low impact conditions. As a result, our empirical knowledge about child anxiety is less extensive than it is for the adult conditions. Nevertheless, the past 15 to 20 years have seen a dramatic increase in the number of studies examining child anxiety and we are now building a good understanding of the nature, development and treatment of these disorders. Even more recently, interest has started to focus on possible prevention of anxiety. Given the overlap between anxiety and depression as well as the continuity from childhood into adulthood, this work has far-reaching implications for prevention of internalising difficulties across the lifespan. Compared with research in the adult realm that tends to split disorders very specifically, within the child and adolescent fields, there is a more common tendency to examine anxiety relatively broadly and, in many cases, to examine internalising disorders as a whole. Therefore, in the current chapter, I will write about anxiety disorders very broadly and consider factors relevant to all the anxiety disorders as a group. This is especially the case for therapy, where most empirically supported psychological treatment packages have tended to include children across the range of anxiety disorders. Given that other chapters in this book focus on obsessive compulsive disorder, post-traumatic reactions and separation anxiety, I will focus, where possible, more directly on the remaining disorders – generalised anxiety, social anxiety and specific phobias. In fact, since publication of the DSM5, obsessive compulsive disorder and post-traumatic stress disorder are no longer included with the anxiety disorders, even though they share many characteristics, risk factors, and treatments. To reduce repetition, I will generally use the terms child anxiety or childhood anxiety to refer to anxiety in both children and adolescents, unless specific age distinctions are necessary. DESCRIPTION AND DIAGNOSIS The core feature of anxiety disorders is avoidance. In most cases this includes overt avoidance of specific situations, places, or stimuli, but it may also involve more subtle forms of avoidance such as hesitancy, uncertainty, withdrawal, or ritualised actions. These behaviours are relatively consistent across disorders and the key difference between specific disorders is the trigger for this avoidance. The avoidance is generally accompanied by affective components of fearfulness, distress or shyness. Some children, however, especially younger ones, may have difficulty verbalising these emotions. Anxiousness occurs due to an expectation that some dangerous or negative event is about to occur – in other words, an expectation of threat. Therefore, in identifying the anxious child, it is crucial to determine that the avoidance occurs due to an expectation of some form of threat. For example, two children may say that they do not want to go to school. In one case this appears to be due to the fact that they are having more fun going to the shops with their friends; in the second case it appears to be due to a belief that other children are making fun of the child. Even though both may superficially seem to be avoiding school, the former case would not reflect anxiety since the behaviour is not motivated by a perceived threat. All of the anxiety disorders will involve an anticipation of threat, which may take the form of worry, rumination, anxious anticipation, or negative thoughts. The key differences between disorders lie in the content of these beliefs, as will be described below. In addition to the described beliefs, behaviours, and emotions, anxious children will often report a range of associated physical complaints reflecting heightened arousal; however, these are rarely specific to a given disorder and hence are rarely diagnostic. Physical symptoms that are common among anxious children include headaches, stomach aches, nausea, vomiting, diarrhoea, and muscle tension. In addition, it is common for many anxious children, especially those that worry considerably, to have difficulty with sleep. Internalising disorders As opposed to “externalising” or “undercontrolled” disorders” – such as conduct disorder, in which children tend to externalize or act out inner conflict or emotions, e.g., through aggression – internalizing disorders reflect problems within the self, such as fears, worrying and unhappiness, traditionally subsumed under the rubric of “neuroses”, "overcontrolled" or “overinhibited" problems. Children with internalising disorders tend to deal with problems and emotional conflict internally rather than acting them out. Internalizing disorders usually cause more distress to the child than to those around them, the opposite of what happens with externalizing disorders. Anxiety disorders F.1 3 IACAPAP Textbook of Child and Adolescent Mental Health Table F.1.1 Core and associated features of the various anxiety disorders. DISORDER CORE FEATURES ASSOCIATED FEATURES Separation anxiety disorder Fear or concern that something bad will happen to the child or attachment figure (commonly a parent) when they are separated. As a result of this belief, the child avoids
Google Sites
Report abuse