Anxiety Disorders

Anxiety Disorders

·        Fears are normal during childhood and adolescence:

o  Age 1 – 2: fear of separation from parents

o  Young child: scared of the dark, animals, storms, monsters

o  Age 7 – 8: begin to worry about their performance

o  Adolescents: concern about being disliked, rejected, or criticised by their peers 

o  Þ Fears generally reflect developmental stage

·        Anxiety disorder:

o  Fears become intense or pervasive and substantially impair functioning

o  Can follow chronic, fluctuating course 

o  Not easy to recognise as young people often know that their fears are groundless and feel ashamed of what they think is a flaw in their character 

·        Anxiety disorders: Separation anxiety disorder, social phobia, generalised anxiety disorder, obsessive compulsive disorder, post-traumatic stress disorder

Separation Anxiety Disorder

·        Child very anxious away from home or from their parents

·        May present with:

o  Refusal to attend school – but school‟s not the problem, the separation is

o  Feeling physically ill in the morning.  Monday‟s the worst day

o  Reluctance to sleep at friends places, school camps, etc

o  Worried that harm will befall their parents while they‟re away

o  Difficulty coping with parents going out

o  Difficulty going off to sleep, or needing company of a parent while they do

·        History should include: 

o   School: problems, bullying, fears, etc

o   Home: stressors, conflicts

o   Maternal depression, anxiety, adjustment disorder, etc 

o   Parents may have some insight – but usually underestimate the severity of the maternal-child dependence and are very defensive

·        Diagnosis: irrational fear of harm to parents or that they will be abandoned by them

·        Differential for school non-attendance:

o   Truancy, conduct disorder: doesn‟t go to school – but doesn‟t stay at home either

o   Anxiety-based refusal

o   Major depression: lacks motivation

o   Other reasons: at home to help with work, etc

·        Epidemiology: F > M.  Peaks in early adolescence

·        Course:

o   May be triggered by a worrying or traumatic incident.  May be family history of anxiety problems 

o   Eventually become isolated from friends and get behind at school. Feel embarrassed and different. ¯Self esteem. All makes returning to school more difficult

o   Prognosis depends on the young person, family strengths and severity

o   Increased risk of agoraphobia in adulthood

·        Management:

o   Support for parents and child 

o   Quick return to school before problem becomes entrenched, even if only for a small portion of the day 

o   Education for child and parent. Facing the fear is initially distressing but reduces the anxiety, avoidance increases it

o   Parents need to be consistent in their commitment to return the child to school 

o   Involve school teachers (eg meet at gate, etc). Problem is actual separation – once settled into the day problem is likely to reduce 

o   Severe or chronic ® referral. Support for parents if they‟re having difficulties. SES Behaviour Support Teams or Resource Teachers for Learning and Behaviour (RTLBs) for child. 

o   No place for medication unless underlying conditions

Bullying

·        = An act of aggression/harassment by a child/youth

·        Starts mid-primary, peaks 3^rd form, nearly gone by 7^th form

·        Typical bullying behaviour: boys hit, girls tease and exclude

·        Teachers generally under-estimate bullying

·        Characteristics of someone who is bullied:

o   Something different: high achiever, less physically attractive, etc

o   Vulnerable: more anxious, cry easily, don‟t fight back 

·        Problem compounded for the bullied in that no one wants to be friends with a person who is bullied ® ­isolation. Standing up to a bully is pretty sophisticated behaviour in early teens – not developmentally consistent with wanting to identify with the peer group 

·        Long term outcomes worse for the bully than for the bullied