Anxiety disorders
One disorder is specific to
children and adolescence: separation anxiety disorder (SAD). Other anxiety
disorders that may occur in children and adolescents include: generalized
anxiety disorder (GAD), panic disorder (with and without agoraphobia), simple
and social phobias, and post-traumatic stress disorder (PTSD). Specific
physical and cognitive symp-toms are described for each disorder. Developmental
principles apply.
· Very young children experience
‘stranger danger’, later simple phobias , and
SAD with the beginning of the school years.
· Middle childhood presentations
include fears of animals, the dark, burglars, and anxiety-related abdominal
pain.
· A recrudescence or first
presentation of SAD may occur at the onset of secondary schooling.
· Adolescents may experience social
phobia, and panic with or without agoraphobia.
Rates vary by disorder. SAD and
GAD are not uncommon presentations to tertiary clinics. Panic disorders are
less common.
Child abuse may present as an
anxiety disorder. Anxiety and depression often co-occur and mood should always
be assessed. Acting out behaviour may be due to anxiety. Truancy must be
differentiated from school refusal s to
separation anxiety. Prominent physical symptoms, esp. without typi-cal
anxiety-related onset (e.g. Monday morning stomach pains), should be
investigated. Occasionally, you must decide ‘who has the anxiety’, the child
not wanting to go to school or the parent.
CBT
is the treatment of choice for
anxiety disorders, general principles include
the following:
· Clarity of diagnosis and
psycho-education of child and parents (over-investigation often causes more
anxiety).
· Helping child to face their fears,
usually by hierarchical desensitization. Rapid exposure techniques (flooding or
implosion) are rarely used.
· Identification of unhelpful,
distorted, or maintaining cognitions, challenging these cognitions, and
practising more functioning thinking.
· Skills acquisition, e.g.
progressive muscle relaxation, guided imagery.
· Parents as motivators and
behavioural coaches.
· Early relapse identification.
Medication
is usually reserved for when there
is either no response or only an
incomplete response to psychological therapy. The selective serotonin reuptake
inhibitors (SSRIs) have been shown to have short term benefit in the treatment
of anxiety disorders, in children and adolescents.
Untreated anxiety disorders
predict later internalizing conditions in girls and externalizing disorders in
boys. Short-term outcome of treatment is positive, especially in conjunction
with parental support.
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