Transcript Chapter 7: Self & Moral Development

Anxiety & Mood
Disorders
In Children
Anxiety Disorders
• Common among children – 9.7% in a
community-based school sample
• More girls than boys
• Fears are normal, but the disorders are
more extreme
• Children tend to cope by becoming
overly dependent on others for support
• Often co-morbid with depressive
disorders or may be influential in the
later development of depression
Separation Anxiety Disorder
• The most common anxiety disorder for children (2 – 41%); may
have other anxiety-based disorders
• Characterized by unrealistic fears, oversensitivity, selfconsciousness, nightmares, chronic anxiety, low self-confidence,
apprehensive in new situations
• Described as shy, sensitive, nervous, submissive, easily
discouraged, worried;
• frequently cry, overly-dependent
• Key feature: excessive anxiety about separation from major
attachment figures and from familiar home surroundings
• A psychosocial stressor may be identified (e.g. a death)
• More common in girls
• Not stable – 44% recovered at 4-year follow-up; some exhibit
school refusal and continue to have adjustment problems
Criteria for Separation
Anxiety Disorder
Developmentally inappropriate and excessive anxiety concerning
separation from home or from those to whom the individual is
attached, as evidenced by 3 or more of the following:
1.
Recurrent excessive distress about being separated from
home or major attachment figures
2.
Persistent and excessive worry about losing or about harm
occurring to family members
3.
Persistent and excessive worry that an untoward event will
lead to separation from a major attachment figure
4.
Persistent reluctance or refusal to go to school or elsewhere
because of fear of separation
5.
Persistently and excessively fearful or reluctant to be alone
or without major attachment figures at home or without
significant adults in other settings
6.
Persistent reluctance or refusal to go to sleep without being
near a major attachment figure or to sleep away from home
7.
Repeated nightmares involving the theme of separation
8.
Repeated complaints of physical symptoms when separation
from major attachment figures occurs or is anticipated
Etiology
• Parental behavior (over-anxious, over-protective &
indifferent or rejecting)
• Cultural factors (those that favor inhibition,
compliance & obedience)
• Constitutional sensitivity to conditioning by
aversive stimuli (e.g. easily upset, difficulty
calming down)
• Traumatic events (illness, hospitalizations,
accidents, losses)
• Sense of diminished control over negative
environmental factors
Treatment
• Successful experiences
• Medication – fluoxetine
• Behavior therapy
- assertiveness training
- desensitization (in vivo methods)
• Cognitive-behavior therapy – group
sessions for recognizing anxiety and coping
more effectively with parent training in
behavioral management
Mood Disorders
• Characteristic behaviors: withdrawal,
crying, avoidance of eye contact,
physical complaints, poor appetite,
aggressive behavior, suicide
• Same criteria as used with adults,
except irritability
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Prevalence
Depression:
• Under 13: 2.8%
• 13–18: 5.6% (girls 5.9%, boys 4.6%)
Bipolar Disorder:
• Diagnosis has increased dramatically, at least in part due to
increased recognition that the disorder does occur in
children
• A high percentage also receive a comorbid diagnosis, often
ADHD
• Equal prevalence in males & females
Disruptive Mood
Dysregulation Disorder
Criteria – p. 156 DSM-5
Key features: chronic, non-episodic
irritability (differentiates from bipolar)
& temper outbursts (supercedes ODD)
At risk for unipolar depressive disorders
and anxiety in adulthood
Etiology
• Parental mood disorders, which also influence interactions
(negative emotional states & negative parental behavior,
less attuned to the child’s needs, modeling of irritability &
affect)
• Prenatal exposure to alcohol
• Exposure to early traumatic events (hyperreactivity of the
nervous system & alteration of neurotransmitter system)
• Divorce
• Attributing positive events to external, specific & unstable
causes and negative events to internal, global & stable
causes
• Fatalistic thinking & feelings of helplessness
Treatment
• Medication – research is contradictory & some shows only
moderate helpfulness & an increased risk of suicide
• The predominant approach has been a combination of
medication and psychotherapy
• Therapy should provide a supportive emotional environment
with the opportunity to learn more adaptive coping
strategies & more effective emotional expression; play
therapy – younger children; discussing feelings openly for
older children; cognitive-behavioral therapy has been shown
to reduce symptoms
• Short-term residential treatment can be effective
• Effective treatment can reduce the recurrence of
depression