Childhood: Clinical and School Psychology – Lecture 2 (UNIVERSITY OF AMSTERDAM)

Disorder

SEPARATION ANXIETY DISORDER

Clinical description

Developmentally inappropriate intense feelings of distress upon separation of the caregiver lasting for at least four weeks. The disorder manifests itself before the age of 18. 6 is considered early onset. School refusal is common.

Symptoms

At least three of the following for at least four weeks:

• Excessive distress in anticipation of separation with the caregiver.
• Excessive worry about potential harm to the caregiver.
• Preoccupation with a future adverse event causing separation from the caregiver.
• Reluctance to go away from familiar territory.
• Reluctance to be alone or sleep away from home.
• Nightmares about separation.

Repeated physical complaints when separation is anticipated.

Course

It is more frequent in females and is comorbid with GAD, depression and somatic complaints. It may be a precursor for increased risk for disorders in adulthood.

Aetiology

Mothers often have a history of anxiety disorders. Overprotectiveness and reinforcement of the child’s avoidance behaviours can maintain the disorder.

Assessment and treatment

Treatment includes cognitive behavioural interventions (e.g. Coping Cat), focussing on coping skills or exposure.

Disorder

SELECTIVE MUTISM

Clinical description

A reluctance to verbalize when expected lasting at least one month. It is not the response to weak language skills or a speech problem.

Course

Children often outgrow it but it can be a risk factor for social anxiety disorder.

Aetiology

The onset is associated with the beginning of formal schooling. Negative affectivity (1), behavioural inhibition (2), parental history of shyness (3), social isolation (4) and indicators of social anxiety are risk factors (5).

Assessment and treatment

Treatment includes behavioural methods (1), systematic desensitization (2) and modelling (3).

Disorder

PHOBIAS AND FEARS

Clinical description

These children experience a persistent and significant fear of an object or place that does not have a reasonable basis. There is frequent avoidance and exposure may elicit strong physiological responses. The focus of the fear is the anticipation of harm and there is a strong desire to escape.

Symptoms

This includes excessive reactions to encountering a feared object or situation and can include the following:

• Immediate fear or anxiety.
• Avoidance.
• Excessive responses.
• Persistence.

Course

More females than males have phobias. Situation-specific phobias develop later than phobias related to environmental concerns. The number of fears decreases with age but worries tend to escalate.

Aetiology

Anxious attachment (1), family characteristics (2), exposure to conditioning experiences (3), parent psychopathology (4), family communication styles (5), parenting practices (6) and attachment history are risk factors. Protective behaviours may lead a child to not learn how to cope with distressing circumstances.

Assessment and treatment

Treatment includes systematic desensitization (1), modelling (2), reinforced practice (3) and exposure (4). In-vivo exposure is most effective although the models can be videotaped.

Disorder

SOCIAL ANXIETY DISORDER

Clinical description

A pervasive fear of embarrassment or humiliation that leads to avoidance of social or performance situations. The fear must be present in front of peers as opposed to only in front of adults.

Symptoms

In situations where people feel that they may be scrutinized excessive fear and anxiety may be:

• Exaggerated beyond any actual threat posed.
• Persistent.
• Causing significant distress or impairment.

Course

The onset is typically in adolescence and there is an increased risk for a lower quality of life and school dropout. People often do not seek treatment. It is more common in children with GAD and their GAD is often more severe.

Aetiology

There typically is evidence of normal social interaction with familiar people and pervasive fear across situations. Parental communication (1), attachment (2), parenting style (3), first-degree relatives with social anxiety disorder (4) and behavioural inhibition (5). People with behavioural inhibition typically experience more social rejection.

Assessment and treatment

Treatment includes systematic desensitization (1), exposure (2), modelling (3), reinforced practice (4) and social skills training (5).

Disorder

PANIC ATTACKS

Clinical description

A sudden overwhelming fear that penetrates thoughts, feelings and sensations. The attacks last about 10 minutes.

Symptoms

It consists of at least four of the following symptoms:

• Heart palpitations.
• Sweating.
• Trembling or shaking.
• Nausea and abdominal discomfort.
• Chills or heat.
• Feeling dizzy or lightheaded.
• A feeling of numbness or a tingling feeling.
• Feelings of loss of control.
• Depersonalization.
• Sensations of choking.
• Chest pain.
• Shortness of breath.
• Fear of dying.

Course

It is more common in adolescents and age of onset is typically between the age of 15 and 19. It can be triggered by specific phobias or can be the response to separation anxiety disorder.

Aetiology

Negative affect (1), anxiety sensitivity (2), separation anxiety (3) and other anxiety and depressive disorders (4) are a risk factor. Panic attacks may occur from the interaction between temperament and attachment issues. It may also be the result of misinterpretation of bodily sensations.

Disorder

PANIC DISORDER

Clinical description

A persistent fear of recurrent panic attacks.

Symptoms

In the month after a panic attacks, the following symptoms are demonstrated:

• There is persistent fear of having another panic attack AND/OR
• The attack results in significant behavioural change resulting from attempts to avoid having another panic attack.

Course

The onset is typically between late adolescence and early thirties. It more common in females than in males and the disorder tends to be chronic when it onsets in adolescence.

Aetiology

A first-degree relative with panic disorder and irregular activity of norepinephrine is a risk factor.

Assessment and treatment

Treatments include cognitive behavioural treatment (1), SSRIs (2) and anti-depressant drugs which restore levels of norepinephrine (3).

Disorder

AGORAPHOBIA

Clinical description

Avoidance of certain situations in which people feel like they cannot escape if something (e.g. panic attack) happens there.

Symptoms

The avoidance of two or more possible situations:

• Use of public transportation.
• Open spaces.
• Enclosed spaces.
• Standing in line.
• Being out of the home alone.

Course

It is more common in females than in males. The onset is typically in late adolescence or early adulthood. People often develop the disorder after a panic attack or a panic disorder.

Aetiology

The family situation often lacks warmth and is high on parental overprotection. There is a strong biological component and it is associated with negative life events.

Assessment and treatment

Treatment includes systematic desensitization (1), participant modelling (2) and reinforced practice (3).

Disorder

GENERAL ANXIETY DISORDER

Clinical description

There is no specific focus of worry but pervasive worry that generalizes across situations and topics. There is excessive worry and an inability to control the worry. It is associated with perfectionistic tendencies and people may require excessive reassurance.

Symptoms

The following symptoms are included in the diagnosis for 6 months:

• Excessive worry.
• Pervasive mood.
• Significant impairment.
• Inability to control the worry.
• Muscle tension.
• Concentration.
• Easily fatigued.
• Restlessness.
• Irritability.
• Problems with concentration.
• Sleep disturbance.

Course

It is often comorbid with separation anxiety disorder in adolescence and adulthood. It is also comorbid with phobia or depression.

Aetiology

A malfunction in the neurotransmitter GABA (1), genetics (2), anxious interpretation style (3), self-blame (4) and anxious parents (5) are risk factors.

Assessment and treatment

The Coping Cat programme can be used as treatment. A child with anxious parents does not benefit from CBT unless the parents are also included.

Disorder

OBSESSIVE-COMPULSIVE AND RELATED DISORDER

Clinical description

Obsessive thoughts and compulsive behaviours. The compulsive behaviours are attempts to neutralize the anxiety caused by the obsessive thoughts.

Course

More females than males have OCD and males have an earlier onset. Hoarding symptoms are more common among older adults but can occur in adolescence.

Aetiology

A family history of Tourette’s disorder (1), malfunction of the caudate nuclei (2), low levels of serotonin (3) and a dysfunction in the orbital region of the prefrontal cortex (4) are risk factors.

Assessment and treatment

Treatments include behavioural programmes (1), medical management (2), exposure and response prevention (3) and CBFT (4).