anxiety disorders university of iowa儿童焦虑障碍爱荷华大学课件

10-27-04 nQuestions nHandouts nChildhood Anxiety Disorders History Descriptions, Definitions, and Diagnostic Indicators Prevalence Etiology Comorbidity Prevention and Intervention The Future Cases 1 Childhood Anxiety Disorders Underreported and Underdiagnosed Or Overlooked and Misjudged 2 Childhood Anxiety Disorders nWhat Are They? Anxiety disorders widely recognized as among the most common disorders affecting children and adolescents. Commonly present as part of a complex picture. Not well understood in children and adolescents. 3 Childhood Anxiety Disorders nHistory Almost 100 years of case studies of childhood fears; “Little Hans” (1909), “Albert”(1920), “Peter”(1924). However, prior to DSM-III (1980),fears and anxiety reactions in children ignored in classification systems. Subclinical fears studied as part of normative development. 4 Childhood Anxiety Disorders Psychopathological phobic reactions appeared in DSM (1952) as psychoneurotic reactions. DSM-II (1968) changed to phobic neuroses and overanxious reaction was listed as a distinct diagnostic category for children. DSM-III(1980) and DSM-III-R (1987) first attempts to delineate developmentally appropriate criteria for phobias and other anxiety disorders in children/adolescents. 5 Childhood Anxiety Disorders nSAD, Avoidant disorder of childhood and adolescence, and OAD listed as three distinct anxiety disorders in childhood. Thus a child could be diagnosed with one of these three types of anxiety disorders plus adult anxiety disorders. DSM-IV (1994) Avoidant Disorder and OAD deleted with only SAD retained as a child or adolescent anxiety disorder. 6 Childhood Anxiety Disorders In DSM-IV and DSM-IV-TR, the following diagnoses could be made for children and adolescents: nSAD. GAD, OCD, agoraphobia, panic disorder, specific phobias, social phobia, PTSD, acute distress disorder, and anxiety states due to medical disorder or substance abuse. SAD=“excessive anxiety or fear concerning separation from home or from those to whom the child is attached” (Chapter 6, M & B, p.283). 7 Childhood Anxiety Disorders What does SAD “look like” ? nmild, moderate, severe nmost often diagnosed in prepubertal children n5-8 year olds, fears of harm to attachment figures. n9-12 year olds, distress at time of separation. n13-16 year olds, somatic complaints and school refusal. none-third concurrent with GAD, one third comorbid with depressive disorder (M & B), 8 Childhood Anxiety Disorders Social Phobia=“marked and persistent fear of one or more social or performance situations in which person fears embarrassment may occur” (Chapter 6, M & B, p.285) What does social phobia “look like” ? nmost often appears in adolescence nnegative self-focus and self-deprecation nhigher levels of depressed mood none study reports =# of boys and girls nmost common anxiety disorder in adults nlimited # of studies with children 9 Childhood Anxiety Disorders OCD=“recurrent and intrusive obsessions and compulsions that are time-consuming (1 hour per day) cause either marked distress for an individual or significant impairment in functioning”. (APA, 1994) What does OCD look like? nin 90% of children with OCD, symptom patterns change over time n50-60% of children with OCD have severe impairment in global functioning nmean age of onset 10-12.5 years of age nonset appears earlier in males than females nhigh incidence of OCD in children and adults with Tourettes disorder 10 Childhood Anxiety Disorders Specific Phobia=“marked and persistent fear of circumscribed objects or situations” (Chapter 6, M&B, p289). What does specific phobia (formerly simple phobia) “look like” ? npersisted for 6 months ncommon phobias= height, darkness, loud noises, injections, dogs, etc. nchildrens responses can be cognitive, behavioral, and physiological nsome phobias usually appear before age 7 and some fit in with normal subclinical fears in children 11 Childhood Anxiety Disorders GAD=the essential feature is overwhelming anxiety and worry about a lot of things, occurring most days, and persisting at least 6 months (Chapter 6, M & B, p292). What does GAD look like? nexcessive and unrealistic worrying observed in 95% of a clinic sample of GAD children nmorbidly self-conscious nfrequent worries are: grades, tests, natural disaster, future performance, being bullied nintensity of worries a differential feature nbegins at any age (one study reporting GAD in a 4 year old) nhigh rate of concurrent disorders 12 Childhood Anxiety Disorders Panic Disorder=“ the occurrence of at least one unexpected panic attack, followed by a minimum of 1 month of any one (or more) of the following: (Chapter 6, M & B, p. 294) persistent fear of future attacks, worry about what the attack meant, or a significant change in behavior related to the attacks. 13 Childhood Anxiety Disorders What does panic disorder “look like” ? nWithout agoraphobia- nWith agoraphobia- nlack of information regarding age and gender patterns npanic attacks and panic disorder occur more frequently in adolescents nmore common among females than males nPrevalence Fonaggy et.al. (2002) reported in epidemiology study 8-12% for 4-20 year olds, In Chapter, 6 M & B varied reports, 10% in 11 studies, 12-20% in 4 of 5 large survey studies, much lower for 792 11 year olds, increased when reassessed at age 15, 14 15 Resources nBarrett & Ollendick (2004) nMash & Barkley (2003) nFinaggy, P., Target, M., Cottrell, D., Phillips, J., Kurtz, Z. (2002). What works for whom? New York: Guilford Press. nKaufmann, J. A. (2005). C