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Anxiety Disorders are one of the most commonmental health concern for Children and
Adolescents in todays society.
Anxiety: apprehension or excessive fear about
real or imagined circumstances. (NASP) Separation Anxiety Disorder (SAD):
characterized by severe distress when separated
from the primary caregiver(s) or home.
School p
hobia
:used to describe children whorefuse to attend school because of emotional
distress.
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` Stranger Anxiety: 7-9 months
` Separation Anxiety: 12-18 months-3 years
SAD
4-5% of the 20%of all anxietydiagnoses
Age of onset:5-8
Seems to occurmore in lower SESfamilies (50-75%)
SchoolPhobia
1-5% of all schoolaged children
Age of onset: 5-8
or 10-13
A ratio of 3:2females to malesfor both disorders,
however
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` 75% of the children with school phobia
have SAD.
` 79% of children with SAD also had at least 1comorbid
disorder.
` Common
comorbid disorders in
clude
:Generalizedanxiety disorder, obsessive-compulsive disorder, panic
disorder, depression, attention deficit hyperactivity disorder,
oppositional defiant disorder, and enuresis.
` Significant negative effects on school performance.
` Long term effects: decreased rate of parenthood as adults,economic deprivation, marital and occupational problems,
social maladjustment, and substance abuse.
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` Very few studies have been conducted with othercultures and ethnic groups outside of themainstream US population.
` Minorities tend to have higher rates of anxiety than
European American Groups.` Other countries and cultures view anxiety and
fears differently.
` Some countries have higher anxiety due to theirvalues and belief systems.
` Some cultures tolerate separation more than othercultures.
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Psychosocial
Cognitive
Biological
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` Heritability accounts for 1/3 of variance in anxiety
disorders.
` Individuals temperament can make a child more
likely or less likely to develop SAD and/or schoolphobia.
` Individuals with anxiety tend to have an:
overactive nervous system, high levels of
epinephrine and norepinephrine, and no increasein cortisol production.
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` Certain situations may trigger the onset of
anxiety in children such as: a death, divorce,
serious illness, violence, and child abuse.
`
Parenting factors and styles can contribute toanxiety.
` Modeling, prompting, and reinforcement of
anxious behaviors by others affect the child
negatively.
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` Negative thoughts and poor self-efficacy help
maintain anxiety.
` Maladaptive cognitions interfere with problem
solving and prevent coping skills to developsuccessfully.
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` SAD can lead to school phobia and can be a
potential cause.
` Students who are bullied and/or lonely have a
greater chance of developing school phobia.` Traumatic events at school can trigger school
phobia (school shooting, child was injured on the
playground, etc.)
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` Some cultures focus on the physical origins
(Hispanic), social origins (Japanese), or even the
spiritual origins (African, American Indian).
` Acculturation effects (added stress and anxiety) Look at the individual within the
context of culture, and do not define
the individual by his/her culture
(Harmon,Langley, Ginsbur, 2006)
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` First you will want to screen all students, to find those who havehigh anxiety. (Self-report questionnaire, teacher
nominations/reports)` Clinical Interviews with child and possibly parent. (Anxiety
Disorders Interview Schedule for Children and parents: ADIS-C,ADIS-P)
` Other things to consider when doing an assessment for SAD
and/or School phobia: Childs history Childs attachment to others Fears Temperament Early adaptability School history
Academic functioning Patterns of school attendance Academic achievement Childs relationship with teachers and other students
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` CBT: is one of the most well known treatments forAnxiety disorders.
` 4 components:
1. Identification and awareness of ones thoughts
2. Evaluation of what one is thinking in an anxietyprovoking situation
3. Development of problem-solving skills
4. Rewarding oneself for non-anxious behavior
` Systematic desensitization: form of exposure
therapy, where the child is exposed to the stimulus
gradually.
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` Emotional regulation: relaxation and breathingtechniques
` Family Therapy/Parent Training: reward brave
behavior, model effective problem solving and
coping techniques, written contracts.` Pharmacology: SSRIs are most effective Medications most commonly prescribed: fluoxetine,
sertraline, and fluvoxamine.
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Tier 3:
For individuals withmore pronounced
impairment.Treatment begins in a
1-on-1 setting.Tier 2:
Intervention for identifiedproblems before they becometoo severe; usually conducted
in groups
Tier 1
:
Every student is taught problem solving skills,and coping strategies to use when anxious.
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`Our role as a School
Psychologist
DSM-V possible changes