E-Book, Englisch, 142 Seiten
Grills-Taquechel / Ollendick Phobic and Anxiety Disorders in Children and Adolescents
1. Auflage 2013
ISBN: 978-1-61676-339-8
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark
E-Book, Englisch, 142 Seiten
Reihe: Advances in Psychotherapy - Evidence-Based Practice
ISBN: 978-1-61676-339-8
Verlag: Hogrefe Publishing
Format: PDF
Kopierschutz: 1 - PDF Watermark
Compact, authoritative guidance to effective assessment and treatment of the most common psychological difficulties in children and adolescents - phobia and anxiety disorders
This authoritative but compact text addresses the psychopathology, assessment, and treatment of the anxiety disorders and phobias in childhood and adolescence. These perplexing conditions are the most prevalent psychological difficulties in young people and result in considerable impairment and distress, not only to the child but also to her or his family. Effective treatments exist, but unfortunately many of these interventions are either not known to the practicing professionals or not used by them. This volume aims to address this gap and to present these interventions in a clear and straightforward manner.
Autoren/Hrsg.
Fachgebiete
Weitere Infos & Material
1;Table of Contents;10
2;Preface;8
3;1 Description;12
4;2 Theories and Models of Phobic and Anxiety Disorders;34
5;3 Diagnosis and Treatment Indications;52
6;4 Treatment;68
7;5 Case Vignettes;98
8;6 Further Reading;104
9;7 References;106
10;8 Appendix: Tools and Resources;130
1.2.1 Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence
Separation anxiety disorder (SAD) refers to excessive and recurrent anxiety regarding separation from the home or individuals to whom the child is attached. Eight primary symptoms are noted, and children must exhibit at least three to receive a diagnosis of SAD. In addition, the child must be 18 years of age or younger, and the symptoms must persist for at least 4 weeks. Early onset is specified if the child meets SAD diagnostic criteria before age 6. Associated features include persistent reluctance to attend school, remain alone, or go to sleep without a major attachment figure present, as well as nightmares involving the theme of separation and the expression of a number of physical complaints when separation occurs or is anticipated.
Selective/elective mutism (SM) occurs in a small percentage of children who refuse to speak in specific social situations (e.g., school) despite the ability to do so. Refusal to speak must occur for at least 1 month, and interference occurs in educational/occupational achievement or social communication domains. However, SM is not diagnosed if the refusal to speak occurs in the first month of school or because of a lack of knowledge/comfort with the language. Children with SM often also experience significant social concerns, shyness, or other anxiety symptoms.
1.2.2 Anxiety Disorders
Specific phobias (SPP) are excessive and persistent fears of explicit objects or situations, which are typically avoided or endured with intense anxiety or distress. Exposure or anticipation of exposure to that feared generally results in extreme anxiety and potentially a panic attack. DSM-IV-TR specifically notes that children may not be cognizant of the unreasonable or excessive nature of their fears; that fears may be expressed through crying, tantrum, freezing, or clinging behaviors; and that the phobia must be present for 6 months or longer. At a clinical level, phobias tend to be involuntary, inappropriate, and limiting to a child’s life (Essau, Conradt, & Petermann, 2000). SPPs can be specified as falling into one of the following subtypes: animal, natural environment, bloodinjection-injury, situational, or other.
Social phobia (SOCP) refers to excessive and persistent fear and avoidance of social situations or situations where scrutiny could lead to embarrassment. Feared situations are typically avoided or endured with intense distress that may take the form of a panic attack. Additional criteria for children in DSM-IV-TR include that the child has age-appropriate social relationships with familiar people and that the child’s anxiety occurs for interactions involving peers as well as adults. As it does for SPP, DSM-IV-TR specifically notes that children may not be cognizant of the unreasonable or excessive nature of their social fears; that they may express their distress by crying, tantrums, freezing, clinging, or shrinking from social situations with unfamiliar people; and that their symptoms must be present for at least 6 months. The descriptor generalized is used as a specifier when most social situations and interactions are feared.
Obsessive-compulsive disorder (OCD) is diagnosed when a child experiences obsessions and/or compulsions that cause distress, are time consuming (i.e., an hour or more each day), and interfere with the child’s daily life. Obsessions are recurrent and intrusive thoughts, impulses, or images that the child attempts to neutralize or suppress with other thoughts or actions. Compulsions are repetitive behaviors or mental acts that are performed in response to an obsession or used to reduce or prevent distress of a dreaded event. Often the child feels driven to perform the compulsive acts and if interrupted or prevented from doing so may feel intense anxiety or panic. Children need not recognize the unreasonable or excessive nature of their obsessions and/ or compulsions. Washing, checking, and ordering rituals are most common, and children will more often perform rituals at home than in front of others. Common obsessions involve contamination, aggressive or harmful acts to self or others, urges for exactness, and religiosity (March & Mulle, 1998; Piacentini & Langley, 2004). In rare cases, OCD symptoms may be associated with pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections (Swedo et al., 1998).
Generalized anxiety disorder (GAD) is characterized by excessive and difficult-to-control anxiety and worry about several different domains that occurs more days than not for at least 6 months. Children must also exhibit at least one of six physical/somatic symptoms. Some of the more common worries among children with GAD concern performances, evaluation by others, perfectionism, health of significant others, and catastrophic events.
Posttraumatic stress disorder (PTSD) and acute stress disorder (ASD) are diagnosed in children who have experienced or witnessed an event that is perceived as threatening or dangerous to the child or others and that involves a response of intense fear, helplessness, or disorganized or agitated behavior. Following the event, the child continues to re-experience it through distressing memories or physiological arousal resulting from internal or external cues that are associated with the event in some way. Additional symptoms include persistent avoidance of stimuli associated with the event, numbing of general responsiveness, and persistent symptoms of arousal that were not present prior to the event. For PTSD (but not ASD), several specifications or qualifications are made for potential symptom variations in children and include that children may respond to traumatic events with disorganized or agitated behaviors and may display different re-experiencing (e.g., nightmares in general, rather than trauma-specific) and/or physical (e.g., stomach aches) symptoms from adults. Specifiers are also provided for PTSD, with acute used if symptoms have been present for less than 3 months, chronic if the symptoms have been present for 3 or more months, and with delayed onset if symptoms developed 6 months or longer after the traumatic event occurred. ASD is diagnosed when symptoms begin within 4 weeks of a traumatic event and last between 2 days and 4 weeks.
Panic disorder (PD) can be diagnosed with agoraphobia (AG), or either disorder can be diagnosed without the other. PD is marked by recurrent panic attacks which are acute and extreme feelings of anxiety that occur unexpectedly and are followed by at least 1 month of persistent concern about having another attack, worry about the consequences of the attack, or a change in behavior related to the attack. AG is characterized by excessive anxiety resulting from situations in which escape or avoidance may be inhibited or in which help might not be available if panic symptoms were to occur.
Two additional diagnoses are provided for when anxiety, panic, or obsessive-compulsive symptoms occur but are determined upon examination to be the direct result of either a medical condition (anxiety due to a general medical condition) or substance use (substance-induced anxiety disorder). In these instances, the specific medical condition (e.g., anxiety due to hypoglycemia) or substance (e.g., cannabis-induced anxiety disorder) is indicated, and for both diagnoses, specifiers are used to denote the type of anxiety symptoms present (e.g., with panic attacks). An additional specifier is used with substance-induced anxiety disorder to indicate whether symptoms occur during intoxication or withdrawal.
Anxiety disorder not otherwise specified (ADNOS) is diagnosed when anxiety symptoms are significant, but criteria are not met for any of the other formal diagnostic categories. ICD-10 provides several categories that are subsumed under ADNOS in DSM-IV-TR, including other phobic anxiety, phobic anxiety disorder–unspecified, other mixed anxiety disorders, other specified anxiety disorders, anxiety disorder–unspecified, other obsessive-compulsive disorders, obsessive-compulsive disorder–unspecified, other reactions to severe stress, and reaction to severe stress–unspecified.
1.2.3 Adjustment Disorders
An adjustment disorder (ADJ) is diagnosed within 3 months of a major life stressor that a child responds to with significant emotional and/or behavioral symptoms which are beyond that expected given the stressor, or that cause impairment in the child’s life. Symptoms cannot be better accounted for by, or serve as an exacerbation of, an Axis I diagnosis like the above-described anxiety disorders; cannot be due to bereavement; and cannot last more than 6 months after the stressor has ended. For children, stressors might include family (e.g., new sibling, parental divorce) or environmental (e.g., new school, family move) issues. Three of the ADJ subtypes concern anxiety and include with anxiety, with mixed anxiety and depressed mood, or with mixed disturbance of emotions and conduct. .
