Childhood Anxiety Disorders

STUDY OBJECTIVES: This work assesses the prevalence and development of disturbing dreams among adolescents and the association of these dreams with anxiety. DESIGN: Sex differences in prevalence were analyzed with chi-square analyses. Changes over time were assessed with Wilcoxon tests and cross-tabulation tables. Associations with anxiety and DSM-III-R symptoms were assessed with ANOVA designs. SETTING: N/A PARTICIPANTS: A total of 610 boys and girls rated their recall of disturbing and normal dreams at both 13 and 16 years of age. Subgroups of subjects were evaluated for anxiety symptoms at age 13 and for DSM-III-R symptoms of separation anxiety (SA), overanxious disorder (OD) and generalized anxiety disorder (GAD) at age 16. INTERVENTIONS: N/A MEASUREMENTS AND RESULTS: The recall of disturbing dreams was more prevalent for girls than for boys at both ages, and increased over time for girls while it decreased for boys. The recall of normal dreams was also more prevalent for girls at both ages, but this difference could not fully account for the difference in recall of disturbing dreams. Normal dream recall increased from age 13 to 16 for both sexes. The frequent occurrence of disturbing dreams was associated with anxiety at age 13 and with GAD, SA and OD symptoms at age 16 for both sexes. Evidence of more numerous OD symptoms for girls with frequent disturbing dreams suggests that this form of anxiety may partially account for the observed sex difference in disturbing dream prevalence. CONCLUSIONS: The findings highlight a prevalence of disturbing dreams that is especially marked for adolescent girls. Unlike previous cross-sectional studies, which have found the same sex difference, this longitudinal design also calls attention to within-subjects changes in disturbing dream recall. The results also confirm that the frequent recall of disturbing dreams is associated with pathological symptoms of trait anxiety-apparently even as young as 13 years of age. Further study of disturbing dreams may contribute to understanding of associated pathophysiological factors which, too, vary by sex (e.g., PTSD, insomnia, depression).

Purpose: We investigated the associations between temperamental factors and anxiety and depression tendencies, and also compared temperamental differences between groups with various degrees of anxiety and depression tendencies. Methods: A total of 689 children (319 boys and 370 girls) aged 8 to 10 years were recruited for this study from August 2012 to October 2012. The measures included the Temperament in Middle Childhood Questionnaire (TMCQ) and the Beck Youth Inventory-Second Edition (BIY-II). Parents completed the TMCQ at home and their children completed the BIY-II at school. Analyses were conducted using Pearson product-moment correlational analysis, multiple regression analysis, and one-way MANOVAs. Results: Children with higher level of negative affect and lower level of extraversion/surgency tended to have a higher tendency toward for anxiety and depression. Attentional focusing and perceptual sensitivity of effortful control could predict a tendency for both anxiety and depression tendency. Compared to the other three groups, children with a lower tendency for anxiety/lower depression tendency, showed a significantly lower level of negative affectivity. Conclusions: It is recommended that mental health professionals use temperament questionnaires as a tool to understand the characteristics of children. Parents, caregivers, and teachers can use them to identify ways to enhance children’s emotion regulation ability, facilitate their attentional focus, and reduce their perceptual sensitivity in order to mitigate the potential development of anxiety and depression. Future studies should establish Taiwan norms for the TMCQ and examine its psychometric properties. Longitudinal studies should be used to explore the predictive power of specific temperamental factors for childhood emotional problems with the goal of designing ways to help high-risk children regulate, adjust, or modify their temperament to prevent possible development of emotional problems.

Introduction
The psychodynamic group consists of four main therapies;  Freud's psychoanalytic approach, Jungian, Adlerian and Object Relations. The therapist is focused on personality reconstruction, gaining insight to unconscious motivations and suppressed materials predominately relating to early childhood. "The basic psychodynamics of the person are established early in life during the stages of psychosexual development. The role of subsequent experiences is determined by the motivational patterns established in early childhood (Mischel, 1971, pg.51).
The cognitive-behavioural group consists of four behavioural treatment therapies;  Behavioural Modification, Cognitive-Behavioural, Rational Emotive Behavioural and Reality Therapy. Behavioural therapists are concerned with the belief systems and thinking process causing the dysfunctional behaviour, which is treated through client's action. "Cognitive therapies assume that distortions in a person's thoughts and beliefs (cognition's) can lead to a number of mental health problems including depression and anxiety" (Robinson, 2000, pg.19).
I have examined perspectives of Richard who has been referred to a psychotherapist after being convicted of drunk driving.  He is 25 yrs old, experiences high anxiety, depression and has had suicidal thoughts.  Additionally he cannot establish close relationships to others and is fearful of certain types of women.  He remembers a rough family life and suffers from low self-esteem, thinking he is better off dead which is what his mother used to say to him.
By assuming the role of the therapist I apply techniques from each therapy most helpful to individual issues mentioned in the case study. I have included points on the therapist's character, as I believe this would determine the effectiveness of the outcome, timeframe and application strength of each technique used. In the conclusion I have put together main points to explain my reasoning.

Σκοπός του βιβλίου αυτού-το οποίο έχει έκταση 487 σελίδων-είναι να αποτελέσει ένα βασικό εγχειρίδιο τόσο για τον φοιτητή όσο και για τον επαγγελµατία κλινικό παιδοψυχολόγο, οι οποίοι ενδιαφέρονται να γνωρίσουν και να κατανοήσουν σε βάθος το πλαίσιο µέσα στο οποίο εκδηλώνονται οι διαταραχές συµπεριφοράς της παιδικής ηλικίας, οι οποίες επηρεάζουν την αναπτυξιακή πορεία του ατόµου. Μέσα από τα 19 κεφάλαια του βιβλίου τα οποία κατανέµονται σε πέντε µέρη, οι συγγραφείς του βιβλίου επιστρατεύοντας την πολύχρονη ερευνητική και κλινική τους εµπειρία στο χώρο της διάγνωσης και θεραπευτικής αντιµετώπισης των αναπτυξιακών διαταραχών και στηριζόµενοι στα πιο σύγχρονα ερευνητικά δεδοµένα από τη διεθνή βιβλιογραφία, παρουσιάζουν όλο σχεδόν το φάσµα των διαταραχών συµπεριφοράς της παιδικής και εφηβικής ηλικίας. Στο βιβλίο αυτό παρουσιάζονται βασικά οι διαταραχές οι οποίες, σύµφωνα µε το διαγνωστικό εγχειρίδιο DSM-IV, συνήθως διαγιγνώσκονται για πρώτη φορά κατά τη βρεφική, παιδική ή εφηβική ηλικία. Παρουσιάζονται επίσης ορισµένα προβλήµατα, όπως για παράδειγµα η παχυσαρκία, τα οποία δεν αναφέρονται ως αυτοτελείς διαγνωστικές κατηγορίες στο DSM-IV αλλά αποτελούν συχνά την γενεσιουργό αιτία σοβαρών προβληµάτων για τα παιδιά και τους εφήβους. Η κάθε διαταραχή αποτελεί ξεχωριστό κεφάλαιο, στο οποίο παρουσιάζονται η κλινική εικόνα της διαταραχής, τα διαγνωστικά της κριτήρια, η επιδηµιολογία, η αιτιολογία καθώς επίσης και η θεραπευτική της αντιµετώπιση. Ιδιαίτερη έµφαση δίνεται στον τρόπο µε τον οποίο η ύπαρξη κάποιας διαταραχής επηρεάζει την αναπτυξιακή πορεία του ατόµου.

Research into the use of transitional objects (Winnicott, 1971) by adult clients in psychotherapy has given little attention to the question of how a transitional object (TO) works. This question is addressed through the use of a semi-structured interview. Data was collected on the clinical practice and theoretical understanding of TO emergence and use of three psychodynamic-interpersonal (PI) and three Gestalt psychotherapists. A grounded theory analysis suggests that a TO works by a process of embodiment which can be structured with reference to a four-level model consisting of physical, process, contextual and conceptual levels. Therapists of both orientations emphasized the TO as a focus of intersubjectivity within the therapeutic relationship. Differences between the PI and Gestalt therapists are also examined. The clinical implications of this four-level model of embodiment for the use of TOs in psychotherapy are explored, together with suggestions for further research.

The aim of this study was to examine how transitional objects (TOs) work from the perspective of adult clients in psychotherapy. Data were collected using a semistructured interview with 6 female clients in humanistic psychotherapy. Grounded-theory analysis of this material suggests that a TO works through a 5-phase process of ‘holding’ in which the client successively integrates 3 themes: (a) the continuity of the therapist's existence, (b) connectedness with the therapist, and (c) the development of a new sense of self. A spiral microtheory is proposed that shows how these themes interact across time and relate to the client's experience of shame. The analysis suggests a use of TOs that is broader than D. W. Winnicott's (1953) conception and includes selfobject functions (H. Kohut, 1971).

There is considerable research and clinical evidence that children who experience loss become traumatized. The results of traumatization include sleeping problems, for example difficulties in initiating sleep and sleep terrors. Psychological intervention programmes, including hypnotherapy, have been shown to have some success in helping children to overcome their sleeping problems. In the present study, a new paradigm qualitative methodology was used in which a small group of children were taught self-hypnosis to manage their sleep difficulties. Within the group, the children's experiences of utilizing self-hypnosis at home were discussed, and a consensus reached concerning its effects. Complementary data were collected through interviews with caregivers and by completion of the Southampton Sleep Management Schedule (Bartlet and Beaumont, 1998). From the study it was concluded that young children can be taught self-hypnosis in order to manage their sleeping problems effectively....

Reflective Network Therapy is a manualized method for treating children 2 to 6 years old. The method is remarkably effective for children with mild to moderate autism. 95% of first tested children treated with, when retested, had achieved statistically significant IQ Gains and mental health improvements within about 8 months of starting treatment, whether they were autistic or had other psychiatric diagnoses.

See: Reflective Network Therapy (RNT): Research Results, Outcome Data and Method Comparisons

STUDY OBJECTIVES: This work assesses the prevalence and development of disturbing dreams among adolescents and the association of these dreams with anxiety. DESIGN: Sex differences in prevalence were analyzed with chi-square analyses. Changes over time were assessed with Wilcoxon tests and cross-tabulation tables. Associations with anxiety and DSM-III-R symptoms were assessed with ANOVA designs. SETTING: N/A PARTICIPANTS: A total of 610 boys and girls rated their recall of disturbing and normal dreams at both 13 and 16 years of age. Subgroups of subjects were evaluated for anxiety symptoms at age 13 and for DSM-III-R symptoms of separation anxiety (SA), overanxious disorder (OD) and generalized anxiety disorder (GAD) at age 16. INTERVENTIONS: N/A MEASUREMENTS AND RESULTS: The recall of disturbing dreams was more prevalent for girls than for boys at both ages, and increased over time for girls while it decreased for boys. The recall of normal dreams was also more prevalent for girls ...

The current study compared ethnic minority and European American clinically-referred anxious youth (N=686; 2-19 years) on internalizing symptoms (i.e., primary anxiety and comorbid depression) and neighborhood context. Data were provided from multiple informants including youth, parents, and teachers. Internalizing symptoms were measured by the Multidimensional Anxiety Scale for Children, Child Depression Inventory, Child Behavior Checklist and Teacher Report Form. Diagnoses were based on the Anxiety Disorders Interview Schedule for Children. Neighborhood context was measured using Census tract data (i.e., owner-occupied housing, education level, poverty level, and median home value). Ethnic minority and European American youth showed differential patterns of diagnosis and severity of anxiety disorders. Further, ethnic minority youth lived in more disadvantaged neighborhoods. Ethnicity and neighborhood context appear to have an additive influence on internalizing symptoms in clinica...

""Few studies have reported long-term follow-up data in adults and even fewer in adolescents. The purpose of this work is to report on the longest follow-up assessment in the literature on treatments for adolescents with social phobia. A 5-year follow-up assessment was conducted with subjects who originally received either Cognitive Behavioral Group Therapy forAdolescents(CBGT-A), Social EffectivenessTherapy forAdolescents—Spanish version (SET-Asv), or Intervencio´n en Adolescentes con Fobia Social—Treatment for
Adolescents with Social Phobia (IAFS) in a controlled clinical trial. Twenty-three subjects completing the treatment conditions were available for the 5-year follow-up. Results demonstrate that subjects treated either with CBGT-A, SET-Asv and IAFS continued to maintain their gains after treatments were terminated. Either the CBGT-A, SET-Asv and IAFS can provide lasting effects to themajority of adolescentswith social anxiety. Issues that may contribute to future research and clinical implications are discussed.""

The current study compared ethnic minority and European American clinically-referred anxious youth (N = 686; 2–19 years) on internalizing symptoms (i.e., primary anxiety and comorbid depression) and neighborhood context. Data were provided from multiple informants including youth, parents, and teachers. Internalizing symptoms were measured by the Multidimensional Anxiety Scale for Children, Child Depression Inventory, Child Behavior Checklist and Teacher Report Form. Diagnoses were based on the Anxiety Disorders Interview Schedule for Children. Neighborhood context was measured using Census tract data (i.e., owner-occupied housing, education level, poverty level, and median home value). Ethnic minority and European American youth showed differential patterns of diagnosis and severity of anxiety disorders. Further, ethnic minority youth lived in more disadvantaged neighborhoods. Ethnicity and neighborhood context appear to have an additive influence on internalizing symptoms in clinically-referred anxious youth. Implications for evidence-based treatments are discussed.► 686 anxious youth were assessed for symptoms of anxiety and depression and neighborhood context. ► Informants included children, parent and teachers. ► Ethnic minority youth were more likely to live in disadvantaged neighborhoods and report more severe symptoms of anxiety and depression. ► Ethnic minority status and neighborhood context demonstrated an additive relationship on symptoms of anxiety and depression.

Tras examinar detenidamente a la literatura, hay distintos elementos que nos permiten hacer aseverar que en la última década se ha constatado un progreso significativo en el estudio y tratamiento de los trastornos de ansiedad en población infanto-juvenil. En primer lugar...

Dispositional anxiety is a well-established risk factor for the development of psychiatric disorders along the internalizing spectrum, including anxiety and depression. Importantly, many of the maladaptive behaviors characteristic of anxiety, such as anticipatory apprehension, occur when threat is absent. This raises the possibility that anxious individuals are less efficient at gating threat’s access to working memory, a limited capacity workspace where information is actively retained, manipulated, and used to flexibly guide goal-directed behavior when it is no longer present in the external environment. Using a well-validated neurophysiological index of working memory storage, we demonstrate that threat-related distracters were difficult to filter on average and that this difficulty was exaggerated among anxious individuals. These results indicate that dispositionally anxious individuals allocate excessive working memory storage to threat, even when it is irrelevant to the task at hand. More broadly, these results provide a novel framework for understanding the maladaptive thoughts and actions characteristic of internalizing disorders.

There is considerable research and clinical evidence that children who experience loss become traumatized. The results of traumatization include sleeping problems, for example difficulties in initiating sleep and sleep terrors. Psychological intervention programmes, including hypnotherapy, have been shown to have some success in helping children to overcome their sleeping problems. In the present study, a new paradigm qualitative methodology was used in which a small group of children were taught self-hypnosis to manage their sleep difficulties. Within the group, the children's experiences of utilizing self-hypnosis at home were discussed, and a consensus reached concerning its effects. Complementary data were collected through interviews with caregivers and by completion of the Southampton Sleep Management Schedule (Bartlet and Beaumont, 1998). From the study it was concluded that young children can be taught self-hypnosis in order to manage their sleeping problems effectively. Furthermore, the present study demonstrated that children can be involved in a collaborative research group. Copyright © 2002 British Society of Experimental and Clinical Hypnosis

Reflective Network Therapy can be readily individualized to treat preschoolers with autism spectrum disorders, serious emotional disorders, social communication disorders, behavioral disorders, anxiety, depression, post traumatic stress disorders, reactive attachment disorders, attention deficit / hyperactivity disorders, and co-occurring disorders (multiple diagnoses).  95% of first tested children treated with RNT, when retested, had achieved statistically significant IQ gains and mental health improvements within about 8 months of starting treatment, whether they were autistic or had other psychiatric diagnoses.  The method is a deliberately synergistic combination of preschool education with in-classroom psychological treatment for emotionally and developmentally disordered children who are two to seven years old. The method is carried out by a network that includes a psychodynamically-trained therapist, teachers, children’s peers and family members. Intensive psychotherapy takes place exclusively within the learning and play activities of the classroom, focusing on one child at a time. Children with mild to moderate autism, serious emotional disorders, behavior problems as well as children with other or multiple diagnoses routinely achieve mental health gains, develop cognitively and become able to transition successfully into regular public school classrooms after treatment. Children are never pulled out of class for individual therapy; it takes place right in the classroom. The child’s here-and-now feelings, behavior, symbolic expressions and responses to other children and classroom events are all opportunities for therapeutic action and become the subjects of in-classroom therapy sessions. Here we present some unique aspects of Reflective Network Therapy, and discuss how interpersonal exercises can occur hundreds of times in a school year using this versatile method.  We have found that these exercises are well suited to influence the brain and mind of an autism spectrum disordered child as well as the brain and mind of a child with a serious emotional disorder. Rich activation of the mirror neuron systems in the child patients treated by this method may account for their measured IQ rises and robust mental health gains.

Story illustrated and narrated by five-year-old Highly Sensitive Person expressing anger about having to go to school every day against her will, and then having to spend an hour per week alone in a room with an unpleasant child psychiatrist who was supposedly treating the child's Separation Anxiety Disorder.

Includes murder, mummification, angel visitations, remorse, redemption, reincarnation, and even a rare depiction of the Jewish G-d (before child was told that such drawings were forbidden). In real life, the child eventually spat on the psychiatrist and didn't have to see her again after that. The child, now an adult, is still self-publishing books on the shadow side of human consciousness.

© 1990 by Ruji Chapnik
From "The Walking Balls" series of picture books self-published in author's childhood.
(Work transcribed by author's older sister)

Adolescent anxiety is common and impairing and often persists into adulthood. There is growing evidence that adult anxiety is characterized by abnormal fear responses to threat and safety cues, along with perturbations in fear-related neural circuits. Although some of this work has been extended to adolescents, with promising results, it is not yet clear whether changes in these circuits across developmental age varies between anxious and non-anxious adolescents. Here we used fMRI to examine how age modulates neural responses as adolescents are exposed to threat and safety cues. Participants were 15 anxious and 11 non-anxious adolescents (age 12–17) who completed a fear conditioning paradigm. The paradigm incorporated a threat cue comprising a neutral face which was paired with a fearful, screaming face, a safety cue comprising a different neutral face, and a control stimulus. Across the whole sample, neural activation to the threat cue (relative to the control cue) correlated positively with age in a number of regions, including the dorsal anterior cingulate and bilateral dorsolateral prefrontal cortex (PFC). However, neural activation to the safety cue (relative to the control cue) was modulated differently by age in the two groups: a more positive association between activation and age was observed in the control group compared to the anxious group in various regions including medial and dorsolateral PFC, anterior insula, and amygdala. These findings suggest that maturation of the neural substrates of fear responses to safety cues may be perturbed in anxious adolescents, potentially contributing to the emergence and maintenance of anxiety disorders in adulthood.