Running head: Three Anxiety Disorders Unique to Children 1

Three Anxiety Disorders Unique to Children

Eleanor Wend HS 513 T301 Assignment 5.3 Bellevue University October 1, 2011

Three Anxiety Disorders Unique to Children

Abstract This paper will explore the three anxiety disorders unique to children: Separation anxiety, Selective mutism and Reactive Attachment Disorder (RAD). The etiology and options for treatment will be discussed. The significance of these disorders for adolescence and adulthood will also be addressed. Keywords: Anxiety disorders unique to children, separation anxiety, selective mutism, reactive attachment disorder (RAD)

Three Anxiety Disorders Unique to Children

Introduction There are three major anxiety disorders that are unique to children. These are separation anxiety, selective mutism and reactive attachment disorder (RAD). All three of these have an onset of prior to age 18. In the case of both selective mutism and reactive attachment disorder the age of onset is usually prior to age 5, although in selective mutism there may be a school age onset older than 5 years. Definitions of the three anxiety disorders unique to children The following are the definitions of the three anxiety disorders unique to children as found in the DSM IV: Separation Anxiety: The essential feature of this disorder is excessive anxiety concerning separation from home. The anxiety is beyond that which is expected for the individuals developmental level. Individuals with this disorder may experience recurrent, excessive distress on separation from home or major attachment figures. Selective Mutism: The essential feature is the persistent failure to speak in specific social situations (e.g. school, with playmates) where speaking is expected, despite speaking in other situations. The disturbance interferes with educational or occupational achievement and with social communication. Reactive Attachment Disorder: The essential feature is markedly disturbed and developmentally inappropriate social relatedness in most contexts that begins before age 5 years and is associated with grossly pathological care. There are two types of this disorder; the Inhibited

Three Anxiety Disorders Unique to Children

and the Disinhibited. In the Inhibited type; the child shows a pattern of excessive inhibited, hypervigilent or highly ambivalent responses. There is a persistent failure to initiate and respond to most social interactions in a developmentally appropriate way. In the Disinhibited type, there is a pattern of diffuse attachments. The child exhibits indiscriminate sociability or lack of selectivity in the choice of attachment figures. (APA, 1994) The Etiology and Treatment options for separation anxiety Possible causes for separation anxiety include a combination of genetic and environmental vulnerabilities rather than by any one thing. There may have been stress while in the womb caused by conditions surrounding the pregnancy and the anxiety level of the mother. Additionally any continued anxiety and stress caused by conditions in the home or medical problems in early childhood may precipitate separation anxiety. It is recommended that parents accompany their children into surgery and hospital visits and stay with them as much as possible. A majority of children with separation anxiety disorder have school refusal as a symptom and up to 80% of children who refuse school qualify for the diagnosis of separation anxiety disorder. Approximately 50%-75% of children who suffer from this disorder come from homes of low socioeconomic status. Family trauma including substance abuse, violence, divorce and death may also cause separation anxiety to develop. (medicinenet.com, 2011) Treatment options for separation anxiety may include anti-anxiety medications, changes in parenting techniques and counseling for both parents and child. In severe cases it may include family education, family therapy and individual psychotherapy. (National Institutes of Health, 2010) (Hedtke, et al., 2009)

Three Anxiety Disorders Unique to Children

The Etiology and Treatment options for selective mutism Possible causes for selective mutism include a high level of social anxiety which may be due to a combination of genetic predisposition and early childhood experiences.. It is recognized as an anxiety disorder and usually has an onset prior to age 5 although is may have a later school age onset.. The following excerpt describes treatment options and prognosis for social mutism disorder:

Selective mutism is most receptive to treatment when it is caught early. If your child has been silent at school for two months or longer, it is important that treatment begin promptly. When the disorder is not caught early, there is a risk that your child will become used to not speaking -- that being silent will become a way of life and more difficult to change. A common treatment for selective mutism is the use of behavior management programs. Such programs involve techniques like desensitization and positive reinforcement, applied both at home and at school under the supervision of a psychologist. Teachers can sometimes become frustrated or angry with children who don't speak. You can help by making sure that your child's teacher knows that the behavior is not intentional. Together you need to encourage your child and offer praise and rewards for positive behaviors. Whereas rewarding positive steps toward speaking is a good thing, punishing silence is not. If your child is afraid to speak, she will not overcome this fear through pressure or punishment. Medication may also be appropriate, particularly in severe or chronic cases, or when other methods have not resulted in improvement. The choice of whether to use medication should be made in consultation with a doctor who has experience prescribing anxiety medication for children. In general, there is a good prognosis for this disorder. Unless there is another problem contributing to the selective mutism, children generally function well in other areas and do not need to be placed in special education classes. Although it is possible for this disorder to continue through to adulthood, it is rare and more likely that social anxiety disorder would develop. (Cuncic, 2009)

Three Anxiety Disorders Unique to Children

The Etiology and Treatment options for Reactive Attachment Disorder The causes of Reactive attachment Disorder (RAD) include a home environment and caregivers who typically neglect, abuse or abandon the child. RAD develops because the childs needs for comfort, affection and nurturing arent met and loving, caring attachments are never established. This may permanently change the childs growing brain and their ability to establish future relationships. (The Mayo Clinic, 2011) The risk of neglect to the infant or child increases when the: Caregiver is mentally retarded Caregiver lacks parenting skills Parents are isolated Parents are teenagers

A frequent change in caregivers (for example, in orphanages or foster care) is another cause of reactive attachment disorder. Children who are adopted from foreign orphanages are commonly affected, particularly if they were removed from their birth parents during the first weeks of life. (The Mayo Clinic, 2011) The following is an excerpt from the National Institutes of Health regarding options in treatment for RAD:
Treatment has two parts. The first priority is to make sure the child is currently in a safe environment where emotional and physical needs are met. Once that has been established, the next step is to change the relationship between the caregiver and the child, if the caregiver has caused the problem. Parenting skills classes can help with this. These skills give the caregiver the ability to meet the child's needs and help them bond with the child.

Three Anxiety Disorders Unique to Children

The caregiver should also have counseling to work on any current problems, such as drug abuse or family violence. Social Services should follow the family to make sure the child remains in a safe, stable environment. Parents who adopt babies or young children from foreign orphanages should be aware that this condition may occur and be sensitive to the child's need for consistency, physical affection, and love. These children may be frightened of people and find physical affection overwhelming at first, and parents should try not to see this as rejection. It is a normal response in someone who has been abused to avoid contact. Hugs should be offered frequently, but not forced.

(National Institutes of Health, 2010) The most significant thing I learned from this research Early recognition and diagnosis have the best prognosis for treatment and the research shows that the most effective treatment involves both the parents and the child. It may include a combination of medication and cognitive-behavioral therapy. A combination of education and public awareness seems to be needed to promote early referral and diagnosis. Additionally a support network in the community of family outreach and mental health professionals and the medical community is needed to support and sustain successful treatment. It appears from the research that these childhood anxiety disorders may be precursors for adolescent and adult disorders when not diagnosed and treated in childhood. For example separation anxiety in children may evolve into social anxiety in adults. (mentalhealth.com, 2011) (National Institutes of Health, 2010) (The Mayo Clinic, 2011) Prognoses in adolescents and adulthood All these diagnoses may lead to school failure, substance abuse and addiction issues, job difficulties, low self-esteem and relationship issues. There is also evidence that there is early sexual precocity and an increase in superficial sexual encounters. If these conditions are left

Three Anxiety Disorders Unique to Children

undiagnosed and untreated there is a high possibility of further conditions such as substance abuse and adult anxiety disorders may occur. Conclusion In conclusion these three anxiety disorders unique to children have far-reaching implications for these children and their futures as well as their communities. Early recognition, diagnosis and treatment can be very effective in preventing later difficulties in adolescence and adulthood as well as preventing second and third generation repeats of these disorders.

Three Anxiety Disorders Unique to Children

References Cunicic, Arlin (2009). Selective Mutism. Retrieved September 29, 2011 from
http://socialanxietydisorder.about.com/od/otheranxietydisorders/a/selectivemutism.ht m

Francis, Allen et al., Task Force. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, D.C.: American Psychiatric Association. Hedtke, K.A., Kendall, P.C. & Tiwari,S. (2009). Safety-seeking and coping behavior during exposure tasks with anxious youth. Journal of Clinical Child and Adolescent Psychology: Jan. 2009, Vol. 38, No. 1, pp1-15. Retrieved September 30, 2011, from http://www.mentalhealth.com/ Jurbergs, N., Ledley, D.R. (2005). Separation anxiety disorder. Pediatric Annals: Feb. 2005, Vol. 34, No. 2, pp108-15. Retrieved September 30, 2011, from http://www.mentalhealth.com/ Netherton, Sandra D., Holmes, Deborah & Walker, Eugene C. (Eds.). (1999). Child and Adolescent Psychological Disorders: A Comprehensive Textbook. New York. Oxford University Press. Reactive Attachment Disorder. (n.d.) Retrieved September 30, 2011, from Mayo Clinic website:
http://www.mayoclinic.com/health/reactive-attachment-disorder/DS00988

Separation Anxiety. (n.d.) Retrieved September 30, 2011, from Medicinenet website: http://www.medicinenet.com/separation_anxiety/article.htm

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Suveg, C., et al. (2009). Changes in emotion regulation following cognitive-behavioral therapy for anxious youth. Journal of Clinical Child and Adolescent Psychology: May. 2009, Vol. 38, No. 3, pp390-401. Retrieved September 30, 2011, from http://www.mentalhealth.com/