**No matter what I do this program will not post the entire article – have a look at this research paper, in its entirety at the website listed diagonally and to the right**
Generalized anxiety must be present over six months to be considered a mental disorder with symptoms like irritability, restlessness, and sleeplessness present consistently over this time period (Masi, 2004, p.1). The etiology, or causes, of childhood anxiety are environmental effects like divorce, or exposure to threats (Masi, 2004, p. 1). Other causes, from a relational perspective, are lower connectedness and modelling of anxiety disorders displayed by anxious parents. There is both a biological basis for childhood anxiety and a psychological one, as children model anxious behaviours of parents with genes influencing susceptibility to anxiety. The epidemiology of childhood anxiety is currently in preliminary research, but anxiety in school age children is on the rise especially in white children, while African-American children generally experience less anxiety overall (Masi, 2004, p. 1). Differential diagnosis for childhood anxiety includes recognition of somatic symptoms like panic attacks or somatic complaints as stated in the Diagnostic Service Manual. To reduce generalized anxiety in primary school aged children, a two-pronged approach is necessary with Cognitive Behavioural Therapy, a therapy that challenges maladaptive thoughts and self-assessments, primary to treatment (Tomb, 2004, p. 9). Secondly, a biological approach requires a serotonin reuptake inhibitor to be prescribed for children with generalized anxiety to reduce somatic symptoms and complaints i.e. fluvoxamine or fluoxetine (Keeton, 2008, p.2). Treatment for childhood generalized anxiety must counter anxious parental modelling and challenge negative self-assessments while addressing the biological component with medication in order to treat all three psychosocial aspects of this mental disorder.
Cormorbidty Associated with Generalized Anxiety
Generalized anxiety follows a cognitive model of negative self-assessments, that is, overestimation of danger, threat, and fear and underestimation of one’s abilities to cope with threats with cormorbid or a dual diagnose often present (Bogels, 2000, p.1). The most common secondary disorder diagnosed in children with generalized anxiety is depression (Tomb, 2004, p. 2). It has also been found that children from parents with at least one diagnosed mental disorder have a biological predisposition towards generalized anxiety, which is often triggered by a stressful environmental situation or stressful life events as the disorder follows the diathesis-stress model. “The diathesis-stress model usually hypothesizes that it is the interaction between cognitive vulnerability
Social Modelling and Treatment
From a social perspective, children with generalized anxiety have also been to shown to model parental anxiety. Treatment approaches must intervene to address the improper modelling of the parent while providing a positive model by which children can draw upon to cope with future anxious parental modeling. As well, both the generalized anxiety and any cormorbid disorders diagnosed must be treated concurrently with the generalized anxiety (Tomb, 2004, p. 2). Specific causes of generalized childhood anxiety across the social paradigm include “parental anxiety, family circumstances, interpersonal problems, traumatic and stressful life events and school [relational] problems (Tomb, 2004, p. 3).” A mental disorder with multiple social causes requires a Cognitive Behavioural Therapist to not only challenge a child’s negative thoughts and beliefs, but to also model positive coping behaviours that can be utilized once the child returns to the anxious family environment. Positive modelling would include management of thoughts and feelings along with the identification of internal motivations. Also, treatment of family members with mental disorders including anxiety has been shown to reduce the effects of anxiety in long-term studies on children with generalized anxiety (Bodden, 2008, p. 1). As generalized anxiety in children has a central social cause, treatment must both address the negative core beliefs in an anxious child while intervening in the relational family structure by providing the child with coping skills to handle stressful life or negative environmental effects.
Generalized Anxiety and the Biological Component
Medication is often a necessary treatment for generalized anxiety as cormorbid disorders like depression create additional somatic symptoms along with those already present from the child’s anxiety. Somatic complaints potentially interfere with the effectiveness of the CBT therapy (Tomb, 2004, p. 2). Medication, such as fluoxetine, can be used in treatment and prescribed to address the biological component while positive coping skills are taught to the child by a CBT therapist. Medication can reduce anxious symptoms in children while a psychologist intervenes in the system of anxious family modelling to provide additional social skills for the anxious child while treating the underlining inner conflicts (Keeton, 2008, p.2). Medications like fluoxetine are a necessary treatment approach especially in diagnosed cormorbid disorders to regulate the anxious child during CBT therapy.
Treatment with Cognitive Behavioural Therapy
Cognitive Behavioural Therapy, a therapy that challenges negative self beliefs or thoughts in children, has been found effective since 1995 in reducing levels of anxiety in children. PATHS (Promoting Alternative Thinking Strategies) has been developed as one of the most effective strategies in treatment and FRIENDS, an Australian program that develops self-esteem and strengths, acts as another alternative (Curtis, 2004, p. 2). CBT is best utilized in a one-on-one client psychologist setting with a child disclosing negative cognitions in a confidential environment while a psychologist offers more positive, adaptive cognitions that would reduce inner childhood conflicts. “A 12-session cognitive-behavioural” approach has been found most effective in addressing the three psychosocial causes of generalized childhood anxiety in a psychological setting (Tomb, 2004, p. 9). PATHS is focused primarily on developing coping skills in children to appropriately deal with anxiety by: increasing self-awareness, managing feelings, identifying motivations, improving empathy and practicing social skills (Curtis, 2004, pp. 2). Each of these five strategies develops “emotional competence” and “changes in children’s social
Anxiety in white children from one study is on the rise with a significant 25% lifetime prevalence rate from Bernstein’s 2008 research (p. 1). The cause of generalized anxiety in children has a biological component, a social component, and a psychological component. The psychological and social aspects can be treated with CBT and the biological component, if somatic complaints are present, can be treated with medication i.e. fluoxetine. Fluoxetine is an “established [treatment] for anxiety disorders in youth” and could be prescribed as needed or until CBT treatment has reduced anxiety producing thoughts (Keeton, 2008, p.2). CBT is useful in challenging negative self-assessments in anxious children and modeling positive behaviour to increase social skills in children and thereby immunize them from stressful environments, including family situations and difficult life events. As childhood anxiety rises across cultures, treatment strategies like CBT must be integrated into school systems in order to decrease cases of childhood anxiety in the general population and to reduce the extended long-term care costs associated with untreated anxiety in children.
Barrett, P., Lowry-Webster, H., & Turner, C. (2000). Friends For Youth Workbook (pp. 1-69).
Bowen Hills: Australian Academic Press.
Bernstein, G. A., & Victor, A. M. (2008). Childhood Anxiety Disorders (p. 1). Humana Press.
Bodden, D. H., Bogels, S. M., Nauta, M. H., De Haan, E., Ringrose, J. M., Appleboom, C. M., et al. (2008, December 12). Child Versus Family Cognitive-Behavioral Therapy in Clinically Anxious Youth: An Efficacy and Partial Effectiveness Study. Retrieved October 15, 2009, from http://ovidsp.tx.ovid.com/spb/ovidweb.cgi?QS2=434f4e1a73d37e8c676ec 2d6238753f2d5a15dce7f8f3a8c339266220c507a79fb92068d4de488dd6490147cde7f80ee 40c70397f5622dcca75e1311ae6b2a0166ec5d63e2a95942ebd43f7b45
Bogels, S. M., & Zigterman, D. (2000). Dysfunctional Cognitions in Children with Social Phobia, Separation Anxiety Disorder, and Generalized Anxiety Disorder. Retrieved October 15, 2009, from http://vnweb.hwwilsonweb.com/hww/results/external_link_maincontentframe.jhtml?_DARGS=/hww/results/results_common.jhtml.42
Curtis, C., & Norgate, R. (2007, March 1). An Evaluation of the Promoting Alternative Thinking Strategies Curriculum at Key Stage 1. Retrieved October 13, 2009, from http://web.ebscohost.com/ehost/pdf?vid=3&hid=104&sid=3324d85d-c08d-4168-ae11- d571dab2b5eb%40sessionmgr112
Dadds, M. R., Holland, D. E., Laurens, K. R., Mullins, M., & Barrett, P. M. (1999). Early Intervention and Prevention of Anxiety Disorders in Children: Results at 2-Year Follow- Up. Retrieved October 15, 2009, from http://web.ebscohost.com/ehost/pdf?vid=3&hid= 105&sid=a964f0d1-b695-4dd2-8b35-377fb7d7fe0f%40sessionmgr112
Fatemi, s. H., & Clayton, P. J. (n.d.). Childhood Anxiety Disorders. Retrieved October 13, 2009, from http://books.google.ca/books?id=RJOy1vy2RKQC&pg=PA375&dq=epidemiology +childhood+anxiety&source=bl&ots=EfxJnBstOFig=d4zYHGMOSy6tQHpwU0_1np QKy-w&hl=en&ei=LCrOSveVOpG0sgPKvPXCDg&sa=X&oi=book_
Keeton, C. P. (2008, April 1). Combining and sequencing medication and cognitive-behaviour therapy for childhood anxiety disorders. Retrieved October 16, 2009, from http://web.ebscohost.com/ehost/pdf?vid=18&hid=107&sid=964bd9bd-2ff6-401c-9833- 2c487f5e9f0a%40sessionmgr4
Masi, G., & Millepiedi, S. (2004, June 1). Generalized Anxiety Disorder in Referred Children and Adolescents. Retrieved October 13, 2009, from http://ovidsp.tx.ovid.com/spb/ovidweb.cgi?QS2=434f4e1a73d37e8c676ec2d6238753f2fd 78f81ea63e8f86a5649719e7960e286701da8078c9e3a3aa618dd82efd1edbb922bdf53a185 8865ff7fa1a632d219dc3b66a635bd7b54c81b16cc3e9
O’Connor, R. C., Rasmussen, S., & Hawton, K. (2009, September 15). Predicting depression, anxiety and self-harm in adolescents: The role of perfectionism and acute life stress. Retrieved October 15, 2009, from http://www.sciencedirect.com/science?_ob=MImg& _imagekey=B6V5W -4X9FGV7-1-1&_cdi=5797&_user=5411015&_orig=search&_c overDate =09%2F24%2F2009&_sk=999999999&view=c&wchp=dGLzVtb- zSkzk&md5=c75a0cd75690bcef47a
Tomb, M. (2004, April 1). Prevention of Anxiety in Children and Adolescents in a School Setting: The Role of School-Based Practitioners. Retrieved October 13, 2009, from http://web.ebscohost.com/ehost/detail?vid=1&hid=7&sid=074fee35-5cbb-480b-a63b-1ffe564d13de%40sessionmgr4&bdata=JmxvZ2lucGFnZT1Mb2dpbi5hc3Amc2l0ZT1laG9zdC1saXZl#db=psyh&AN=2005-00445-003