Evi Aki, Brooke Babbitt, Kelli Slemp, Marketia White, Ashley Ontiveros, Mark Vickers Case Study: Frannie + Frannie Frannie is a 7 year old girl who was brought to a mental health outpatient clinic by her mother because of her difficulties with peer relationships. Fannies second grade teacher let her mom know of classroom problems with Frannie not interacting with other children in the class. Frannie does not play at recess and has a lot of difficulty even responding to classmates. It has been 6 months since the beginning of school. At home, Frannie is warm and outgoing with her family, laughing and talking normally. + Defining Social Anxiety Anxiety ( as defined by the book) is a mood state that is characterized by strong negative emotion and bodily symptoms of tension in which a child apprehensively anticipates future danger or misfortune.
strong negative emotion
fear
When a child experiences these feelings in an excessive amount is when the feelings become classified as a disorder.
+ Defining Social Anxiety Continued Also, Frannie is able to communicate and interact while being warm and outgoing with her family. Therefore, it is solely based on the environment in which she is placed. social.
Although there are many different types of anxiety, Frannie is specifically experiencing Social Anxiety.
http://www.youtube.com/watch?v=i7EAsMNZ6uA Discomfort interacting with peers Withdrawn/nervous around other children Shake and cry when expected to interact
+ Social Anxiety Disorder Emotional Symptoms/Diagnosis/Criteria A. Marked fear or anxiety of social situations B. Fear that they will show anxiety symptoms and be negatively judged C. Social situations almost always provoke fear or anxiety D. Social situations are avoided or endured with intense fear E. Fear or anxiety are out of proportion F. Fear typically last for more then 6 months G. Fear, anxiety, or avoidance causes clinically significant distress or impairment H. The fear, anxiety or avoidance is not attributable to the effects of a substance or medical condition I. Not better explained by another mental disorder J. If another medical condition stuttering, Parkinson's disease, obesity, disfigurement from burns or injury is present fear anxiety are ok K. *special note* can not be performance only fear + Reasons for Diagnoses Social Anxiety Teacher notices marked fear or anxiety Symptoms have continued for at least 6 months Going to neighbors house provokes fear through shown through her crying + Social Anxiety + Symptoms of Social Disorder Heart Palpitations-71% Trembling or Shaking-67% Chills- 63% Sweating or Hot Flashes- 54% Upset Stomach or Nausea- 54% Red face or blushing Shortness of breath Physical Symptoms http://www.helpguide.org/mental/social_anxiety_support_symptom_causes_treatment.htm Racing Heart Tightness in Chest Accidental Bowel Movements Dizziness Fainting Crying Panic Attack + Symptoms of Social Anxiety Avoiding social situations to a degree that limits usual activities or disrupts a normal life Staying quiet or hiding in the background in order to escape notice and embarrassment A need to not feel alone (a friend) Behavioral + Causal Factors Direct conditioning/ Learned behavior- a child may learn to become socially avoidant by a parent who exhibits shyness or an avoidant personality Traumatic experience in a social environment may create anxiety from all social encounters after that experience Parental overprotection and/or rejection have been associated with social anxiety disorder An anxious temperament in the home
+ Causal Factors Continued Genetics -Anxiety disorders tend to run in families -A history of shyness and chronic illness can increase the risk Brain Function/Chemistry - An overactive amygdala: this can cause someone to have an increased fear response which can cause anxiety in social situations - An imbalance in serotonin- those with social anxiety disorder can be extra sensitive to the effects of serotonin in the brain. Serotonin is responsible for mood and emotional control
+ Triggers for Social Anxiety Meeting new people Being the center of attention Being watched while doing something Making small talk Public speaking Performing on stage Being criticized Attending parties or other social gatherings Talking with important people Being called on in class Going on a date Making phone calls Using public restrooms Taking exams Eating or drinking in public Speaking in a meeting
http://helpguide.org/mental/social_anxiety_support_symptom_causes_treatment.htm + Therapy Cognitive Behavioral Therapy Exposure Therapy Virtual Reality Therapy http://www.youtube.com/watch?v=i7E AsMNZ6uA Treatments and Roadblocks to Social Anxiety + Medication Anti depressant medication -Selective Serotonin Reuptake Inhibitors (SSRIs) - escitalopram - sertraline -Cons becomes worse before it gets better, does not work right away Beta blockers -Cons work better with short-lived anxiety. Benzodiazepines -Cons addictive, lose effect shortly after taking them, drowsy Medicine not taken for long Treatments & Roadblocks to Social Anxiety + Social Anxiety & Co-Occuring Disorders The most common co-occuring disorders are:
+ (Co-occuring) Diagnosis Selective mutism (SM) is an anxiety disorder in which a child is unable to speak in public situations where speaking is expected. Children with SM often speak normally in familiar situations, such as at home or alone with parents; but cannot speak at all or above a whisper, in other social or public settings such as parks, shopping malls, restaurants, or school.
Studies and research often indicate children with SM suffer from social anxiety, far beyond normal shyness, which affects not only their ability to converse in public, but also interferes with their academic and social development. (Dummit et al, May 1997, J Am Acad Child Adol Psychiatry)
In the Case Study of Frannie + (Co-occuring) Diagnosis Frannies mother tried repeatedly to get her involved with other children in the neighborhood. She would take Frannie by the hand and lead her to neighbors home where there were children of the same age. When she did this, Frannie would start to shake or cry and would not be able to say a word to the neighbors child. The teacher reports that in the classroom, Frannie never initiates conversation with the other children and has great difficulty responding even when approached by another child. At home, Frannie is warm and outgoing with her family. In the Case Study of Frannie http://www.youtube.com/watch?v=gmEJEfy5f50&feature=youtu.be Kaylas story / Example of SM