Transcript MHN702 Module 6 Video 2

In this video we are going to have a look at the different anxiety disorders that occur during childhood and
adolescence and the average age of onset for these disorders. We'll then discuss in more depth the three most
common anxiety disorders in youth: social anxiety disorder, separation anxiety disorder and specific phobia.
Anxiety disorders are the most frequently diagnosed class of mental disorder in children and adolescents. The
majority of people who develop an anxiety disorder throughout their life, do so by late adolescence or early
adulthood. Here we can see the results of a large meta-analysis conducted by Lijster et al. 2017. They found that
the mean age of onset across all anxiety disorders was 21.3 years of age. They also found that separation anxiety
disorder, specific phobia and social anxiety disorder all had an average age of onset before 15 years of age.
Social anxiety disorder formerly known as social phobia is the persistent fear and avoidance of social or
performance situations in which the individual is exposed to possible scrutiny by others. Median age of onset is
approximately 13 years of age, with 75 of all cases beginning between the ages of 8 and 15 years. Early
childhood behavioural inhibition, a temperamental style where the child displays heightened fear and
reservation around unfamiliar situations or people, has been shown in a number of studies to predict the
development of social anxiety disorder in adolescents. In a study by Chronis-Tuscano et al. 2009, temperament
was measured at multiple time points between 14 months and 7 years of age. Participants then underwent a
diagnostic interview between 14 and 16 years of age. The results showed behavioural inhibition in childhood
was a significant predictor of a social anxiety disorder diagnosis in adolescence. Participants who displayed
behavioural inhibition temperament in childhood were on average 3.8 times more likely to develop social
anxiety disorder in adolescence. Diagnostic criteria for social anxiety disorder include: a heightened fear or
anxiety about situations where the individual may be exposed to possible scrutiny by others, fear that the
individual may display anxiety related symptoms, the social situation must almost always provoke fear, the
social situations are avoided or endured with intense fear, the fear and avoidance behaviour is persistent lasting
six months or longer, it causes significant distress or impairment to social academic or occupational activities
and it is not better explained by substance use or other mental disorders. Separation anxiety disorder is the most
common anxiety disorder in children under 12 years of age and is characterized by excessive anxiety regarding
being separated from the home or people the child is attached to. While heightened anxiety regarding separation
around one year of age may be part of normal development, separation anxiety disorder is more likely from
around preschool age throughout childhood and and to a lesser extent into adolescence. In DSM-4 there was an
age restriction on the diagnosis of separation anxiety disorder of a maximum of 18 years of age. In DSM-5 this
age restriction was removed. Common functional consequences in school-aged children and adolescents may
include avoiding school, not wanting to stay over at friends houses and not going on school camps. Diagnostic
criteria include: recurrent and excessive distress when experiencing or anticipating separation from home or
major attachment figures, persistent and excessive worry about losing a major attachment figure, refusal to go
out, reluctance about being alone and nightmares involving separation. These behaviours must be ongoing,
lasting at least four weeks in children and adolescents. The disturbance must cause clinically significant distress
and impairment to social academic or occupational functioning and the disturbance must not be better explained
by another mental disorder. In this graph we can see the results of a study which looked at the likelihood of
developing panic disorder between people who had separation anxiety disorder, shown in the black dots, and
those who didn't, the white dots. We can see that people who have had a separation anxiety disorder as a child,
have a significantly higher chance of developing panic disorder during adolescence and early adulthood than
those who didn't. Specific phobia is an identifiable and persistent fear that is excessive and unreasonable and is
triggered by the presence or anticipation of a specific object or situation termed the phobic stimulus. Common
phobias include fear of injections, animals, heights, insects, blood, enclosed spaces and flying. Prevalence rates
are around five percent in children and sixteen percent in 13 to 17 year olds. Approximately 75 percent of
people diagnosed with specific phobia, fear more than one stimulus and females are around twice as likely to
suffer with specific phobia than males. Diagnostic criteria for specific phobia include: a marked fear or anxiety
about a specific object or situation, in children this may be expressed by clinging, crying, tantrums and freezing;
the phobic stimulus must almost always provoke fear or anxiety; the phobic stimulus is actively avoided and this
behaviour is persistent, lasting over six months; the disturbance causes clinically significant distress or
impairment in social, academic or occupational situations and it cannot be better explained by another mental
disorder. In the graph shown here we can see the age specific prevalence rates for four types of specific phobia
while the overall percentage ranges between eight and eleven percent, the pattern of change is very similar and
shows that each subtype peaks at around 15 years of age before flattening out. In this video we have looked at
the most common anxiety disorders in childhood and adolescence. We have also looked at social anxiety
disorder, specific phobia and separation anxiety disorder more closely including a look at the main diagnostic
criteria. An understanding of the prevalence rates and diagnostic criteria for these mental disorders should help
us to identify individuals at risk and encourage early intervention be sought before early symptoms become
diagnosable disorders.