M2 – GROUP B

Palad, Mary Grace Ann P.; Llanes, Nerea; Dasalla, Karen Jane; Ghale Gurung, Sanish;
Dakshina, Udawatta; Siriwardana, Alahakoonlage Isuru Dushantha;
Thakur, Nabin
CASE
 A case of a 7-year-old girl, a grade schooler who presented with a poor track record of school
attendance.
 She was anxious and sensitive child.
 Her mother has difficulty in bringing her to school because she was constantly tearful.
 She was always upset and cries constantly if her mother was not with her.
 She will not sleep in her own room and by the morning has often worked her way to her
parents’ room or bed.

With the criteria and manifestations that are also the salient features of our case, we could say the
diagnosis is Separation Anxiety Disorder.
MENTAL STATUS EXAM
 APPEARANCE
 7 years old little girl who has normal height and weight for her age.
 She is well groomed with good personal hygiene.
 She is also well dressed wearing a pink dress and a white shoes.
 She sits almost on top of her mother during the interview.
 She did not maintained good eye contact with the psychiatrist.
 No evidence of physical abuse noted.

 BEHAVIOUR
 Patient was uncooperative during the interview.

 She likes to play with the psychiatrist.

 Keep remains close physical contact with her mother all the time.
MENTAL STATUS EXAM
 SPEECH AND LANGUAGE
 She spokes poorly.

 Volume is low with the conversation.

 Reluctant to talk and almost inconsolable.

 Talk with babyish voice.

 MOOD AND AFFECT

 The patient is sad and worried, as she says “ My mom might leave me” .
 Patient’s affect is anxious and irritable.
MENTAL STATUS EXAM
 THOUGHT CONTENT
 She is preoccupied with thoughts that her mother will leave sometime.
 No presence of hallucination, delusion, neither suicidal nor homicidal ideation.

 THOUGHT PROCESS
 Patient is speaking with clarity.

 There are evidence of flight of ideas, loosening of associations, perseveration, tangentially,

and thought blocking.
MENTAL STATUS EXAM
 COGNITION
 She is alert and awake throughout the interview
 Oriented to person but not to place and time.
 She can name 3 objects and can recall it when asked.
 Calculations: 2+2 =4, 3-1 = 2
 Her memory is intact and no abnormality in language, abstract and visual proportional.

 INSIGHT AND JUDGMENT

 Poor. The patient doesn’t understand her situation, symptoms, diagnosis, and its impact on
them and their daily functioning.  
 MANAGEMENT
 In order to calm patients with separation anxiety disorder, the treating physician must enable them to
feel safe on their own. Many patients feel unsafe when apart from the person or item that they are
attached to, therefore, special efforts are needed to assure them of the safety of their surroundings.

 Parents may be able to help their children deal with such undue insecurity by deliberate periodic
planned absences from the child, having first informed the child of their plans sympathetically, and
returning at the promised time to build confidence that they will return.

 Dealing with the clinging behavior of the child with compassion and maturity is of key importance.
Rather than sneaking away for some work in a suspicious manner, it is vastly preferable to have an
active conversation about the reason for going away, which can reassure the child. Parents themselves
should remain composed while dealing with a child with separation anxiety disorder.

 Also, encouraging the child to participate in various outdoor activities and praising even the smallest
of achievements in due measure can also prove to be helpful for such children to gain more confidence
Parental Attachment Patterns in
Mothers of Children with Anxiety
Disorder
Saban Karaya , Timuçin Aktan, and Lider Zeynep Karaya
 Parental Attachment Patterns in Mothers of
Children with Anxiety Disorder
INTRODUCTION

 Attachment is an important emotional concept for the individual, as it is based on relations of comfort,
self-confidence and satisfaction. It may be described as a cluster of strong emotional ties that people
develop for individuals they care about. It is shaped by the nature of the relations with the caregiver. Its
nature is specific to any kind of relationship.

 The authors defined anxiety as bodily response to a perception of danger. If it is exaggerated or overplayed
in case of the perception of danger that influences functionality, it may lead to a disorder in the long term.

 Some of the most common symptoms of anxiety in children include crying, unwillingness to go to school,
fear, sadness, fear of separation, tension, restlessness, difficulty at focusing, difficulty at falling asleep, dry
mouth and dizziness
Parental Attachment Patterns in Mothers of Children
with Anxiety Disorder
 The study explained that bonding between the child and parent plays a crucial part in the healthy
upbringing of a child and negative types of attachment influence an individual’s quality of life
adversely in later years. Children express their feelings of attachment for their parents through
behavior, such as crying, calling, greeting, laughing.

 The securely attached child shows positive emotions to the family. It can be separated from
parents without stress, seeks parents’ comfort when scared and positively responds to parents’
return. Children with an anxious attachment may be cautious around strangers and get very
anxious as their parents leave. The avoidant child may neglect the family, does not want much
care from their parents and does not care about strangers.
Parental Attachment Patterns in Mothers of Children
with Anxiety Disorder
SIGNIFICANCE OF THE STUDIES
 To compare the attachment patterns between the mothers of children diagnosed with an
anxiety disorder against the mothers of children with no mental illness
 As no particular study previously focused on the relationship between the anxiety
disorder of the children and the attachment patterns of their mothers to their
parents,
Parental Attachment Patterns in Mothers of Children
with Anxiety Disorder
METHODOLOGY
 Ethics Approval
All subjects gave their informed consent for inclusion before they participated in the study.

 Setting
The sample of the study consisted of the mothers of children who were admitted to a city hospital
and a private clinic in the city of Kayseri, Turkey, and diagnosed with an anxiety disorder by
specialist child psychiatrists.

 Participants
The criteria to be included in the study were being a caregiver and parent of a child diagnosed
with an anxiety disorder. The participants were 80 mothers (40 in the experimental group and 40
in the control group). Two requirements included being at the age of between 20 and 65 years
old, and that the parent had a child diagnosed with an anxiety disorder.
Parental Attachment Patterns in Mothers of Children
with Anxiety Disorder
METHODOLOGY
 Data Collection A sociodemographic form was used to collect information about the participants involving
education, occupation, marital status, number of children and income. The majority (77.5%) of the mothers in the
study were middle-aged and their level of education was mostly (60%) high school or lower. The majority of them
(88.88%) were married for 11–30 years with at least 2 children.

A second data collection tool, the parental bonding instrument (PBI), was utilized to gather data about parental
attachment perceptions of the participating mothers. It evaluates an individual’s perceived relationship with parents. The
scale consists of 25 items and is administered separately for each parent. Each item is scored between 0–3 on a Likert
scale. The maximum total score is 36. In the scale, 12 items (0–36 points) measure the dimension of care and 13 (0–39
points) measure the dimension of control/overprotection.

Optimal parenting involves approaches with low protection and high care in raising children. Neglectful parenting
corresponds to low protection and low care. The parenting style with high protection and high care is described as
affectionate constraint, while low care and high protection constitute the affectionless control. The cut-off points for these
values on the relevant scale were 27 points for care and 13.5 points for protection in mother; and 24 points for care and
12.5 points for protection in father subsamples.
Parental Attachment Patterns in Mothers of Children with Anxiety Disorder

CONCLUSION
 In terms of parenting styles, it was observed that perceived parental styles were similar.
Nevertheless, the number of “negligent parent” was higher and the number of the “loving
restriction” was lower in the experimental group.

 A comparison of both groups also revealed that “loveless restriction” and “negligent parenting”
styles were observed more frequently in the experimental group and less so in the control group.
As previously reported the parents of mothers of children with anxiety disorders may be more
negligent in terms of attachment patterns

 In contrast to similar research findings, we found that care and overprotection were not
statistically significant for neither the mothers nor the fathers. In conclusion, the overprotective
parenting style engenders anxious and dysfunctional attitudes about dependency on gender-
specific manners for the child toward caregivers.
Parental Attachment Patterns in Mothers of Children
with Anxiety Disorder
RECOMMENDATION
 This study was conducted with a quantitative research approach and under the rules of
descriptive analysis so the findings somewhat may be extended to its setting and a similar group
of parents. For further studies in the future, data could be collected not only from the mothers,
but also from the fathers, because it could provide richer and deeper information.