Separation Anxiety Disorder and School Phobia[1][1]

8/9/2019 Separation Anxiety Disorder and School Phobia[1][1]

1/16


2/16

Anxiety Disorders are one of the most commonmental health concern for Children and

Adolescents in todays society.

Anxiety: apprehension or excessive fear about

real or imagined circumstances. (NASP) Separation Anxiety Disorder (SAD):

characterized by severe distress when separated

from the primary caregiver(s) or home.

School p

hobia

:used to describe children whorefuse to attend school because of emotional

distress.


3/16

` Stranger Anxiety: 7-9 months

` Separation Anxiety: 12-18 months-3 years

SAD

4-5% of the 20%of all anxietydiagnoses

Age of onset:5-8

Seems to occurmore in lower SESfamilies (50-75%)

SchoolPhobia

1-5% of all schoolaged children

Age of onset: 5-8

or 10-13

A ratio of 3:2females to malesfor both disorders,

however


4/16

` 75% of the children with school phobia

have SAD.

` 79% of children with SAD also had at least 1comorbid

disorder.

` Common

comorbid disorders in

clude

:Generalizedanxiety disorder, obsessive-compulsive disorder, panic

disorder, depression, attention deficit hyperactivity disorder,

oppositional defiant disorder, and enuresis.

` Significant negative effects on school performance.

` Long term effects: decreased rate of parenthood as adults,economic deprivation, marital and occupational problems,

social maladjustment, and substance abuse.


5/16

` Very few studies have been conducted with othercultures and ethnic groups outside of themainstream US population.

` Minorities tend to have higher rates of anxiety than

European American Groups.` Other countries and cultures view anxiety and

fears differently.

` Some countries have higher anxiety due to theirvalues and belief systems.

` Some cultures tolerate separation more than othercultures.


6/16

Psychosocial

Cognitive

Biological


7/16

` Heritability accounts for 1/3 of variance in anxiety

disorders.

` Individuals temperament can make a child more

likely or less likely to develop SAD and/or schoolphobia.

` Individuals with anxiety tend to have an:

overactive nervous system, high levels of

epinephrine and norepinephrine, and no increasein cortisol production.


8/16

` Certain situations may trigger the onset of

anxiety in children such as: a death, divorce,

serious illness, violence, and child abuse.

`

Parenting factors and styles can contribute toanxiety.

` Modeling, prompting, and reinforcement of

anxious behaviors by others affect the child

negatively.


9/16

` Negative thoughts and poor self-efficacy help

maintain anxiety.

` Maladaptive cognitions interfere with problem

solving and prevent coping skills to developsuccessfully.


10/16

` SAD can lead to school phobia and can be a

potential cause.

` Students who are bullied and/or lonely have a

greater chance of developing school phobia.` Traumatic events at school can trigger school

phobia (school shooting, child was injured on the

playground, etc.)


11/16

` Some cultures focus on the physical origins

(Hispanic), social origins (Japanese), or even the

spiritual origins (African, American Indian).

` Acculturation effects (added stress and anxiety) Look at the individual within the

context of culture, and do not define

the individual by his/her culture

(Harmon,Langley, Ginsbur, 2006)


12/16

` First you will want to screen all students, to find those who havehigh anxiety. (Self-report questionnaire, teacher

nominations/reports)` Clinical Interviews with child and possibly parent. (Anxiety

Disorders Interview Schedule for Children and parents: ADIS-C,ADIS-P)

` Other things to consider when doing an assessment for SAD

and/or School phobia: Childs history Childs attachment to others Fears Temperament Early adaptability School history

Academic functioning Patterns of school attendance Academic achievement Childs relationship with teachers and other students


13/16

` CBT: is one of the most well known treatments forAnxiety disorders.

` 4 components:

1. Identification and awareness of ones thoughts

2. Evaluation of what one is thinking in an anxietyprovoking situation

3. Development of problem-solving skills

4. Rewarding oneself for non-anxious behavior

` Systematic desensitization: form of exposure

therapy, where the child is exposed to the stimulus

gradually.


14/16

` Emotional regulation: relaxation and breathingtechniques

` Family Therapy/Parent Training: reward brave

behavior, model effective problem solving and

coping techniques, written contracts.` Pharmacology: SSRIs are most effective Medications most commonly prescribed: fluoxetine,

sertraline, and fluvoxamine.


15/16

Tier 3:

For individuals withmore pronounced

impairment.Treatment begins in a

1-on-1 setting.Tier 2:

Intervention for identifiedproblems before they becometoo severe; usually conducted

in groups

Tier 1

:

Every student is taught problem solving skills,and coping strategies to use when anxious.


16/16

`Our role as a School

Psychologist

DSM-V possible changes

Documents

Separation Anxiety Disorder and School Phobia[1][1]