V Anxiety Disorders are one of the most common

mental health concern for Children and

Adolescents in today¶s society.
V 
æ apprehension or excessive fear about
real or imagined circumstances. (NASP)
V ž


  
žæ
characterized by severe distress when separated
from the primary caregiver(s) or home.
V ž


æ used to describe children who
refuse to attend school because of emotional
distress.
 Stranger Anxietyæ 7-9 months
 Separation Anxietyæ 12-18 months-3 years

SAD School
Phobia

4-5% of the 20%

of all anxiety 1-5% of all school
diagnoses aged children

Age of onsetæ 5-8

Age of onsetæ 5-8 or 10-13

Seems to occur A ratio of 3æ2

more in lower SES females to males
families (50-75%) for both disorders,
however«
 75% of the children with school phobia
have SAD.
 79% of children with SAD also had at least 1comorbid
disorder.
 à 
    
  æ Generalized
anxiety disorder, obsessive-compulsive disorder, panic
disorder, depression, attention deficit hyperactivity disorder,
oppositional defiant disorder, and enuresis.
 Significant negative effects on school performance.

  

 æ decreased rate of parenthood as adults,
economic deprivation, marital and occupational problems,
social maladjustment, and substance abuse.
 ²ery few studies have been conducted with other
cultures and ethnic groups outside of the
mainstream 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 their
values and belief systems.
 Some cultures tolerate separation more than other
cultures.
Biological Psychosocial

Cognitive
 eritability accounts for 1/3 of variance in anxiety
disorders.
 Individual¶s temperament can make a child more
likely or less likely to develop SAD and/or school
phobia.
 Individuals with anxiety tend to have anæ
overactive nervous system, high levels of
epinephrine and norepinephrine, and no increase
in cortisol production.
 Certain situations may trigger the onset of
anxiety in children such asæ a death, divorce,
serious illness, violence, and child abuse.
 Parenting factors and styles can contribute to
anxiety.
 Modeling, prompting, and reinforcement of
anxious behaviors by others affect the child
negatively.
 Negative thoughts and poor self-efficacy help
maintain anxiety.
 Maladaptive cognitions interfere with problem
solving and prevent coping skills to develop
successfully.
 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.)
 Some cultures focus on the physical origins
(ispanic), social origins (Japanese), or even the
spiritual origins (African, American Indian).
 Acculturation effects (added stress and anxiety)
¬ Ã ook at the individual within the
context of culture, and do not define
the individual by his/her culture
(armon, angley, Ginsbur, 2006)´
 •irst you will want to screen all students, to find those who have
high anxiety. (Self-report questionnaire, teacher
nominations/reports)
 Clinical Interviews with child and possibly parent. (Anxiety
Disorders Interview Schedule for Children and parentsæ ADIS-C,
ADIS-P)
 Other things to consider when doing an assessment for SAD
and/or School phobiaæ

Child¶s history

Child¶s attachment to others

•ears

Temperament

Early adaptability

School history

Academic functioning

Patterns of school attendance

Academic achievement

Child¶s relationship with teachers and other students
 à
 is one of the most well known treatments for
Anxiety disorders.
 4 componentsæ

1. Identification and awareness of one¶s thoughts

2. Evaluation of what one is thinking in an anxiety
provoking situation
3. Development of problem-solving skills
4. Rewarding oneself for non-anxious behavior
 Systematic desensitizationæ form of exposure
therapy, where the child is exposed to the stimulus
gradually.
 %  
 æ relaxation and breathing
techniques
 •


 

  æ reward brave
behavior, model effective problem solving and
coping techniques, written contracts.
 
   SSRI¶s are most effective

Medications most commonly prescribedæ fluoxetine,
sertraline, and fluvoxamine.




•or individuals with

more pronounced
impairment.
Treatment begins in a
1-on-1 setting.



Intervention for identified
problems before they become
too severe; usually conducted
in groups



Every student is taught problem solving skills,
and coping strategies to use when anxious.
 Ourrole as a School
Psychologist

DSM-² possible changes