Children’s Anxiety and Depression

1. Valerie Crandall, MDPediatric Behavior MedicineJohns Hopkins UniversityBaltimore, MD Children’s Anxiety and Depression

3. Disruptive behavior Apprehension—false starts Indecision Withdrawal Brief physical contacts—touch and release Hyperactivity Overt Signs:

4. Non-compliance Recurrent abdominal pain—RAP (no organic basis) Asthma Pruritis Facial expressions Covert signs:

5. Neatness-- +/- Friendship retention Possibilities:

6. Nature / Nurture Nature reflects social capacity on an organic basis—brain centers Nurture reflects patterning, rearing, learning, physical and emotional security Social development:

7. Co-morbidities—(transient) • Situations • Losses • Missed opportunities (games, trips, etc.) • Chronic illness • Cancer • Diabetes • Cystic fibrosis • Epilepsy • “I’m different” Risk factors:

8. Maternal anxiety Being female Very low birth weight (<1500gm) 4 x peers’ incidence of anxiety/depression Other….believe it or not!

9. Emotional Physical Situational Self esteem Self image—physical health Stability/consistency…security Therefore…multifactorial basis for A&D:

10. Change is OK ! …but manage it.

11. Bedwetting—outgrow by age 4, familial • Night terrors (PavoNocturnus) • Night walking—outgrow in 6 mos.…all believed to reflect CNS immaturity • Remove stress—especially for night terrors • Reassure—still “clearly wrong”; concentrate • Emotional security What is NOT anxiety—

13. Increased volume of Superior Temporal Gyrusass’d with increased anxiety Posterior right hemisphereass’d with GAD (generalized anxiety disorder) Brain:

14. Amygdala/Hippocampus • (Fear and fear-related centers) • Larger and more electrically active…ass’d with increased anxiety states in turn, influences social behavior in turn, programs frontal lobe Brain:

15. …factors influencing social development (Pediatric Social Security) Physical Emotional Situational

17. Clues (all ages): • Peer relationships • Dating relationships • Pain—especially chronic • No victimization • Think about security • Promotes self-control…..self discipline

18. Anger Anger management BE CALM…..NOT CONFRONTATIONAL Related Pediatric Issues:

20. Examples: • Breath holding • Stomping • Screaming Anger… Tantrums

21. “I don’t want to be here.”

23. Sense of well-being……Be calm, don’t confront.

24. List of options: • Ignore • Give child some space • Offer a diversion • Investigate what is frustrating the child • Enhance communication by pointing to possibilities • Hug to reassure…but don’t invade space if needed • Speak calmly, preferably eye-to-eye • Laugh…don’t mock • Relocate What to do?

25. TouchingHugging

26. Primitive—

27. …..if not, question a possible mental cause • Asberger’s syndrome • Bipolar disorder (2% of adults) Tantrums usually outgrown by age 4.

28. Hormone rages Responses are learned …so, self examination is a good idea Time Personal space Adolescent moods:

30. Depression, Anxiety, Rage Social development physical, emotional, situational Children mimic …model from parents and teachers Summary:

31. Good luck !