Monday, September 10, 2012

Essay on Anxiety Disorders

Sample Essay on Anxiety Disorders

Affecting approximately 10% of all youngsters under the age of 18, anxiety disorders are among the second most common psychiatric disorders among children and adolescents.

With this numbers in mind, a trained clinician assessing a child with anxiety problems should pay attention at the limitations and challenges he or she might face.

As an example, let us consider the faced when assessing a child with Attention Deficit/Hyperactivity Disorder. The first complication one might encounter is the influence of office atmosphere upon the child during the examination. Children may simply not show symptoms during the appointment if they are able to control their behavior for short periods of time (hyperactive/impulsive type) or appear to pay attention (inattentive type) at the doctor’s office.

Children (especially younger) may have difficulty talking about their behavior, and also be unaware, or unwilling to admit, that their difficulties or behavior may indicate symptoms of a disorder, which, in turn, complicates the assessing.

When counseling a child, it is preferable to ask specific and detailed questions about symptoms, and in addition interview parents, teachers or other caregivers, who are able to describe the child’s behaviors more accurately. The parent needs to be continually part of communication between the teacher and the doctor.

Another challenge to assessing is the fact that, as a child grows, symptoms vary and their appearance may change, therefore, to determine the appropriate diagnosis, it is often better to see a child over time.

When counseling a child with ADHD it is also important to remember that other behavioral conditions may look like ADHD or may co-exist with this disorder (e.g. the conduct disorder or oppositional defiant disorder, etc). Mood disorders (e.g. depression and bipolar disorder) influence the child’s ability to pay attention, and are often preceded by ADHD.

The misdiagnosis of bipolar disorder as ADHD can lead to inappropriate treatment resulting in rapid cycling or mania. Anxiety disorders (like generalized anxiety disorder, social phobia, specific phobias, separation anxiety disorder and panic disorder) may look like ADHD, because a child’s anxiety can produce difficulty concentrating or agitation.

When assessing a child, it is important to obtain additional information thorough relevant laboratory tests and physical examinations upon the child’s background (e.g. abuse, the cases of physical trauma, neglect, caffeine and medical conditions (like hypothyroidism, hyperthyroidism, seizure disorders, genetic conditions, sleep disorders, head trauma, and toxic exposures) can cause ADHD-like symptoms of hyperactivity or problems with paying attention.

Medical, educational, and behavioral history, plus the developmental survey, evidence of normal vision and hearing, and recognition of any systemic illness constitute a comprehensive evaluation for ADHD. The prevailing criteria are contained in the Diagnostic and Statistical Manual of the American Psychiatric Association--Fourth Edition--Text Revision, known as DSM-IV. Making a diagnosis based solely on a diagnostic checklist is inadequate – it should be based on the history and clinical observation reviewing the individual’s current and past life. Additionally, clear impairment of functioning in at home and school and the presence of 6 of the 9 inattention or hyperactivity symptoms as specified in the DSM-IV are necessary to make that diagnosis.

Psychological testing, although not diagnostically helpful, can detect the possible coexistence of learning disabilities. Conservative estimates of the prevalence of learning disorders among children with ADHD are about 20-25%.

When children attend a counseling session for assessment they may face uneasiness and anxiety, or, on the contrary, stay mute. This occurs due to the temporary loss of significant people, familiar surroundings and special items (like toys, etc.). It is extremely important to address their needs of safety and comfort and to provide a respective environment. This might include the participation of the caregiver or a private item. The inattentive type of ADHD-diagnosed children might benefit from a place with no extra distraction, but not a hostile medical office, but rather a place of mutual trust.

Counseling children with ADHD takes a lot of encouragement and support. Therefore, it is of vital importance to coach a family about what they can reasonably expect from their child and the means to stimulate positive response upon the requests from him or her.

The specialist trying to formulate a therapeutic relationship with these children might also encounter certain problems, like a problem of sharing necessary information (sometimes children – especially younger ones – are unable to answer the questions properly or even reluctant to do so). The children’s perceptions of closeness with their therapists are often associated with their perceptions of closeness with their mothers, their own age, and welfare status of the family. The more coincidence there is, the better relationship becomes, and the more benefits could be gained from the counseling process.

Generally, children are much more emotionally vulnerable and family (caregiver)-dependent, which on the one hand complicates the counseling but at the same time it provides additional opportunities of making parent-teacher-therapist alliances that might be beneficial for both the child and the assessing process itself. It is important to develop emotional sensitivity, mindfulness, compassion validation and empathic understanding that comprehend truly effective therapeutic relationship.
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