Course:KIN366/ConceptLibrary/Anxiety

Movement Experiences for Children
KIN 366
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Instructor:	Shannon S. D. Bredin
Email:	shannon.bredin@ubc.ca
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Anxiety is an uncomfortable state of inner turmoil that causes excessive worry, or uneasiness and is accompanied by nervous behaviour, and undesirable rumination (Carenotes, 2014; Seligman, Walker & Rosenhan, 2000). It is a basic emotion present in infancy, childhood, adolescence and even into adulthood. It varies on a continuum from mild to severe. Severe anxiety can be categorized into a number of anxiety disorders which can be associated with considerable complications and is highly co-morbid among other mental illnesses (Beesdo-Baum & Knappe, 2012). While anxiety is primarily composed of mental distress, it can be significantly disruptive physically to one’s body as well.

History

Anxiety is a part of evolution. When there is a perceived threat or harmful event an automatic response activates the flight or fight system. Anxiety is the system malfunctioning, it creates a sense of nervousness when there is actually nothing to be feared. During the era of the Greek rule the term “hysteria” was coined. It described anxiety-prone women who behaved in strange, high-strung manners. This was believed to have a biological origin from the uterus. In the early renaissance, highly anxious women, prone to “hysteria”, were frequently incriminated of being witches. During the Victorian era, women continued to be seen as suffering from anxiety and were sent to local insane asylums or relieved through electroshock therapy and lobotomies in severe cases. It was until after the American Civil War that men began to be recognized as having anxiety-related difficulties as well. In the mid twentieth century modern medicine techniques began to emerge to treat anxiety, but it wasn’t until the 1980’s that the term “anxiety disorder” was established. Today a number of anxiety disorders can be recognized and effective strategies for coping and different forms of treatment have been discovered to assist with the anxiety people experience (CalmClinic, 2015a).

Etiology

The exact cause of anxiety disorders is unknown; however, there are multiple biological, psychological, cognitive, behavioural and social factors which play an important role in the etiology of such disorders.

Biological

Biological factors can include genetics, specific regions in the brain, as well as neurotransmitters receptor systems. Anxiety disorders tend to run in families and it is thought that genetics moderately influences anxiety disorders (Doğan, 2012). The dorsal periaqueductal grey in the mid-brain, the hippocampus and the limbic system are key sites in the brain which have been found to be involved in anxiety as well (Clement & Chapouthier, 1998). Although three main neurotransmitter systems appear to be highly responsible for the array of symptoms in anxiety disorders, other neurotransmitters such as dopamine and glutamate also support neurochemical disruptions leading to the expression of anxiety (Doğan, 2012; Clement & Chapouthier, 1998).

Psychological

Psychodynamic theories attempt to explain anxiety disorders in relation to psychological factors. According to such theories, anxiety emerges as a result of unconscious conflict (Doğan, 2012). Psychoanalysts’ have inferred that Sigmund Freud’s theory of unconscious conflict is a potential cause of anxiety manifesting (Gavin, 2012).

Cognitive and Behavioural

Cognitive factors are also important in interpreting anxiety. With anxiety disorders certain events or stimuli are misinterpreted, causing significant disturbance or unwarranted negative representation to the individual. Due to these cognitive misinterpretations behavioural theorists have then used learning theories to attempt to explain and understand anxiety to a greater degree. Learning theories suggest that anxiety results when neutral stimuli evoke fear and avoidance and is reinforced through avoidance behaviour (Doğan, 2012).

Social

Social factors which influence anxiety can include social isolation, lack of support, major adverse events, as well as, harsh discipline, abuse and neglect to name a few (Doğan, 2012). Early life experiences in family settings are also linked with anxiety. In infancy insecure attachment, discrepant co-parenting and parental modeling of anxiety are seen to be problematic. Into early and middle childhood, marital conflict, rejection, and negative events are common risk factors (O’Connell, Boat & Warner, 2009).

Types

There are several types of anxiety disorder which exist. They can include panic disorder, social anxiety disorder, specific phobias, post traumatic stress disorder and generalized anxiety disorders (Antai-Otong, 2006).

Panic Disorder

Panic Disorder involves feelings of terror which are irrational and strike unpredictably, known as panic attacks. Panic attacks can last minutes to hours and include symptoms of intense discomfort such as chest pain, sweating, chills, trembling and or nausea (Antai-Otong, 2006; WebMD, 2015). Panic attacks can be expected or unexpected and results in changes in behaviour which are maladaptive such as avoidance (American Psychiatric Association, 2000).

Social Anxiety Disorder

Social Anxiety Disorder is an irrational fear of social situations. It causes people to feel uncomfortable and in some causes completely avoid social situations entirely. Worry often results from fear of being judged, scrutinized, embarrassed or negatively evaluated by others (American Psychiatric Association, 2000; Antai-Otong, 2006; WebMD, 2015).

Post Traumatic Stress Disorder

Post Traumatic Stress Disorder (PTSD) results from past traumatic physical or emotional memories. Common events which may cause such this disorder to develop include life-threatening events, war terrorism, or natural disasters (Antai-Otong, 2006). Central symptoms concern intrusion of memories associated with such traumatic events (American Psychiatric Association, 2000).

Specific Phobias

Specific Phobias is a marked fear or anxiety, which is intense and inappropriate, to objects or situations. Like with social anxiety people often avoid the situation or object altogether (WebMD, 2015). The fear is out of proportion to actual danger, and causes clinically significant distress to important areas of functioning. Diagnosis of specific phobia is assigned if criteria for PSTD are not met (American Psychiatric Association, 2000).

Generalized Anxiety Disorder

Generalized Anxiety Disorder involves excessive, unrealistic worry and tension that lasts 6 months or longer. The worry is difficult to control and is out of proportion to the situation. (Antai-Otong, 2006; WebMD, 2015). In children only one of the six symptom items is required for a diagnosis. These symptoms include restlessness, or feeling on edge, being easily fatigued, irritability, difficulty concentrating, muscle tension and sleep disturbance (American Psychiatric Association, 2000).

Prevalence

Anxiety disorders as a whole are the most frequently experienced of all psychiatric disorders (Doğan, 2012).

Infancy

Between the ages of seven months and one year, most infants develop and experiences distress when separated from their primary caregiver. This fear peaks at nine to eighteen months but with normal development then begin to decrease by around age two to three years of age. If the infant continues to worry and fear strangers as well as separation from their primary caregiver past this approximate age they are more likely to develop an anxiety disorder later in childhood or adolescents. Approximately 15% of infants will experience separation anxiety (Costello, Egger, & Angold, 2005).

Preschool Children

As children age they are more likely to be diagnosed with an anxiety disorder. For example two to three year olds the prevalence is approximately 8% while at age four to five it increases to approximately 12%. At this age range, no significant gender differences for specific anxiety disorders have been found (Costello, Egger, & Angold, 2005).

School-Aged Children and Adolescents

As children continue to age, girls are slightly more likely than boys to report anxiety disorders (Costello, Egger, & Angold, 2005). The median age of onset in childhood is around eleven years of age and anxiety is usually co-morbid with other disorders. Reported prevalence rate of anxiety disorder which impairs daily functioning is approximately 5-10% (Esbjorn, Hoeyer, Dyrborg, Leth, & Kendall, 2010).

Diagnosis

Anxiety disorders alongside other mental disorder are diagnosed using the Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria. The DSM is well recognized by the American Psychiatric Association (APA) and each disorder has specific diagnostic criteria which have been subjected to scientific review (American Psychiatric Association, 2000).

Implications

Although anxiety is a mental condition it is associated with social, behavioural, physical and intellectual aspects and symptoms which can profoundly impact everyday life functioning. Specifically, some symptoms may result in hindered movement which might then further perpetuate the anxiety (Calm Clinic, 2015-Anxiety Hinders Movement). Over the years it has been observed that there is a relationship between anxiety disorders and motor impairment (Pine, Wasserman, Fried, Parides, & Shaffer, 1997)

Motor Impairments

Infancy

Attachment theory was developed in 1969 by John Bowbly. The theory was developed to better understand primary caregiver-infant relationships while forming a basis for child development. Infants require a secure attachment or base in order to develop and explore their environments. If they lack this early high-quality consistent care stress and anxiety may result, which in turn can impede the regular development of the child (Colmer, Rutherford, & Murphy, 2011). Based on this theory, episodes of anxiety have been observed in infants who have not established a secure base of attachment, also known as separation anxiety. The infant will typically protest to being abandoned by crying and clinging to the primary caregiver (Walker, 2013). This sort of anxious attachment at age one is related to behavioural, school related, and interpersonal problems in preschool (Sroufe, 1983). However, if the relationship between an infant and mother, or primary caregiver has been established there is a greater potential for secure exploratory behaviours by the infant (Rutter, 1980). Secure exploratory behaviours allow infants to feel more comfortable moving about in their surroundings allowing them to develop basic motor skills.

Childhood

Greater motor problems in children with anxiety disorders in comparison to control children have also been found. Such impairments can occur with varying degrees of severity, but it has been difficult to establish a direct causal correlation. Motor proficiency is important for children in developing independent mastery skills as well as enhancing opportunities for social interaction (Skirbekk, Hansen, Oerbeck, Wentzel-Larsen & Kristensen, 2012). In childhood it is important that children develop a perception of personal control (locus of control) over the events in their environment. External control has been found to correlate with anxiety. The greater control children perceive, the less likely they are to be anxious (Chorpita & Barlow, 1998). They are also more likely they are to engage and feel comfortable in social situations such as play with other peers, sports related activities and other movement involved activities.For these reasons it is important to continue to address anxiety into childhood in order proficiently continue motor development.

Adolescence

Although anxiety has proven to impact motor development in infancy and childhood, chronic anxiety disorders often begin in adolescence with a substantial portion of anxious adolescents then becoming anxious adults. Although children can be diagnosed with anxiety it is more common with adolescents. Furthermore, physical symptoms must be present in order for certain types of anxiety disorders to be diagnosed (Clark, Smith, Neighbors, Skerlec, & Randall, 1994). This may include motor tension and autonomic hyperactivity which negatively impacts how people move about and interact with people and objects in their environments.

Treatment and Strategies

Medical Treatment Methods

Medical forms of treatment for anxiety include selective serotonin reuptake inhibitors (SSRIs), antidepressants, and antipsychotic medications. Cognitive behavioural therapy (CBT), another form of treatment, involves interplay among people’s thoughts, feelings and behaviours (Spector, Orrell, Lattimer, Hoe, King, & Harwood, 2012). Both drug treatments and CBT techniques may substantially improve quality of life for people suffering from anxiety disorders (Bandelow, 2008).

Complementary and Alternative Therapies

This form of treatment can include cognitive feedback such as hypnosis, physical treatments such as massage, as well as other therapies including spiritual healing, aromatherapy and dietary modifications. Complementary and alternative therapies perceived helpfulness is comparable to those who use conventional methods. They can also be used alongside other conventional methods such as medical treatments and have been proven to be effective (Kessler et al., 2001).

Familial Influences

Although medical methods and complementary and alternative therapies have proven to be effect in treating anxiety, familial influences are important factors to address early in development as well. Family characteristics that provide infants and children with the opportunity to experience control early in development are of theoretical importance. Parenting styles which allow increased sense of control in children provide children with the opportunity to develop new skills and explore or manipulate their environments in a way which in turn also assists with motor development (Chorpita & Barlow, 1998). It is important that parents or primary caregivers are supportive to their children if they experience anxiety. Many resources are available within communities if they are unsure how to deal with certain situations.

Coping Strategies

Coping strategies can involve active, avoidance, distraction and support seeking coping. Active coping has found to be a significantly positive strategy for coping with anxiety (Thorde, Andrews, & Nordstokke, 2013). Active coping uses either behavioural or psychological efforts in an attempt to deal with the problem situation through the resources which are currently available (Zeidner & Endler, 1996). Coping efficacy may relate to fewer experiences of anxiety by providing a sense of achievement and regularity that problems have been solved in the past and can be overcome if they arise again (Thorde, Andrews, & Nordstokke, 2013).

References

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, D.C.

Antai-Otong, D. (2006). Anxiety disorders. Nursing, 36(3), 48-49.

Bandelow, B. (2008). The medical treatment of obsessive-compulsive disorder and anxiety. CNS Spectrums, 13(9 Suppl 14), 37-46.

CalmClinic. (2015a). A brief history of anxiety. Retrieved from http://www.calmclinic.com/brief-history-of-anxiety

CalmClinic. (2015b). Anxiety hinders movement. Retrieved from http://www.calmclinic.com/anxiety/symptoms/hinders-movement

CareNotes (2014). Anxiety. Health Reference Center Academic. Truven Health Analytics Inc. Retrieved from: http://go.galegroup.com.ezproxy.library.ubc.ca/ps/i.do?id=GALE%7CA385799581&v=2.1&u=ubcolumbia&it=r&p=HRCA&sw=w&authCount=1

Chorpita, B. F., & Barlow, D. H. (1998). The development of anxiety: The role of control in the early environment. Psychological Bulletin, 124(1), 3-21.

Clark, D.B., Smith, M.G., Neighbors, B. D., Skerlec, L.M., & Randall, J. (1994). Anxiety disorders in adolescence: Characteristics, prevalence, and comorbdities. Clinical Psychology Review, 14(2), 113-137.

Clement, Y., & Chapouthier, G. (1998). Biological bases of anxiety. Neuroscience and Biobehavioural Reviews, 22(5), 623-633.

Colmer, K., Rutherford, L., & Murphy, P. (2011). Attachment theory and primary caregiving. Australasian Journal of Early Childhood, 36(4), 16-20.

Costello, E.J., Egger, H.L., & Angold, A. (2005). The development epidemiology of anxiety disorders: Phenomenology, prevalence, and comorbidity. Child and Adolescent Psychiatric Clinics of North America, 14(4), 631-648.

Esbjorn, B. H., Hoeyer, M., Dyrborg, J., Leth, I., & Kendall. P.C. (2010). Prevalence and co-morbidity among anxiety disorders in a national cohort of psychiatrically referred children and adolescents. Journal of Anxiety Disorders, 24(8), 866-872.

Gavin, K. (2012). Freud’s theory of unconscious conflict linked to anxiety symptoms in new U-M brain research. Health System, University of Michigan. Retrieved from http://www.uofmhealth.org/news/unconscious-anxiety

Kessler, R.C., Soukup, J., Davis, R.B., Foster, D.F., Wilkey, S.A., Van Rompay, M. I. & Eisenberg, D.M. (2001). The use of complementary and alternative therapies to treat anxiety and depression in the United States. The American Journal of Psychiatry, 158(2), 289-294.

O’Connell, M.E., Boat, T., & Warner, K.E. (2009). Preventing mental, emotional, and behavioural disorders among young people: progress and possibilities. Washington, D.C.: National Academies Press.

Pine, D.S., Wasserman, G.A., Fried, J.E., Parides, M., & Shaffer, D. (1997). Neurological soft signs: one-year stability and relationship to psychiatric symptoms in boys. Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1579–1586.

Seligman, M., Walker, E.F., & Rosenhan, D.L. (2000). Abnormal psychology (4th ed.). New York: W.W. Norton & Company.

Skirbekk, B., Hansen, B. H., Oerbeck, B., Wentzel-Larsen, T., & Kristensen, H. (2012). Motor impairment in children with anxiety disorders. Psychiatry research, 198 (1), 135-139.

Spector, A., Orrell, M., Lattimer, M., Hoe, J., King, M. & Harwood, K. (2012). Cognitive behavioural therapy (CBT) for anxiety in people with dementia: study protocol or a randomised controlled trial. BioMed Central Ltd.

Sroufe, L.A. (1983). Infant-caregiver attachment and patterns of adaptation in preschool: The roots of maladaptation and competence. In M. Perlmutter (Ed.), Minnesota symposium in child psychology, 16, 41-91. Hillsdale, NJ: Erlbaum.

Thorde, K.J., Andrews, J. J. W., & Nordstokke, D. (2013). Relations among children’s coping strategies and anxiety: The mediating role of coping efficacy. The Journal of General Psychology, 140 (3), 204-223.

Rutter, M. (1980). Attachment and the development of social relationships. Scientific foundation of developmental psychiatry. London: Heinemann.

Walker, W.L. (2013). Anxiety in children. Public health, 83(1), 5-15.

WebMD. (2015). Anxiety disorders. Retrieved from http://www.webmd.com/anxiety-panic/guide/mental-health-anxiety-disorders

Zeidner, M., & Endler, N. S. (1996). Handbook of coping: Theory, research, applications. New York: Wiley.