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ASSESSMENT OF GENERALIZED ANXIETY DISORDER

DSM-IV-TR ANXIETY DISORDERS GENERALIZED ANXIETY DISORDER (GAD): DSM-IV-TR DIAGNOSTIC CRITERIA
Generalized AnxietyDisorder A) Excessiveanxiety&worrymoredaysthannotforat least6monthsaboutanumberofeventsandac vi es. B) Thepersonndsitdiculttocontroltheworry. PanicDisorder w/Agoraphobia Obsessive Compulsive Disorder AnxietyDisorder DuetoGeneral MedicalCondi on C) Theanxiety&worryareassociatedwith3(ormore)of thefollowingsixsymptoms.(Only1needforchildren) *Restlessnessorfeelingkeyeduporonedge *Beingeasilyfa gued *Dicultyconcentra ngormindgoingblank *Irritability *Muscletension *Sleepdisturbance D) Focusofanxietyandworryisnotconnedtofeaturesof anAxis1Disorder E) Theanxiety,worryorphysicalsymptomscauseclinically signicantdistressorimpairmentinsocial,occupa onal orotherimportantareasoffunc oning F) Thedisturbanceisnotduetothedirectpsychological eectsofasubstance,orageneralmedicalcondi onand doesnotoccurexclusivelyduringamooddisorder,apsy cho cdisorderorapervasivedevelopmentaldisorder.
(APA,2000,p.476)

PanicDisorder w/oAgoraphobia

Social Phobia

Agoraphobiaw/o Historyof PanicDisorder

PostTrauma c StressDisorder

SubstanceInduced AnxietyDisorder

Specic Phobias

AcuteStress Disorder

Anxiety DisorderNOS

CORE SIGNS & SYMPTOMS


OF

GAD

Excessiveworryaboutmul plesitua ons Percep onthatworryisuncontrollable Physiological/Cogni veSymptoms(SeeDSMIVCriteria)

ASSOCIATED CHARACTERISTICS
MuscleTension:trembling,twitching,muscleaches/soreness Soma cSymptoms:swea ng,nausea,diarrhea ExaggeratedStartleResponse:Increaseeyeblinking,s ness,holding breath AutonomicHyperarousal:acceleratedheartrate,shortnessofbreath, dizziness

COMORBID CONDITIONS

Major Depressive Disorder

RISK FACTORS
Readinesstoreacttonovelevents:Lowthreshold BehavioralInhibi on:Shywithstrangers, mid Paren ngStyle:Overprotec ve A achmentStyle:Insecure Gene cPredisposi on:Inhibited,tense,fearful FamilyFactors:LowSES,chao chousehold Parentalfactors:Historyofanxiety,depression,substanceuse NeurobiologicalFactors:Overac vebehavioralinhibi onsystem Substance Substance Related Disorders Disorders Dysthymic Disorder Disorder

GAD
Condi ons Associated withStress withStress Other Other Anxiety Disorders Disorders

GENDER & CULTURAL DIFFERENCES


Girls:Earliersymptoms,highernumberofsymptoms Boys:Fewerspecicfears,morefearsofeconomic&academicfailure SES:Lowversusmiddlesimilarnumberoffears,butdierentfocus Ethnicity:Dierentfearsbasedonculturalvalues

PRESENTED

BY:

JO FRIESEN, STEPH POOLE, SHAWNA SJOQUIST, STACY THIRY

GAD ASSESSMENT FRAMEWORK


POTENTIAL REFERRAL QUESTIONS
Whydoesmychildoverreacttominordailystressors? Whyismychildrefusingtogetoutofbedandgotoschool? Whydoesmychildhavedicultycoping? Whyismychildrestless/irritable/ red?

ASSESSMENT COMPONENTS

SIDEBARTITLE
Interviews
Structured Unstructured Parent,Child, Teacher

Ques onnaires
SelfReports ParentReports TeacherReports

Observa on
School Home Rela onal StressfulSitua ons

ASSESSMENT TOOLS & TECHNIQUES


Diagnos cInterviewScheduleforChildren(DISC) AnxietyDisordersInterviewSchedule:Child&Parent(ADISC/P) Child&AdolescentPsychiatricAssessment(CAPA) ChildrensAssessmentSchedule(CAS) Diagnos cInterviewforChildren&Adults(DICA) MillionAdolescentClinicalInventory(MACI) Mul dimensionalAnxietyScaleforChildren(MASC) BeckAnxietyInventoryforYouth(BAIY) StateTraitAnxietyInventoryforChildren(STAIC) ChildhoodAnxietySensi vityIndex(CASI) BehavioralAvoidanceTest(BAT) AtSchool AtHome Duringstressfulsitua ons Duringsocialinterac ons
A

Observa ons

RED FLAGS: Learningdicul es Socialwithdrawal Ina en on Li leworrier Worriesaboutpast,present&future Worriesaboutperformance Perfec onism Selfconscious,needsreassurance Suicidea empts/idea on NEED TO EVALUATE: MedicalHistory SocialHistory Educa onalHistory DevelopmentalHistory FamilialHistory

Reports

Interviews

MAKING

DIAGNOSIS
ComprehensiveAssessment MeetsDiagnos cCriteria Mul pleMethods,Mul pleSources, Mul pleSitua ons RuleOutOtherCausesforSymptoms UseallPiecestoSolveAssessmentPuzzle

Towarranttreatment, thefearoranxietymust:
Bedevelopmentallyinappropriate Causesucientdistress&interference

REFERENCES
Albano, A. M., & Hack, S. (2004). Children and adolescents. In Heimberg, R.G., Mennin, D.S., & Turk, C.L. (Eds.), Generalized Anxiety Disorder (pp. 383-408). New York, NY: Guilford Press. Albano, A. M., Chorpita, B. F., & Barlow, D. H. (2003). Childhood anxiety disorders. In E. J. Mash & R. A.Barkley (Eds.), Child psychopathology (2nd ed., 279-329). New York, NY: Guilford Press. American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders: Fourth Edition: Text Revision. Washington, DC. Barrios, B, A., & Hartmann, D. P. (1997). Fears and anxieties. In E.J. Mash & L. G. Terdal, Assessment of childhood disorders (3rd ed., 230-278). New York, NY: Guilford Press. Behar, E., DiMarco, I., Hekler, E. B., Mohlman, J., & Staples, A. M. (2009). Current theoretical models of generalized anxiety disorder (GAD): Conceptual review and treatment implications. Journal of Anxiety Disorders, 23(8), 1011-1023. doi:10.1016/j.janxdis.2009.07.006 Biederman, J., Hirshfeld-Becker, D.R., Rosenbaum, J. F., Herot, C., Friedman, D., Snidman, N., Kagan, J., & Faraone, S. V. (2001). Further evidence of association between behavioral inhibition and social anxiety in children. American Journal of Psychiatry, 158 (10), 1673-1679. Mash, E. J. & Barkley, R. A. (2006). Treatment of childhood disorders. New York, NY: Guilford Press. Mash, E. J. & Barkley, R. A. (2007). Assessment of Childhood Disorders. New York, NY: Guilford Press. Mash, E.J., & Wolfe, D.A. (2007). Abnormal Child Psychology (3rd ed.). Toronto, ON: Nelson. McConaughy, S.H. (2005). Clinical interviews for children and adolescents: Assessment to intervention. New York, NY: Guildford Press. Rak, C.F., & Patterson, L. E. (1996). Promoting resilience in at-risk children. Journal of Counseling & Development, 74, 368 373. Robinson, K. (2003). Assessment of childhood anxiety. In C. R. Reynolds & R. W. Kamphaus, Handbook of psychological & educational assessment of children (2nd ed., 508-525). New York, NY: Guilford Press. Sattler, J .M., & Hoge, R. D. (2006). Assessment of children: Behavioral, social and clinical foundations (5th ed.). La Mesa, CA: Jerome M. Sattler, Publisher. Southam-Gerow, M. A., & Chorpita, B. F. (2010). Anxiety in children and adolescents. In Mash, E.J., & Barkley, R.A. (Eds.) Assessment of Childhood Disorders (4th ed., pp. 447-397). New York, NY: Guildford Press.

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