Howard J. Nathan, MD, FRCPC
- Professor and Vice Chairman (Research)
- Department of Anesthesiology
- University of Ottawa
- Ottawa, Ontario, Canada
Of these four possible explanations only the process postulated in the fourth can properly be called projection when the term is used in the restricted sense of attributing to others unwelcome features of the self fungus gnats washing up liquid purchase butenafine 15 gm without a prescription. How large a proportion of misattributions have this sort of origin is a matter for inquiry fungus on lips butenafine 15 gm overnight delivery. The case of Schreber: a re-examination the urgent need for fresh thinking in this area of psychopathology is shown by the findings of a re-examination by Niederland (1959a and b) of the case from which all psychoanalytic theorizing about paranoia and paranoid symptoms derives antifungal soap for ringworm generic 15 gm butenafine fast delivery. Although he later published other papers on paranoia antifungal amazon order 15 gm butenafine amex, according to Strachey (1958) Freud never modified his earlier views in any material way fungus body wash generic 15 gm butenafine with amex. Daniel Paul Schreber was born in 1842 fungi scientific definition order 15 gm butenafine with amex, the second son of an eminent physician and pedagogue. He then developed a psychiatric illness from which he recovered after some months. This time he remained in an asylum for nine years (1893-1902) towards the end of which he wrote his memoirs. In 1903, shortly after his discharge, they were published, and soon became a subject of psychiatric interest. A principal theme concerns a number of bodily experiences that were extremely painful and humiliating to him. Hardly a single limb or organ in my body escaped being temporarily damaged by miracles, nor a -174single muscle being pulled by miracles, Even now the miracles which I experience hourly are 1 still of a nature to frighten every other human being to death. In delusions of persecution the distortion consists in a transformation of affect; what should have been felt internally as love is perceived externally as hate. In them he asserts the vital importance of starting the prescribed regimes during infancy and states repeatedly that he has applied his methods to his own children. The physical methods, recommended for application daily throughout childhood and adolescence, include a number of exercises and harnesses whereby posture is to be controlled. Because the device was apt to produce a stiffening effect it was recommended that its use be restricted to one or two hours a day. An example of an exercise is to place two chairs facing each other with a gap between of a few feet. A child is instructed to put his head on the seat of one chair and his feet on that of the other and to stiffen his back to make a bridge, in which position he must remain. The dire results that Schreber senior ascribed to bad posture included impeded circulation and, later, paralysis of arm and foot. Of one of his devices, an iron crossbar designed to ensure that a child sits straight, he comments that, besides its physical benefits, it provides an effective moral corrective. The strong impression given that Schreber senior was a psychotic character is supported by a note made by a hospital psychiatrist and based, it is thought, on information from a member or close acquaintance of the family. The father prescribes that, in order to toughen an infant, he should be washed in cold water from the age of three months and also subjected to various local cold applications. The son complains that his eyes and eyelids are the target of uninterrupted miracles. The father prescribes repeated visual exercises and advises spraying the eyes with cold water should there be irritation and fatigue following over-stimulation. Father prescribes a harness consisting of an iron bar that presses against the collar bones should a child not sit straight and upright. As Niederland (1959a) himself remarks, the hypothesis is in keeping with ideas that Freud was entertaining towards the end of his life (but which still have been little exploited). If this approach to understanding paranoid delusions is adopted, many problems remain still to be solved. How comes it that the patient has no recollection of how his parents treated him as a childfl Why is it that, instead, childhood experiences are misplaced in time and the agent responsible for them is misidentifiedfl Possible answers to these questions invoke hypotheses regarding the kinds of injunction, explicit or implicit, a parent may issue to a child; for example, an injunction on a child to construe whatever happens to him as beneficial, an injunction to see his parent as above criticism, an injunction neither to perceive nor to remember certain acts that he none the less witnesses or experiences. These hypotheses, with much evidence to show that they apply to the case of Schreber, are advanced in a recent paper by Schatzman (1971). Yet a further hypothesis, not discussed by Schatzman, is that children wish to see their parents in a favourable light and often distort their perceptions accordingly. Meanwhile, enough has been said to show that, when the actual experiences they have had during childhood are known and can be taken into account, the pathological fears of adult patients can often be seen in a radically new light. Paranoid symptoms that had been regarded as autogenous and imaginary are seen to be intelligible, albeit distorted, responses to historical events. Thus in what follows we are concerned with the developmental processes that lead a young child to respond with fear when he finds, or believes, his attachment figure to be inaccessible. Is inaccessibility of mother in itself a situation that arouses fear in human children without its being necessary for any learning to have taken placefl Or is such fear elicited in an individual only after he has come to associate her inaccessibility with a distressing or frightening experiencefl If the latter, what is the nature of such distressing or frightening experience, and by what type of learning does it become linked with separationfl For, as was emphasized repeatedly in the first volume, there are many forms of behaviour that, like this one, can usefully be classed as instinctive but that develop functionally only when the environment provides opportunity for learning of some specific kind to occur. In other words, to hold the hypothesis that fear behaviour in a situation of maternal inaccessibility is instinctive in no way rules out the possibility that learning of some kind is necessary for its development. One is that it is embedded in a paradigm very different from the one adopted here (see Chapter 5). Another is that it seems to postulate a degree of insight into cause and effect that not only is improbable in an infant of a year or so of age but that we now know to be unnecessary to account for the findings. Objections of a similar sort apply to the theories advanced by Klein, which presuppose even more sophisticated cognitive functioning (see Appendix I). In Chapter 14 of that volume an account is given of the conditions that terminate crying during the early months of life. These findings readily explain why babies are said to cry from loneliness and to have a desire to be picked up. Although to attribute such sentiments to babies in the early months of life is almost certainly not warranted, the statements none the less contain more than a grain of truth. When they are not rocked and not spoken to infants are apt to cry; when they are rocked and spoken to they cease crying and are content. And by far the most probable agent to rock and talk to a baby is his mother figure. In view of this, it could be argued, an infant comes to learn that presence of mother is associated with comfort while absence of mother is associated with distress. This hypothesis is similar to one suggested by Rycroft (1968a) and referred to in Chapter 6 above. On present evidence it is not possible to decide between hypotheses A, B2, and B3; each is plausible. Furthermore, even if it were true, it would not make hypotheses B2 and B3 irrelevant, since learning of the kinds proposed by these two hypotheses could still occur and might be of much significance in accounting for degrees of separation anxiety above a minimum. Whether hypothesis A is valid or not appears, at present, to be of no great clinical importance. This is because, were the forms of learning postulated by hypotheses B2 and B3 to occur at all, which they probably do, they would be taking place during the latter half of the first and during the second year of life and, except where a child had no mother figure, would be virtually unavoidable. As a situation that arouses fear, therefore, separation from an attachment figure would still be nearly universal, almost as much as it would were hypothesis A to apply. Support for the view that associative learning of the kinds postulated by hypotheses B2 and B3 does take place comes from studies of individual differences in susceptibility to respond with fear, especially to separation. These show, as is discussed in detail in later chapters, that children who have been well mothered, and therefore, in all likelihood, have been protected from the experience both of intense distress and of intense fear, are those least susceptible to respond with fear to situations of all kinds, including separation; whereas children who have had intensely distressing and frightening experiences when away from mother are apt to show an increased susceptibility to fear, especially to fear of being separated again. Should, as therefore seems likely, both these forms of associative learning occur during infancy and early childhood, their effects on personality development might possibly be rather different. Whether or not differences of these kinds occur in fact can be determined only by further research. Whereas situations that arouse fear can be regarded as constituting either natural or cultural clues to an increased risk of danger, they are certainly not infallible indicators of actual danger. How we feel in a situation bears therefore only an indirect relationship to the degree of risk present in that situation. Because the world as reflected in feeling is distinct from, though correlated with, the world as it is, two terminologies are necessary. At this point it is necessary to settle on some analogously distinct terms suitable to refer, on the one hand, to a state of feeling antithetical to feeling afraid and, on the other, to a situation antithetical to one of danger. As such it applies to the world as it is and not to the world as reflected in feeling. The distinction drawn here between feeling secure and being safe is not always made so that a number of terms current in the literature do not conform to the usage proposed. For example, with reference to states of feeling, children and grown-ups are habitually described as being either secure or insecure. Moreover, because any person who is acting as an attachment figure for another is commonly referred to as providing that other with a sense of security, it is often convenient to describe an attachment figure also as a security figure or as providing a secure base. At the same time, it must be emphasized that a secure base, however much it may lead someone to feel secure, is no guarantee of safety, any more than a natural clue, however frightening we find it, is a certain indicator of danger. As a guide to what is safe and what is dangerous the kind of feeling a situation arouses in us is never more than rough and ready. In this chapter and those following an attempt is made to identify some of the many variables that are operating. It must be assumed that genetic differences play some part in accounting for variance between individuals with regard to susceptibility to fear. Very little is yet known about their role in humans, but it is well documented in the case of other mammals. A difference in susceptibility in humans that is likely to be in part genetically determined is one between men and women. Sex Differences Feminist opinion notwithstanding, it is very commonly believed that there are some differences in susceptibility to fear as between men and women. At the same time it is clear that in this regard there is much overlap between any population of women and a comparable population of men. Culture, moreover, can either magnify such potential differences as there may be, for example by sanctioning the expression of fear by members of one sex but not by those of the other, or else try to reduce them. Evidence from four sources supports the idea of a difference in susceptibility between the sexes: In the experiments with nursery-school children, carried out by Jersild & Holmes (1935a) and described in Chapter 7, -187a higher percentage of the girls were afraid than of the boys. The situations in which the difference was most marked were going into the dark passage and approaching the two animals, snake and dog. In these three situations the percentages of boys who showed fear were respectively 36, 40, and 46. In interviews of mothers of children aged six to twelve years Lapouse & Monk (1959) found that the proportion of girls reported as being afraid of strangers and animals, notably snakes, was higher than that of boys. In two other studies in which children of about the same age were interviewed, girls reported more situations as feared than did boys (Jersild, Markey & Jersild 1933; Croake 1969). In epidemiological studies of psychiatric casualties women are reported to suffer from anxiety states about twice as frequently as men (Leightonet al. A difference in the opposite direction -that females tend to show less fear than do males -seems not to have been reported. In most races of man, as in other species of groundliving primates, males are larger and stronger than females (Cole 1963). While males bear the brunt of defence against predators, as well as attacking them when necessary, females protect young and, unless prevented from doing so, are more likely to retire from dangerous situations than to grapple with them. It would be strange were such long-standing differences between the sexes in respect of body structure and social role not to be reflected in complementary differences in behavioural bias. Minimal Brain Damage In Chapter 16 of the first volume an account is given of a longitudinal study of twenty-nine pairs of boys (Ucko 1965), which shows that children who at birth are noted to be suffering from asphyxia are much more sensitive to environmental change than are matched controls. When the family went on holiday -188or changed house, boys who had suffered from asphyxia were more likely to be upset than were the controls. The same was true when a member of the family -father, mother, or sibling -was absent for a time. These differences were apparent during each of the first three years of life (though not significantly so during the third). A comparable difference was seen when some of the children started nursery school. Soon after his fifth birthday every child started infant school, making this the only event that was common to them all (though of course they went to many different schools). On a three-point scale (reduced from five points), the children distribute as shown below: Asphyxiated Controls at birth Enjoyed school from the start or at least accepted it 8 17 Mild apprehension and protest disappearing within one week 8 10 Mild apprehension or 13 2 148 Asphyxiated Controls at birth marked disturbance lasting more than a week Totals 29 29 Childhood Autism the behaviour of an autistic child shows a complete absence of attachment together with many indications of chronic fear. Tinbergen & Tinbergen (1972), adopting an ethological approach, suggest that the underlying condition may be one of chronic and pervasive fear, which cannot be allayed by contact with an attachment figure because the child also fears humans. If this is so, the syndrome could be conceived as resulting from a persistently lowered threshold to fear-arousing stimuli combined with delayed development of and/or inhibition of attachment. Causal factors might then include any of -189the following: (a) genetic factors, (b) brain damage, (c) inappropriate mothering. Clancy & McBride (1969) describe a treatment programme based on this type of theory. Blindness Nagera & Colonna (1965) report that blind children are apt to be more than usually afraid of such common fear-arousing situations as animals, mechanical noises, thunder and wind, and to live in a state of permanent alertness. A principal reason for this is probably that, being blind, they are likely to be out of contact with their attachment figure far more often than are sighted children, and thus often to be effectively alone when something frightening occurs. Their tendencies on some occasions to remain rigidly immobile and, on others, to seek very close bodily contact with an adult are in keeping with this explanation. Great difficulties arise for such children after a brief separation because a blind child cannot track his mother visually and keep close to her as a sighted child commonly does on such occasions. Fraiberg (1971) describes the very acute reaction of a blind boy of fourteen months after his mother had been absent for three days, during which he had been cared for by various friends and relations. Only when his mother held him was there any respite; and then he would crawl relentlessly all over her. Because the screaming was so distressing to mother it was suggested she give him pots and pans to bang together instead.
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It calls antifungal kit amazon purchase 15gm butenafine with visa, frst antifungal for jock itch effective butenafine 15 gm, for the creation of a positive and supportive environment in the school and classroom that will beneft all students; second fungus gnats hot water purchase butenafine 15 gm otc, for prevention programming for students at risk; and third fungus in ear canal order cheapest butenafine, for intervention antifungal vaccine 15 gm butenafine free shipping, including outside referrals yates anti fungal generic 15gm butenafine overnight delivery, for students in distress. The present document, Supporting Minds, outlines strategies that are most relevant at the level of universal and prevention programming, and is designed to help educators identify students who may be in need of extra support from a trained mental health professional. In the revised elementary health and physical education curriculum policy document (Interim Edition, 2010), the concept of mental health has been integrated across the curriculum. The focus is on mental health and emotional well-being rather than on mental illness, although an understanding of mental illness from the perspective of care for others and reducing stigma is included. Building resiliency skills and learning about protective and risk factors are a part of the learning. Substance use, misuse, addictions, and related behaviour, including gambling, are also included. This same approach is being used in the revised health and physical education curriculum for Grades 9 to 12 (2013). Learning about mental health is also addressed in a variety of courses in the forthcoming revised social sciences and humanities curriculum. Initiatives Related to Student Behaviour The school environment has a considerable infuence on student mental health. The document Caring and Safe Schools in Ontario: Supporting Students with Special Education Needs through Progressive Discipline, Kindergarten to Grade 12 (2010) highlights the importance of promoting positive behaviour through a caring and safe school culture. Students with mental health problems ofen demonstrate behaviour that is troubling and confusing to educators. Many of the recommendations in Caring and Safe Schools are relevant to Supporting Minds, particularly with regard to students who struggle with externalizing disorders. Consideration of the mental health and well-being of these very young students is central to the program. However, educators need to be mindful of the fact that very young children cannot fully express their thoughts and feelings and that this can make recognizing potential problems a challenge. Educators also need to be aware that the signs of mental health problems in a young child may be quite diferent from those in an older child or adult. Other Ministry of Education Initiatives Supporting children and youth in school is a multifaceted undertaking. As well, the International Alliance for Child and Adolescent Mental Health in Schools (Intercamhs) has commissioned an International Survey of Principals Concerning Emotional and Mental Health and Well-being, and results from several countries are posted on its website. Increasingly, these groups are working together to ensure that their eforts are complementary. The toolkit provides guidelines for using the Action Signs efectively in clinical and school settings as well as tools for disseminating the information. You are not alone not 1 in a 1000, but 1 in 10, because many kids have similar problems! Talk with a helpful adult, such as your family, doctor, school nurse or counsellor, or religious leader, if you have one. Sudden overwhelming fear for no reason, sometimes with a racing heart or fast breathing 4. Extreme diffculty in concentrating or staying still that puts you in physical danger or causes school failure 9. No changes or alterations can be made to the material without the express permission of the authors. It was written primarily to such as at-risk families and those with help child welfare caseworkers and other confrmed reports of maltreatment or neglect, professionals who work with at-risk families are described below. The distinctiveness of this Young Children by Improving approach lies in the use of live coaching Parent-Child Interaction and the treatment of both parent and child together. These more intensive parenting intervention and children are often described as negative, most applicable for children with serious argumentative, disobedient, and aggressive. Benefts learn to model and reinforce constructive this material may be freely reproduced and distributed. Children, in turn, respond to these While child behavior problems and child healthier relationships and interactions. In addition the University of Oklahoma is piloting to reporting decreases in child behavior these studies (see. This phase engaging in sadistic physical abuse, or emphasizes building a nurturing relationship parents with substance abuse issues and secure bond between parent and child. Phase I sessions are structured so that the child selects a toy or activity, and the parent plays along while being coached by the this material may be freely reproduced and distributed. Parents are taught and make the child feel good about his or to give clear, direct commands to the child her relationship with the parent. When what the child says to show that they are a child obeys the command, parents are listening and to encourage improved instructed to provide labeled or specifc praise communication. The timeout procedure the child is doing, which shows approval typically begins with the parent issuing the and helps teach the child how to play with child a warning and a clear choice of action others. Parents are enthusiastic and issue commands to their child and follow show excitement about what the child is through with the appropriate consequence doing. In addition, parents are provided with strategies for Parents are guided to praise wanted managing challenging situations outside of behaviors, like sharing, and to ignore therapy (for example, when a child throws a unwanted or annoying behaviors, such as tantrum in the grocery store or hits another whining (unless the behaviors are destructive child). The child, caregiver, and family should feel comfortable with, and have this material may be freely reproduced and distributed. Parent-child parents: Effcacy for reducing future abuse interaction therapy with a family at high risk reports. A comparison between African interaction therapy with behavior problem American and Caucasian children referred children: One and two year maintenance for treatment of disruptive behavior of treatment effects in the family. Closing the quality chasm in socioeconomic status African American child abuse treatment: Identifying and families in Parent-Child Interaction Therapy: disseminating best practices. Change trajectories for interaction therapy for Mexican Americans: parent-child interaction sequences during A randomized clinical trial. Journal of parent-child interaction therapy for child Clinical Child & Adolescent Psychology, physical abuse. Theoretical and empirical underpinnings of Parent-child interaction therapy with parent-child interaction therapy with child behavior problem children: Generalization physical abuse populations. Parent training through foster parents in parent-child interaction play: Parent-child interaction therapy with therapy. Parentchild interaction therapy: An intensive child interaction therapy: Interim report dyadic intervention for physically abusive of a randomized trial with short-term families. Acknowledgment: the original (2007) and current versions of this issue brief were Timmer, S. ParentGateway, in partnership with the Chadwick child interaction therapy: Application to Center for Children and Families at Rady maltreating parent-child dyads. Challenging foster caregiverdiscussed here are solely the responsibility of maltreated child relationships: the the authors and do not represent the offcial effectiveness of parent-child interaction views or policies of the funding agency. A Guide for Adults Amit Basak is a tool designed to help assist adults who suspect Parent they may have autism, as well as those who have Liz Bell been recently diagnosed with the disorder. It Sallie Bernard* was created by the Autism Speaks Family Services Parent, Executive Director, SafeMinds staff, in conjunction with a group of contributors Cuong Do* made up of adults with autism and other professionParent als, as well as the Family Services Committee. Mayerson* Neurodevelopmental Disabilities Founding Attorney, Mayerson & Associates Megan Farley, Ph. Director Autistic Global Initiative, Parent, Self-advocate Jeremy Sicile-Kira Lori Rickles John Taylor Parent Sondra Williams Stuart Savitz* Gillian Wilson Parent Paul Shattuck, Ph. Rather, Autism Speaks provides general information about autism as a service to the community. The information provided in this tool kit is not a recommendation, referral or endorsement of any resource, therapeutic method, or service provider and does not replace the advice of medical, legal or educational professionals. Autism Speaks has not validated and is not responsible for any information or services provided by third parties. You are urged to use independent judgment and request references when considering any resource associated with the provision of services related to autism. The use of these trademarks by unaffliated representatives for endorsement, advertising, promotional, and sales materials is prohibited by law. As autism awareness has grown dramatically in recent years, many young adults and adults have learned the signs and felt there may be a connection between their feelings and behaviors and the symptoms of autism. Many have been misdiagnosed with other conditions or were never able to get a formal diagnosis of a condition or disorder that explains their symptoms. This kit will provide an overview of autism to help you better understand the disorder and will hopefully clarify whether you should seek out a professional for a thorough evaluation. If/When you are in fact diagnosed with autism, the kit will also walk you through next steps in terms of accessing services and provide you with critical information about your rights and entitlements as an adult on the spectrum. There is also a list of helpful resources for you to fnd more information about next steps for the days and months following your diagnosis. While no studies have been able to confrm the prevalence rate for adults and more research is needed, autism statistics from the U. Careful research shows that this increase is only partly explained by improved diagnosis and awareness. Studies also show that autism is four to fve times more common among boys than girls. An estimated 1 out of 42 boys and 1 in 189 girls are diagnosed with autism in the United States. Government autism terms of negotiating the world before my statistics suggest that prevalence rates have diagnosis. First and foremost, we now know that there is no one cause of autism, just as Some factors that have been identifed to increase there is no one type of autism. Over the last fve the risk of autism include parental age, extreme years, scientists have identifed a number of rare prematurity, diffculties during birth, mothers exposed gene changes or mutations associated with autism. It Research has identifed more than 100 autism risk is important to keep in mind that these factors, genes.
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Depressive antifungal oral gel discount 15 gm butenafine with amex, anxiety lawn antifungal buy butenafine 15 gm otc, and somatoform disorders in primary care: prevalence and recognition antifungal body wash walmart order butenafine with a mastercard. Prevalance of anxiety foot fungus definition buy discount butenafine 15 gm line, depression antifungal antibacterial soap 15gm butenafine with visa, and substance use disorders in an urban general medicine practice antifungal for lips buy butenafine online. Health-related quality of life and utilities in primary-care patients with generalized anxiety disorder. Frequency and patterns of psychiatric comorbidity in a sample of primary care patients with anxiety disorders. Delivery of evidence-based treatment for multiple anxiety disorders in primary care: a randomized controlled trial. Functioning and disability levels in primary care out86 Anxiety and Related Disorders patients with one or more anxiety disorders. Underrecognition of anxiety and mood disorders in primary care: why does the problem exist and what can be donefl Efficacy of self-help manuals for anxiety disorders in primary care: a systematic review. Treatment of anxiety disorders in primary care practice: a randomised controlled trial. Delays in referral of patients with social phobia, panic disorder and generalized anxiety disorder attending a specialist anxiety clinic. Psychiatric treatment in primary care patients with anxiety disorders: a comparison of care received from primary care providers and psychiatrists. Anxiety disorders are the most common mental health problems reported by children, adolescents and adults (Costello, Angold, & Burns, 1996; Goodman, Ford, Richards, Gatward, & Melzer, 2000; Kessler et al. The prevalence of childhood anxiety disorders ranges from 10% to 22% (Dadds, Spence, Holland, Barrett, & Laurens, 1997. About one in 6 children have anxiety that causes impairment in their daily lives (Dadds, Spence, Holland, Barrett, & Laurens, 1997). There are many sequelae of anxiety disorders including an elevated risk for later development of mood disorders, other anxiety disorders, substance use as well as physical health concerns (Kessler et al. In addition to the impairment and suffering experienced by children and adolescents, there is a significant cost associated with anxiety disorders. It is estimated that the United States spends more than $42 billion a year on anxiety disorders (Greenberg et al, 1999). In clinics, waiting lists are long and no-show and attrition rates sometimes are over 50% (Weist et al,1999). Many children who do receive clinical intervention fail to respond (Barrett, Dadds, & Rapee, 1996; Donovan & Spence, 2000; Weisz et al. There are no definitive biological or psychological tests for anxiety disorders and diagnoses are made clinically based on information from multiple sources i. Anxiety disorders in children often first manifest as physiological symptoms and are misinterpreted as physical illness. Some young children may manifest temper tantrums when in fact they are having panic attacks. These physical symptoms often result in avoidance behavior which often manifests as school refusal. Behaviors resulting from anxiety such as school refusal and temper tantrums are viewed as oppositionality. Due to the avoidance as the end result of anxiety disorders, they are often unrecognized and hence untreated in children. Moreover, these children are usually perfectionistic and want to please so they further go unnoticed especially in a classroom setting. On the other hand, children with disruptive behavior disorders are noticed more and thus are more frequently referred for treatment (Compton et al, 2004, In-Albon & Schneider, 2007). Families, in general, prefer nonmedical or psychosocial interventions at initial evaluation (Walker et al, 2001). Prevention Due to these concerns, it seems logical to move toward services that provide prevention of anxiety disorders. The benefits of prevention are that a large number of people can be targeted over a short period of time, it is more cost effective and there is reduced distress for children due to earlier intervention (Lowry-Webster, 2001). From a health care perspective, they address and identify risk and protective factors in individuals, providing for better long-term prognoses. In addition, these programs accrue economic benefits because prevention is often less expensive than the economic and societal costs once an illness has manifested (Beardslee et al, 2011). For implementation of prevention programs, it is important to consider the risk factors, protective factors and strategies for prevention. There is a complex interplay of biological, psychological and environmental factors in the development of childhood anxiety disorders (Donovan et al, 2000). In the development of childhood anxiety the following risk factors have been implicated. Risks and protective factors in childhood anxiety disorders Puberty results in maturational changes not only physically but also emotionally. Puberty may increase risk factors for many psychiatric disorders including anxiety disorders. Prevention of Childhood Anxiety Disorders 89 According to Leen-Feldner et al, adolescents with advanced pubertal status and greater reactivity to a hyperventilation challenge were at increased risk for panic symptoms (LeenFeldner et al, 2007). In a study by Otto et al, 2007), risk factors for fear conditioning were examined in a nonclinical sample. Those in the sample that had higher levels of anxiety sensitivity (increased anxiety symptoms) predicted increased tendency towards fear conditioning (Otto et al,2007). The quality of attachment between an infant and the primary caregiver is an important indicator of future development of anxiety disorders (Erickson et al, 1985; Lewis et al, 1984; Sroufe et al, 1990). In a study by Warren et al,1997, the role of attachment style on the later development of anxiety disorders was studied in 172 children at 12 months and then later at 17. At 12 months a pattern of anxious resistant attachment predicted later anxiety disorders, even after controlling for infant temperament and maternal anxiety. It is estimated that heritability accounts for about 40-50% of anxiety symptoms in children (Thapar et al, 1995). Behavioral inhibition has been identified by Kagan et al(Kagan et al, 1989; Kagan et al, 1991)as a stable temperament style consisting of shyness and elevated physiological arousal having a strong genetic component (DiLalla et al, 1994; Plomin et al, 1989). Children with behavior inhibition are more likely to develop an anxiety disorder (Biederman et al, 1993; Kagan, 1997; Rosenbaum et al, 1993). Other risk factors for childhood anxiety disorders are traumatic and stressful life events following which children have higher levels of fears. Higher rates of anxiety disorders are present in children following major natural disasters (Dollinger et al, 1984). Moreover, parenting behaviors have been identified to interact with other risk factors in the development of childhood anxiety. Parents of anxious children often model, prompt, and reinforce anxious behavior in their children (Barrett et al, 1996). Other parental characteristics that contribute to risk factors for childhood anxiety are being overly controlling, critical and, overprotective (Krohne et al, 1991). Protective factors either promote positive development or protect against risk factors. Lastly, the type of responses children use to cope with stressful experiences influence how much anxiety and distress they experience (Spence et al, 2001). Prevention strategies In the past few years school personnel have become interested in programming to address the social and emotional needs of children due to the resultant deleterious effects of difficulties in these areas on their academic and social functioning. In this regard, there has 90 Anxiety and Related Disorders been a shift to implement evidence-based psychosocial treatments in schools in a preventative fashion (Miller et al, 2010). Recent governmental policy initiatives are requiring the implementation of evidence-based treatments in schools (Robertson, David & Rao, 2003). Having a classroom intervention by teachers and school counselors makes it easier to identify children suffering from anxiety. Teachers have unlimited access to children in their classroom and know their strengths and weaknesses well. It is not only cost-effective for teachers to provide the intervention to students but students can learn from peers and share their experiences with them thus providing support (Miller et al, 2010). Individual cognitive behavioral therapy has been studied for childhood anxiety disorders and is effective for 70% for clinically referred children (In-Albon & Schneider, 2007). The recent challenge for many researchers has been to study the successful implementation of these studies into a community or school setting. These studies have the challenge of following the treatment but being flexible to a real-world setting. The Committee on Prevention of Mental Disorders (Mrazek et al, 1994) describes a continuum of interventions going from prevention at one end and treatment at the other end. The following are three main forms of prevention: universal, targeted or selective, and indicated. A universal preventive approaches are either designed to enhance resilience in all children. These programs are more readily accepted because they are proactive, emphasizing positive coping skills and provided to everyone thus avoiding any possibility of stigmatization though labeling. Under the targeted programs, selective programs are for children who are at increased risk of developing disorders and involves screening. Indicated programs also require screening and are for individuals with minimal symptoms who do not meet diagnostic criteria for any disorder. Treatment programs target children with a diagnosed condition (Lowry-Webster et al, 2001). In this paper both the universal and targeted school-based anxiety prevention programs will be reviewed. Universal prevention strategies A study by Hains (Hains et al, 1992) examined the effectiveness of two cognitive-behavioral interventions to help adolescent boys cope with stress and other negative emotions. The project was described to all sophomores and juniors and those who were interested were invited to attend an orientation meeting. Twenty-five adolescent boys ages 15-16 year old were randomly assigned to either a group receiving cognitive restructuring or to a second group receiving anxiety management training. Both these groups were compared to a wait-list control group on measures of anxiety, anger, self-esteem, depression, and reports of anxious self-statements. Both the intervention groups showed significant decline in levels of anxiety, expression of anger, and depression. There are 2-4 parent sessions teaching parents coping strategies for their own anxiety, reinforcement strategies, contingency management and problem-solving and communications skills. Children with internalizing symptoms were assigned to either an intervention led by a psychologist, a teacher or a control condition with a standard curriculum. At the end, children reported considerable decrease in anxiety symptoms in either intervention by a psychologist or a teacher. Both groups reported significant decrease in anxiety and the decline was significantly greater in the intervention group regardless of their risk status. A follow up study after one year by Lowry-Webster et al (2003) showed that results were maintained with the intervention group having lower scores on anxiety self-report measures. Eightyfive per cent of children in the intervention group who were scoring above the clinical cutoff for anxiety and depression were symptom free in the intervention condition compared to 31. In a study of universal prevention with 733 children enrolled in grade 6 (ages 9-10) and grade 9 (ages 14-16), Lock et al, 2003 studied children from 7 different socioeconomic school settings. Results showed a general decrease in anxiety scores which were significant for students in the intervention group at the end of the program and at 1 year follow up. This study also showed that children in Grade 6 had higher levels of anxiety before intervention but post-intervention had greater reductions in anxiety and depression at 12 month follow up compared to grade 9 children. In addition, there was a delayed effect in improvement of depression symptoms that was apparent only at the 1 year follow up. In addition, girls tended to have higher levels of anxiety than boys and girls in Grade 6 were more responsive to the intervention than Grade 9 girls. Barrett et al (2006) evaluated the above mentioned study by Lock et al for its long term effectiveness at 36 months. The decrease in scores due to the intervention were maintained in grade 6 but not for children in grade 9 emphasizing the fact that intervention in grade 6 might be an optimal time for decreasing risk for anxiety. There were significantly fewer high-risk students at 36-month follow-up in the intervention condition than in the control condition proving the durability of prevention effects for children in Grade 6. The outcomes were noticeable for up to 3years following a brief 92 Anxiety and Related Disorders cognitive behavioral intervention delivered by teachers within the school. For girls who had the highest anxiety and showed the biggest decline after one year, the preventive effect lasted for only 24 months.
Alhucema (Lavender). Butenafine.
- Are there any interactions with medications?
- Dosing considerations for Lavender.
- Hair loss in a condition called alopecia areata when applied to the scalp in combination with other oils.
- How does Lavender work?
- Are there safety concerns?
- Depression, sleeplessness, agitation, general psychological well-being, loss of appetite, colic, headache, migraine, toothache, acne, nausea, vomiting, cancer, use as a mosquito repellent and insect repellent, and other conditions.
- What other names is Lavender known by?
- What is Lavender?
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