Psychoanalyse first started to receive serious attention under Sigmund Freud, who formulated his own theory of psychoanalysis in Vienna in the s. Freud was a neurologist trying to find an effective treatment for patients with neurotic or hysterical symptoms. He then wrote a monograph about this subject. Charcot had introduced hypnotism as an experimental research tool and developed the photographic representation of clinical symptoms.
Assessment of anxiety in youth with ASD. Perform a Developmentally Appropriate Multi-Informant and Multi-Method Assessment of Anxiety Current evidence recommends the use of multiple assessment modalities and informants when assessing anxiety in children with ASD.
Assessment of anxiety in this population can be more laborious than in TD youth because of potentially compromised language and cognitive functions in the child and the presence of multiple complex co-occurring conditions that overlap with anxiety.
It is also important to evaluate the anxiety symptoms in the context of child and family stressors.
Children with ASD may differ in their ability to self-report symptoms of anxiety due to age, verbal fluency, and cognitive ability. Other children may be able to provide responses using visual analog scales rather than through verbal response. If emotional insight is compromised, results must be interpreted cautiously.
Parent report and other caregiver information. If child self-report is compromised, the evaluation must rely on reported observed behaviors. Irritability, tantrums, disruptive behavior, aggression, worsening sleep problems, and self-injury may also suggest the presence of anxiety.
Parents who have an anxiety disorder may have enhanced perceptions of anxiety in their child. There are few well-validated tools for assessing anxiety in youth with ASD, and as such, clinicians often depend on measures used in TD children when assessing anxiety in ASD. Furthermore, a recent study reported that some of these scales may not detect atypical fears.
In the office, clinicians should conduct a physical and mental status examination when evaluating for anxiety. Elevated heart rate or blood pressure may reflect situational anxiety related to the medical procedure or office visit.
Other signs of anxiety include tremors, nail biting, bald spots secondary to hair pulling, and skin lesions due to skin picking. Mental status examination may reveal poor eye contact, negative affect eg, fear, irritabilityand changes in communication eg, stuttering, increased vocalizations, decreased verbal exchanges.
The presence of disruptive behaviors may reflect anxiety; however, these behaviors may also reflect a desire to escape from the situation and therefore require careful assessment. Some children may not exhibit signs of anxiety on examination even though they experience anxiety in other settings.
Thus, the assessment of anxiety in children with ASD should include a focus on both categorical and atypical symptoms. Anxiety and ASD symptoms can overlap. For example, social avoidance may represent behavioral avoidance of feared stimuli, which suggests social anxiety, or social indifference, which is a core feature of ASD.
A referral to a behavioral psychologist, who can conduct a functional behavioral analysis, may help differentiate these etiologies.
Clinicians can also ask questions to help tease out whether overlapping symptoms are explained solely by ASD or are consistent with a co-occurring anxiety disorder. Some of these questions include asking about behavioral signs of anxiety that may accompany the symptom in question eg, is the social avoidance associated with fearful affect, irritability, or physiologic symptoms?
It is also important to assess baseline ASD symptoms to differentiate preexisting ASD characteristics from new-onset anxiety symptoms eg, has the child always avoided crowds or is this a new behavior? Other questions to ask include whether ASD symptoms have intensified eg, has the frequency of repetitive behaviors increased recently?
Treating other conditions that may exacerbate anxiety should therefore be part of the treatment plan and should be considered before treating anxiety directly.
Co-occurring medical disorders are prevalent in youth with ASD but may also reflect the presence of anxiety.
For example, gastrointestinal 28 and sleep problems 29 may cause or aggravate anxiety, particularly if symptoms are more frequent or severe or may be caused by anxiety. Complex partial seizures can present with anxiety-like symptoms, including fear, misperceptions, and irritability.
Any medical issues affecting anxiety therefore warrant treatment. For example, inadequate educational supports or high academic expectations may cause increased stress due to academic challenges.
Many children with ASD experience bullying and peer victimization in school, which may lead to significant anxiety. Clinicians can help with educational advocacy eg, talking to school staff or writing letters indicating the need for increased services at schoolsuggest strategies to stabilize the home environment eg, increasing structure and predictabilityaccessing resources eg, behavioral therapy, respite careand promoting parental self-care eg, taking breaks, seeking personal mental health and medical treatments.
Assess the Degree of Anxiety-Related Impairment After collecting all of the data, the clinician should assess if anxiety-related impairment is present eg, How much does anxiety interfere with daily functioning?
Is impaired functioning present across 1 or multiple settings?
Assessing the contribution of anxiety symptoms eg, schoolwork avoidance or behavioral challenges at school and home to the overall impairment and functioning of the child with ASD will help to prioritize treatment.Second, studies needed to include at least one treatment group that received a psychological intervention with some level of standardized family involvement described, specifically a clearly defined portion of the treatment which all family members received (e.g., “Parents attended sessions 4, 5, and 12”).
Major depressive disorder has significant potential morbidity and mortality, contributing to suicide (see the image below), incidence and adverse outcomes of medical illness, disruption in interpersonal relationships, substance abuse, and lost work time.
With appropriate treatment, % of individuals with major depressive disorder can achi. The eligible studies were directly coded on an Excel database data by the first author. The coding was reviewed by the second and third authors, and doubts were resolved through discussion among all the authors.
HTML Full text] [Mobile Full text] [Sword Plugin for Repository] Beta: Original Article: Stakeholder analysis of Iran's health insurance system Majid Heydari, Hesam Seyedin, Mehdi Jafari, Reza Dehnavieh. Major depressive disorder has significant potential morbidity and mortality, contributing to suicide (see the image below), incidence and adverse outcomes of medical illness, disruption in interpersonal relationships, substance abuse, and lost work time.
With appropriate treatment, % of individuals with major depressive disorder can achi. Behavioral therapy utilizing exposure and response prevention (ERP) is considered the psychosocial treatment of choice for obsessive-compulsive disorder (OCD).