From Science Daily:

Anxious people have long been classified as “hypersensitive” — they’re thought to be more fearful and feel threatened more easily than their counterparts. But new research from Tel Aviv University shows that the anxious may not be hypersensitive at all — in fact, they may not be sensitive enough.

As part of a study on how the brain processes fear in anxious and non-anxious individuals, Tahl Frenkel, a Ph.D. candidate in TAU’s School of Psychological Sciences and the Adler Center for Research in Child Developmental and Psychopathology, working with her supervisor Prof. Yair Bar-Haim, measured brain activity as study participants were shown images designed to induce fear and anxiety. Using an EEG to measure electrical activity caused by the neuronal activity that represents deep processing of these stimuli, the researchers discovered that the anxious group was actually less stimulated by the images than the non-anxious group.

Surprisingly, anxious study participants weren’t shown to be as physiologically sensitive to subtle changes in their environment as less fearful individuals, Frenkel explains. She theorizes that anxious people could have a deficit in their threat evaluation capabilities — necessary for effective decision-making and fear regulation — leading to an under-reaction to subtle threatening stimuli. Non-anxious individuals seem to have a subconscious “early warning system,” allowing them to prepare for evolving threats. Essentially, anxious people are “surprised” by fearful stimuli that non-anxious individuals have already subconsciously noticed, analyzed, and evaluated.

This supports our frequent observation of anxiety in children with poorly integrated sensory processing, who tend to selectively attend to one mode of sensation (typically vision) to the exclusion of the conflicting or incongruous input. They lack the kind of flexible shifting of attention that would allow them to alert and orient to the subtle environmental cues that would otherwise help them anticipate changes, transitions, and other events with enough time to generate a purposeful response. Instead, they tend to react with a fight/flight response and often make attempts to avoid this kind of ambiguity by adhering to predictable routines and controlling the actions of others with their own emotions and behavior. 

When confronted with a potential threat, Frenkel concluded, non-anxious people unconsciously notice subtle changes in the environment before they consciously recognize the threat. Lacking such preparation, anxious individuals often react more strongly, as the threat takes them more “by surprise.”

“The EEG results tell us that what looks like hypersensitivity on a behavioral level is in fact the anxious person’s attempt to compensate for a deficit in the sensitivity of their perception,” she explains.

Read the article here. 

From Science Daily:

As children move toward adolescence, they rely increasingly on close relationships with peers. Socially withdrawn children, who have less contact with peers, may miss out on the support that friendships provide. In a new study about the peer relationships of almost 2,500 fifth graders who are socially withdrawn in different ways and those who aren’t withdrawn, researchers have found that withdrawn children who can be described as “anxious-solitary” differ considerably in their relationships with peers, compared to other withdrawn children and children who aren’t withdrawn.

(…)

Socially withdrawn children who are classified as anxious-solitary are believed to experience competing motivations — they want to interact with peers, but the prospect of doing so causes anxiety that interferes with such interactions. In contrast, unsociable children are seen as having what’s called low approach and low avoidance motives — that is, they have little desire to interact with peers but aren’t repelled by the prospect of doing so; for these children, the overtures of peers don’t make them feel anxious.

Unfortunately, this pattern is all too familiar. Kids who have trouble integrating sights, sound, motion, and movement also have trouble making sense of the actions of others, decoding their intentions, and reading their responses. Fortunately, we also know how to support them: by helping them to attune to and give meaning to the actions and ideas of others, we can scaffold successful experiences, change their perception of the interaction, and ultimately, bolster their confidence! 

Read the full article here. 

Discovery Mind & Brain blog, Vital Signs presents a thoughtful case study introducing selective mutism:

“I understand your daughter is having some problems with her speech. Can you tell me what your concerns are?”

The mother was also petite and neatly dressed. She looked directly at me and said, “Well, she seems to have trouble talking.”

OK, maybe I was wrong. This was probably a child with some articulation problems. “What kind of trouble?” I asked.

The young woman grimaced slightly before answering. “Well, she, uh…she doesn’t talk.”

Maybe I wasn’t so wrong after all. Not talking is a complaint I hear from parents of children who turn out to have severe speech and language disorders. But those conditions generally declare themselves before age 6. Something was different here.

“Doesn’t talk?”

“No, not at all. At least that’s what her teacher says.”

“Her teacher? So she doesn’t talk at school?”

“Not a bit.”

“What about at home?”

The girl’s mother shook her head with a rueful grin. “At home I can’t shut her up! She talks a mile a minute.” She paused, and the grin faded. “I just don’t understand it.” Apparently Taylor’s pediatrician had not understood it either, but her mother had just given me the key. 

The article goes on to describe how the profession’s understanding of how this anxiety disorder has changed over time, discusses the neurobiology, differential diagnosis from autism and speech/language disorders, and discusses potential treatments. 

Selective mutism is now considered by many clinicians to be a manifestation of a type of social anxiety or social phobia. A certain amount of anxiety is useful to keep us out of dangerous situations, but in anxiety disorders the perception of what is dangerous may be distorted.

Some researchers suggest that these disorders may be triggered by an imbalance of neurotransmitters in an area of the brain called the amygdala. The amygdala helps determine the emotional significance of things we perceive: “Uh-oh, is that somebody brandishing a knife—or just a bush moving in the wind?” Directors of horror movies are experts at manipulating this part of the brain.

Activity in the amygdala is regulated by at least three systems of brain chemicals called neuro transmitters—serotonin, norepineph rine, and GABA (gamma-amino butyric acid). An excess or deficiency in any of these neurotransmitters can affect the activity level of the amygdala and thereby influence how likely we are to perceive a given situation as threatening. For a child with selective mutism, being in a situation where she has to talk to someone she doesn’t know induces a feeling of terror, exactly as if she were facing genuine danger.

In addition to an imbalance in neurotransmitters, genetics, temperament, family dynamics, and environmental factors may also play a role in selective mutism, according to recent research. The relative contribution of each of these factors varies from child to child.

I referred Taylor to our practice’s child psychiatry department, where her treatment would include behavioral therapy aimed at decreasing social anxiety. This therapy takes advantage of the fact that the amygdala doesn’t respond just to the emotional neurotransmitter systems; it also receives messages from the cortical centers of cognition and judgment, which we can influence through rational thought.

Though it is not mentioned specifically, given the nature of this disorder, it stands to reason that a child who exhibits selective mutism would also benefit from Floortime’s developmental and relationship based approach, supporting the child to give greater meaning to their experience in a co-regulated interaction with a familiar and trusted adult play partner, pacing and providing scaffolding support to build her internal sense of confidence and self-efficacy. 

Read the whole article here. 

From the New York Times:

Is it really possible to diagnose such a grown-up affliction in such a young child? And is diagnosing clinical depression in a preschooler a good idea, or are children that young too immature, too changeable, too temperamental to be laden with such a momentous label? Preschool depression may be a legitimate ailment, one that could gain traction with parents in the way that attention deficit hyperactivity disorder (A.D.H.D.) and oppositional defiant disorder (O.D.D.) — afflictions few people heard of 30 years ago — have entered the what-to-worry-about lexicon. But when the rate of development among children varies so widely and burgeoning personalities are still in flux, how can we know at what point a child crosses the line from altogether unremarkable to somewhat different to clinically disordered? Just how early can depression begin?

Much of the article is devoted to debating whether it’s possible or even appropriate to apply a major psychiatric diagnosis to very young children and considers how professionals might differentiate clinical symptoms from the typical and appropriate range of emotions explored and experienced throughout development. 

The most obvious and pervasive symptom, not surprisingly, is sadness. But it’s not “I didn’t get the toy I wanted at Target; now I’m really sad,” cautions Helen Egger, a Duke University child psychiatrist and epidemiologist. The misery needs to persist across time, in different settings, with different people. Nor is it enough just to be sad; after all, sadness in the face of unachieved goals or a loss of well-being is normal. But the depressed child apparently has such difficulty resolving the sadness that it becomes pervasive and inhibits his functioning. “You can watch two kids try to put on shoes, and as soon as something gets stuck, one child pulls it off and throws it across the room,” says Tamar Chansky, who treats preschoolers who are depressed or are at risk for depression in her clinic. “He hits himself, throws objects and says things like ‘I did this wrong; I’m stupid.’ ”

Though there is no consensus about the prevalence, etiology, or course of childhood depression, it is generally agreed that the plasticity of the brain in childhood makes early detection and treatment essential. 

Could we somehow nip adult depression in the bud? We may never get a definitive answer, even if we do begin to systematically diagnose and treat preschool depression. “The promise of early-childhood mental health is that if you intervene early enough to change negative conditions, rather than perpetuate negative behaviors, you really are preventing the development of a full-fledged diagnosis,” says Alicia Lieberman at U.C.S.F. “Of course, you would never then know if the child would have become a depressed adult.”

The article briefly considers treatment options, describing one method of treatment. 

One established method is called Parent-Child Interaction Therapy, or P.C.I.T. Originally developed in the 1970s to treat disruptive disorders — which typically include violent or aggressive behavior in preschoolers — P.C.I.T. is generally a short-term program, usually 10 to 16 weeks under the supervision of a trained therapist, with ongoing follow-up in the home. Luby adapted the program for depression and began using it in 2007 in an ongoing study on a potential treatment. During each weekly hourlong session, parents are taught to encourage their children to acquire emotion regulation, stress management, guilt reparation and other coping skills. The hope is that children will learn to handle depressive symptoms and parents will reinforce those lessons.

The most relevant aspects of this therapy to our practice are that it is driven by supporting the relationship between parent and child and that it is experience-based; the article acknowledges that children lack the requisite ability to think abstractly and reflect about themselves and their emotional responses. The author describes observing a session in which the therapist orchestrated an incident, deliberately invoking feelings of guilt in order to provide an opportunity for the parent to help the child to reflect and manage his emotional response. 

Read the article here. 

If you have access, read the study by Joan L. Luby exploring the efficacy of DSM IV criteria and proposed modifications for the diagnosis of childhood depression here.