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Comorbidity of childhood balance and anxiety disorders: treatment and theory Ph.D. study by Orit Erez. Comorbidity of balance and anxiety disorders.

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Comorbidity of childhood balance and anxiety disorders treatment and theory ph d study by orit erez l.jpg
Comorbidity of childhood balance and anxiety disorders: treatment and theoryPh.D. study by Orit Erez


Comorbidity of balance and anxiety disorders l.jpg
Comorbidity of balance and anxiety disorders treatment and theory

A recent special issue of the J. of Anxiety Disorders, reviewed the experimental and clinical findings related to comorbidity of balance disorders and anxiety (Sklare et al., 2001).


Comorbidity of balance and anxiety disorders causality l.jpg

Balance treatment and theory

disorder

Anxiety

disorder

Balance

disorder

Anxiety

disorder

Comorbidity of balance and anxiety disorders Causality ????

We are interested in this option

Balance

disorder

~

~

Anxiety

disorder


Balance disorder as the origin of balance and anxiety comorbidity l.jpg
Balance disorder as the origin of treatment and theorybalance and anxiety comorbidity

Theoretical implication: Anxiety evolves from normal limbic system that responds excessively to interaction with deficient balance system.

Clinical implication: Successful balance treatment may ameliorate also the anxiety symptoms.


Checking for comorbidity in childhood l.jpg
Checking for comorbidity in childhood treatment and theory

In children with anxiety as primary disorder.

In children with balance as primary disorder.


Comorbidity with anxiety as primary disorder l.jpg
Comorbidity with anxiety as primary disorder treatment and theory

Is childhood anxiety associated with poor balance performance ?

( Erez et al., J. of Anxiety Disorders, 2003)


Subjects l.jpg
Subjects treatment and theory

Exclusion criteria:no past history of acute vestibular disorder or chronic ear disease.


Slide8 l.jpg

Procedure in chronological order: treatment and theory

  • DSM-IV based diagnosis of anxiety disorder by a psychiatrist.

  • Elevated anxiety confirmed on Fear Survey Schedule for Children (FSSC; Ollendick, 1983).

  • Neurological and neuro-otological examination by a neurologist.

  • Static and dynamic balance tests by a movement therapist (Orit Erez).

  • Dizziness & motion sickness questionnaires.


Results l.jpg
Results treatment and theory

Children with anxiety disorders vs. controls:

  • Reported more dizziness episodes (80 vs. 40%).

  • Reported enhanced sensitivity to motion sickness

    provoking situations.

  • Were hypersensitive to the rotary chair test.


Children with anxiety disorders had more balance mistakes relative to controls l.jpg
Children with anxiety disorders had more balance mistakes relative to controls

*p<0.05; **p<0.01; ***p<0.001


Time to task completion was longer in children with anxiety disorders relative to controls l.jpg
Time to task completion was longer in children with anxiety disorders relative to controls

*p<0.05; **p<0.01; ***p<0.001



Comorbidity with balance as primary disorder l.jpg
Comorbidity with balance as primary disorder performance ?

Are children with poor balance performance more anxious than normal controls?

Thesis by Moran Levin (2004)


Subjects14 l.jpg
Subjects performance ?


Slide15 l.jpg

Inclusion criteria in clinical group: performance ?< normal balance performance (Bruininks 1978).Normal schooling system.

Inclusion criteria in control group:No known balance difficulties.

Exclusion criteria:Tactile difficulties (Royeen & Fortune, 1990).Previous psychological or occupational therapies.No other major developmental problems.


Slide16 l.jpg

Procedure in chronological order: performance ?

  • Balance and anxiety were assessed upon arrival

    at the clinic.

  • Controls were tested at the school.

  • Testing and treatment were administered by a

    certified occupational therapist, experienced in

    sensory integration techniques (Moran Meidan).


Slide17 l.jpg

Balance tests: performance ?

  • Balance sub-test of the Bruninks-Oseretsky Test of Motor Proficiency (Bruninks, 1978).

  • Vestibular scale of The Parental Sensory Profile Assessment (Dunn, 1999).

    Anxiety tests:

  • Anxiety-Depression Parental Scale of the Child Behavior Checklist (CBCL; Achenbach, 1991).

  • Fear Survey Schedule for Children – self report (FSSC; Ollendick, 1983).


Slide18 l.jpg

Obvious result: performance ?

Clinical < Controls on balance tests; p<.001.

New result:

Clinical > Controls on anxiety tests; p<.001.


Relation between parental report on balance and emotionality l.jpg

r=-.32 performance ?

r=-.52*

Relation between parental report on balance and emotionality


Relation between balance performance and parental report on emotionality l.jpg

r=.03 performance ?

r=-.72*

Relation between balance performance and parental report on emotionality


Relation between parental report on balance and self report on emotionality l.jpg

r=.14 performance ?

r=-.31

Relation between parental report on balance and self report on emotionality


Relation between balance performance and self report on emotionality l.jpg

r=-.52* performance ?

r=-.63*

Relation between balance performance and self report on emotionality



Treatment of children with balance as primary disorder and elevated anxiety l.jpg
Treatment of children normal controls?with balance as primary disorderand elevated anxiety

Can balance treatment alleviate the anxiety?

Thesis by Einat Karmon-Weisman (2004)


Subjects25 l.jpg
Subjects normal controls?


Slide26 l.jpg

Inclusion criteria: normal controls?< normal balance performance (Bruininks 1978).> normal self report on Fear Survey (Ollendick, 1983). Normal schooling system.Exclusion criteria:Tactile difficulties (Royeen & Fortune, 1990).Previous psychological or occupational therapies.No other major developmental problems.


Slide27 l.jpg

Procedure in chronological order: normal controls?

  • Balance and anxiety were assessed upon arrival at the clinic.

  • Half of the children received 12 weekly sessions of OT with

    sensory-motor orientation:

    Improvement of flexor and tensor muscle tone.

    Maintenance of balance in different postures.

    Vestibular stim in various positions, speeds & intensities.

  • Balance and anxiety were reassessed after the last treatment.

  • Testing and treatment were administered by a certified

    occupational therapist, experienced in sensory integration

    techniques (Einat Veisman-Carmon).


Slide28 l.jpg

Balance tests: normal controls?

  • Balance sub-test of the Bruninks-Oseretsky Test of Motor Proficiency (Bruninks, 1978).

  • Vestibular scale of The Parental Sensory Profile Assessment (Dunn, 1999).

    Anxiety tests:

  • Anxiety-Depression Parental Scale of the Child Behavior Checklist (CBCL; Achenbach, 1991).

  • Fear Survey Schedule for Children – self report (FSSC; Ollendick, 1983).


Balance bruninks oseretsky test of motor proficiency l.jpg

15 normal controls?

14

13

12

11

15

O

10

14

9

13

8

12

7

11

6

10

5

9

4

O

8

O

3

7

2

6

1

5

0

4

3

O

2

1

After treatment

Before treatment

Treatment

Control

Balance(Bruninks-Oseretsky Test of Motor Proficiency)

Group by Time: p<.001


Vestibular processing parental report l.jpg

50 normal controls?

O

40

30

O

40

20

30

10

Before treatment

After treatment

O

O

Treatment

20

Control

10

0

Vestibular Processing(Parental Report)

Group by Time: p<.001


Anxiety level cbcl parental reports l.jpg

O normal controls?

15.00

O

O

15.00

10.00

10.00

5.00

O

5.00

0.00

0.00

Before treatment

After treatment

Treatment

Control

Anxiety Level(CBCL: Parental reports)

Group by Time: p<.001


Anxiety level fear survey schedule for children child report l.jpg

O normal controls?

O

150

O

150

100

O

100

50

50

0

Before treatment

After treatment

0

Treatment

Control

Anxiety Level(Fear Survey Schedule for Children: Child Report)

Group by Time: p<.001



Theoretical background normal individual facing an aversive challenge l.jpg
Theoretical background: normal controls?Normal individual facing an aversive challenge

Two stage theory of learning predicts:

1st stage: Fast acquisition of fear response.

2nd stage: Slow acquisition of motor response.

Extension to three stage theory of learning:

3rd stage: Extinction of fear response after acquisition of motor response.


Theoretical background individual with balance disorder facing balance challenging conditions l.jpg
Theoretical background: normal controls?Individual with balance disorder facing balance challenging conditions

Three stage theory of learning predicts:

1st stage: Fast acquisition of fear response.

2nd stage: No acquisition of balance restoration motor response.

3rd stage: No extinction of fear response.


The next step treatment of children with anxiety as primary disorder and poor balance l.jpg
The next step: Treatment of children with anxiety normal controls?as primary disorder and poor balance

Select a group of children with generalized or separation anxiety.

Test the group for comorbidity with balance deficiency.

Provide a 2-3 months physical balance training.

Test for improvement of balance skills.

Test for a short and long-term amelioration of anxiety symptoms.


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