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

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

Balance

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
Balance disorder as the origin of balance 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
Checking for comorbidity in childhood

In children with anxiety as primary disorder.

In children with balance as primary disorder.

comorbidity with anxiety as primary disorder
Comorbidity with anxiety as primary disorder

Is childhood anxiety associated with poor balance performance ?

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

subjects
Subjects

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

slide8
Procedure in chronological order:
  • 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
Results

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
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
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
Comorbidity with balance as primary disorder

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

Thesis by Moran Levin (2004)

slide15
Inclusion criteria in clinical group:< 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
Procedure in chronological order:
  • 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
Balance tests:
  • 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
Obvious result:

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

New result:

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

treatment of children with balance as primary disorder and elevated anxiety
Treatment of children with balance as primary disorderand elevated anxiety

Can balance treatment alleviate the anxiety?

Thesis by Einat Karmon-Weisman (2004)

slide26
Inclusion criteria:< 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
Procedure in chronological order:
  • 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
Balance tests:
  • 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

15

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

50

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

O

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

O

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
Theoretical background: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
Theoretical background: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
The next step: Treatment of children with anxiety 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.