Dr. Roxanne Dryden-Edwards is an adult, child, and adolescent psychiatrist. She is a former Chair of the Committee on Developmental Disabilities for the American Psychiatric Association, Assistant Professor of Psychiatry at Johns Hopkins Hospital in Baltimore, Maryland, and Medical Director of the National Center for Children and Families in Bethesda, Maryland.
Melissa Conrad Stöppler, MD, is a U.S. board-certified Anatomic Pathologist with subspecialty training in the fields of Experimental and Molecular Pathology. Dr. Stöppler's educational background includes a BA with Highest Distinction from the University of Virginia and an MD from the University of North Carolina. She completed residency training in Anatomic Pathology at Georgetown University followed by subspecialty fellowship training in molecular diagnostics and experimental pathology.
What are causes and risk factors for separation anxiety disorder?
Separation anxiety disorder (as with most mental-health conditions) is likely caused by the combination of genetic and environmental vulnerabilities rather than by any one thing.
In addition to being more common in children with family histories of
anxiety, children whose mothers were stressed during pregnancy with them tend to be more at risk for developing this disorder.
A majority of children with separation anxiety disorder have school refusal as a symptom and up to 80% of children who refuse school qualify for the diagnosis of separation anxiety disorder.
Approximately 50%-75% of children who suffer from this disorder come from homes of low socioeconomic status.
How is separation anxiety disorder diagnosed?
Health-care professionals who have training and experience understanding symptoms of children and adolescents are usually the most qualified to assess separation anxiety disorder. The assessment most often involves a pediatrician and child psychologist, child psychiatrist, or other mental-health professional interviewing both the child and his or her parent(s) when assessing separation anxiety disorder. Those interviews often take place separately to allow everyone to speak freely. This is particularly important given how differently children and their parents may see the situation and how difficult it can be for children to hear their problems discussed. In addition to asking about specific symptoms of anxiety, the professional will likely explore whether the child has symptoms of any other mental-health issues and will recommend that the child receive a full physical examination and lab work to ensure that there is no medical reason for the issues the child is experiencing.
What is the treatment for separation anxiety disorder?
Counseling, rather than medication, is the treatment of choice for separation anxiety disorder that is mild in severity. For children who either have not improved with counseling alone, suffer from more severe symptoms, have other emotional problems in addition to separation disorder, treatment should consist of a combination of approaches. Psychotherapy, medication, and parent counseling are three interventions that have been found to be effective for the treatment of separation anxiety disorder, particularly in combination.
Behavioral modification therapy is an intervention that directly addresses the behavioral symptoms of separation anxiety disorder. This intervention tends to be more effective and less burdensome to the child if behaviors are addressed positively rather than negatively. The child is not usually punished for continuing to suffer from symptoms but rewarded for small victories over symptoms. For example, instead of withholding dessert from a preschooler who refuses to go into her room for bedtime, give hugs and praise for the child when she can go near her room at first, followed by being able to go in and stay for five minutes, increasing the length of time she needs to be in her room before being praised. Even if she needs significant parental support at first (for example, sitting in the room with her on the parent's lap, then next to her, then just outside the room after she becomes comfortable with each step), this approach allows the child to feel a sense of success at every step and build on it rather than experiencing a sense of failure, which tends to lower the child's likelihood of being able to overcome her anxiety. The implementation of behavioral therapy
generally involves the practitioner providing parenting tips to the child's caregivers, regular meetings with the child, and
may include guidance to teachers on how to help alleviate the child's anxiety.
Cognitive therapy is used to help children learn how they think and increase their ability to
solve problems and focus on the positive things that are going on, even in the midst of their anxiety. By learning to focus on more positive thoughts and feelings, children may become more open to learning strategies to deal with anxiety, such as playing games, coloring, watching television, or listening to music. Although formal relaxation techniques such as imagining themselves in a relaxing situation may be considered more appropriate interventions for older children, adolescents, and adults, even toddlers can be taught simple relaxation techniques, such as imitating their parents, taking deep breaths, or slowly counting to 10 as ways to calm themselves.
If psychotherapy is unsuccessful or if the children's symptoms are so severe that they are nearly incapacitating, medication is considered a viable option. However, there are no medications specifically approved by the U.S. Food and Drug Administration (FDA) to treat separation anxiety disorder. Selective
serotonin reuptake inhibitors (SSRIs) such as fluvoxamine (Luvox) have been found to be an effective treatment for separation anxiety disorder.
SSRIs are medications that increase the amount of the neurochemical serotonin in the brain. These medications work by selectively inhibiting (blocking) serotonin reuptake in the brain. This block occurs at the synapse, the place where brain cells (neurons) are connected to each other. Serotonin is one of the chemicals in the brain that carries messages across these connections (synapses) from one neuron to another.
The SSRIs work by keeping serotonin present in high concentrations in the synapses. These drugs do this by preventing the reuptake of serotonin back into the sending nerve cell. The reuptake of serotonin is responsible for turning off the production of new serotonin. Therefore, the serotonin message keeps on coming through. It is thought that this, in turn, helps arouse (activate) cells that have been deactivated by anxiety, thereby relieving a child's anxiety symptoms.
SSRIs have fewer side effects than the tricyclic antidepressants (TCAs). These medications do not tend to cause orthostatic hypotension (a sudden drop in blood pressure when sitting up or standing)
or heart rhythm disturbances, like the TCAs. Therefore, SSRIs are often the first-line medication treatment for separation anxiety disorder.
Examples of SSRIs include
SSRIs are generally well tolerated, and side effects are usually mild. The most common side effects are nausea, diarrhea, agitation, insomnia, and headache. Side effects generally go away within the first month of SSRI use. Some patients experience tremors with SSRIs. The serotonin syndrome
(also called serotonergic [caused by serotonin] syndrome) is a serious neurologic condition associated with the use of SSRIs, characterized by high fevers, seizures, and heart rhythm disturbances. There has also been heightened concern that children and adolescents are at increased risk of having the rare reaction of feeling acutely (suddenly and significantly) more anxious
or newly depressed, even to the point of wanting, planning, attempting or in extremely rare cases, completing suicide or homicide. Serotonin syndrome, as well as acute worsening of emotional symptoms, is very rare.
All people are unique biochemically so the occurrence of side effects or the lack of a satisfactory result with one SSRI does not mean another medication in this group will not be beneficial. However, if someone in the patient's family had a positive response to a particular drug, that drug may be preferable to try first. Medications that are sometimes considered in treating separation anxiety disorder when SSRIs either don't work or are poorly tolerated include tricyclic antidepressants (TCAs) and benzodiazepines. These medications were developed in the 1950s and 1960s to treat depression. TCAs
work mainly by increasing the level of norepinephrine in the brain synapses,
although they also may affect serotonin levels. Examples of tricyclic
antidepressants include
TCAs are generally safe and well tolerated when properly prescribed and administered. Overdose of TCAs can cause life-threatening heart rhythm disturbances. Rarely, this can occur even if an overdose is not taken. Some TCAs can also have anti-cholinergic side effects, which are due to the blocking of the activity of the nerves that are responsible for control of the heart rate, gut motion, visual focus, and saliva production. Thus, some TCAs can produce dry mouth, blurred vision, constipation, and dizziness upon standing. The dizziness results from low blood pressure. TCAs should also be avoided in patients with seizure disorders or a history of strokes.
Benzodiazepines tend to be the least-prescribed group of medications to children suffering from separation anxiety disorder. This group of medications is thought to work by increasing the activity of calming chemicals in the brain. Benzodiazepines include clonazepam (Klonopin) and alprazolam (Xanax). Unfortunately, there is a possible risk of the child becoming dependent on benzodiazepines. These medications tend to only be used as a last resort, when the child has had unsuccessful trials of the other two classes of medications.
Anxiety is a feeling of apprehension and fear characterized by physical symptoms. Anxiety disorders are serious medical illnesses that affect approximately 19 million American adults.
Stress occurs when forces from the outside world impinge on the individual. Stress is a normal part of life. However, over-stress, can be harmful. There is now speculation, as well as some evidence, that points to the abnormal stress responses as being involved in causing various diseases or conditions.
Depression is an illness that involves the body, mood, and thoughts and affects the way a person eats and sleeps, the way one feels about oneself, and the way one thinks about things. The principal types of depression are major depression, dysthymia, and bipolar disease (also called manic-depressive disease).
Suicide is the process of intentionally ending one's own life. Approximately 1 million people worldwide commit suicide each year, and 10 million to 20 million attempt suicide annually.
Phobias are unrelenting fears of activities (social phobias), situations (agoraphobia), and specific items (arachnophobia). There is thought to be a hereditary component to phobias, though there may be a cultural influence or they may be triggered by life events. Symptoms and signs of phobias include having a panic attack, shaking, breathing troubles, rapid heart beat, and a strong desire to escape the situation. Treatment of phobias typically involves desensitization, cognitive behavioral therapy, and medications such as selective serotonin reuptake inhibitors and beta blockers.
Pregnancy planning is important to help prevent exposure of the mother and fetus to potentially harmful medications and substances during the early days, and throughout the pregnancy. Nutritional planning, prevention of birth defects, conditions such as high blood pressure, heart disease, diabetes, and kidney disease need careful monitoring. Gestational diabetes, preeclampsia, and pregnancy induced hypertension are conditions that may arise during pregnancy. Immunizations, inherited disorders, exercise, air travel, intercourse, and birth control are important factors to consider when planning a pregnancy.
Childhood depression can interfere with social activities, interests, schoolwork and family life. Symptoms and signs include anger, social withdrawal, vocal outbursts, fatigue, physical complaints, and thoughts of suicide. Treatment may involve psychotherapy and medication.
Good parenting helps foster empathy, honesty, self-reliance, self-control, kindness, cooperation, and cheerfulness, says Steinberg, a distinguished professor of psychology at Temple University in Philadelphia. It also promotes intellectual curiosity, motivation, and desire to achieve. It helps protect children from developing anxiety, depression, eating disorders, antisocial behavior, and alcohol and drug abuse.
Nightmares are dreams that cause high anxiety or terror. Nightmares may be a part of posttraumatic stress disorder (PTSD), and they usually occur during rapid eye movement (REM) sleep. There are several different treatment options for nightmares, including cognitive-behavioral therapy and medications.
Bipolar disorder, or manic-depressive illness, is a disorder that causes unusual and extreme mood changes. Symptoms of bipolar disorder in children and teens include having trouble concentrating, behaving in risky ways and losing interest in activities they once enjoyed. Treatment for bipolar disorder in children and teenagers incorporates psychotherapy and medications.
Children's health is focused on the well-being of children from conception through adolescence. There are many aspects of children's health, including growth and development, illnesses, injuries, behavior, mental illness, family health and community health.
Kids get headaches and migraines too. Many adults with headaches started having them as kids, in fact, 20% of adult headache sufferers say their headaches started before age 10, and 50% report their headaches started before age 20.
Teenagers recognize that they are developmentally between child and adult. Teen health prevention includes maintaining a healthy diet, exercising regularly, preventing injuries and screening annually for potential health conditions that could adversely affect teenage health.
Pregnancy can bring challenges like weight gain, stretch marks, varicose veins, heartburn, constipation, hemorrhoids, problems sleeping, and wondering if it is safe to have sex while pregnant. Learn how to manage and move through these challenges during pregnancy.
Sleep needs in children and teenagers depends on the age of the child. Sleep disorders in children such as sleep apnea, parasomnias, confusional arousals, night terrors, nightmares, narcolepsy, and sleepwalking can effect a child's or teen's sleep. Healthy sleep habits and good sleep hygiene can help your infant, toddler, preschooler, tween, or teenager get a good night's sleep.
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