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 happens if separation anxiety disorder is left untreated?
Separation anxiety disorder puts its sufferers at risk for depression and anxiety problems as adults,
as well as personality disorders, in which anxiety is a major symptom.
Where can I find more information on separation anxiety disorder?
American Academy of Child and Adolescent Psychiatry
3615 Wisconsin Avenue NW
Washington, DC 20016
Phone: 202-966-7300
Fax: 202-966-2891 http://www.aacap.org
American Academy of Pediatrics
141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
Phone: 847-434-4000
Fax: 847-434-8000
Email: kidsdocs@aap.org http://www.aap.org
Anxiety Disorders Association of America (ADAA)
8730 Georgia Avenue, Suite 600
Silver Spring, MD 20910
Phone: 240-485-1001
Fax: 240-485-1035
Email: information@adaa.org http://www.adaa.org
National Institute of Mental Health (NIMH), Public Information & Communication Branch
6001 Executive Boulevard, Room 8184, MSC 9663
Bethesda, MD 20892-9663
Phone: 301-443-4513
Toll Free: 1-866-615-6464
TTY: 301-443-8431
TTY Toll Free: 1-866-415-8051
Fax: 301-443-4279
Email: nimhinfo@nih.gov http://www.nimh.nih.gov
Infants show stranger anxiety by crying when someone unfamiliar approaches. It is a normal stage of development that usually starts at about 8 months of age and abates by 2 years of age.
Separation anxiety as a normal life stage first develops at about 7 months of age, once object permanence has been established. It is at its strongest at 10-18 months
of age and usually subsides by 3 years of age.
Separation anxiety disorder begins in childhood and is characterized by worrying out of proportion to the situation of temporarily leaving home or otherwise separating from loved ones.
Approximately 4%-5% of children and adolescents suffer from separation anxiety disorder.
Examples of separation anxiety disorder symptoms include school refusal or school phobia, resistance to going to bed at night, and physical complaints in reaction to actual or anticipated separation from primary caretakers.
Professionals trained and experienced in assessing mental health in children will likely interview the child and parents separately and ask about symptoms of anxiety, screen for other mental-health
conditions, and recommend the child receive a full medical evaluation.
Separation anxiety disorder is likely caused by the combination of genetic and environmental vulnerabilities. Risk factors include low socioeconomic status, family histories of anxiety, and mothers who were stressed during pregnancy.
A majority of children with separation anxiety disorder have school refusal as a symptom. Up to 80% of children who refuse school qualify for a
diagnosis of separation anxiety disorder.
Counseling is usually considered the best treatment method compared to medications. Types of counseling used to treat separation anxiety disorder include behavioral, cognitive, and individual psychotherapies, as well as parent counseling and guiding teachers on how to help the child.
SSRIs like fluvoxamine are considered the safest and most effective medications to treat separation anxiety disorder, followed by tricyclic antidepressants (TCAs), with benzodiazepines as a last resort.
Children with separation anxiety disorder are at higher risk for developing other mental-health problems, particularly anxiety disorders.
REFERENCES:
American Academy of Child and Adolescent Psychiatry. "Practice Parameter for the Assessment and Treatment of Children and Adolescents With Anxiety Disorders." Journal of the American Academy of Child and Adolescent Psychiatry 46.2 (2007): 267-283.
American Academy of Pediatrics. "Separation Anxiety Disorder: Planning Treatment." Pediatrics in Review 21
(2000): 248.
den Boer, J.A. "Social Phobia: Epidemiology, Recognition and Treatment." British Medical Journal
315 (1997): 796-800.
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition,
Treatment Revision. American Psychiatric Association: Washington, D.C., 2000.
Foley, D.L., D.B. Goldston, E.J. Costello, and A. Angold. "Proximal Psychiatric Risk Factors for Suicidality in Youth."
Archives of General Psychiatry 63 (2006): 1017-1024.
Foley, D., M. Rutter, A. Pickles, A. Angold, M. Hermine, J. Silberg, and L. Eaves. "Informant
Disagreement for Separation Anxiety Disorder." Journal of the American Academy of Child and Adolescent Psychiatry
43.4 Apr. 2004: 452-460.
Fremont, W.P. "School Refusal in Children and Adolescents." American Family Physician Oct. 15, 2003.
Lewinsohn, P.M., J.M. Holm-Denoma, J.W. Small, J.R. Seeley, and T.E. Joiner. "Separation Anxiety Disorder in Childhood as a Risk Factor for Future Mental Illness." Journal of the American Academy of Child and Adolescent Psychiatry 47.5 May 2008: 548-555.
Masi, G., M. Mucci, and S. Millepiedi. "Separation Anxiety Disorder in Children and Adolescents: Epidemiology, Diagnosis and Management." CNS Drugs 15.2 (2001): 93-104.
National Institute of Mental Health. "Behavioral Therapy Effectively Treats Children With Social Phobia." Dec. 17, 2007.
Osone, A., and S. Takahashi. "Possible Link Between Childhood Separation Anxiety and Adulthood Personality Disorder in Patients With Anxiety Disorders in Japan." Journal of Clinical Psychiatry 67.9 Sept. 2006: 1451-1457.
Talge, N.M., C. Neal, and V. Glover. "Antenatal Maternal Stress and Long-Term Effects on Child Neurodevelopment: How and Why?" Journal of Child Psychology and Psychiatry 48.3-4 Mar. 7, 2007: 245-261.
van der Linden, G.J., D.J. Stein, and A.J. van Balkom. "The Efficacy of the Selective Serotonin Reuptake Inhibitors for Social Anxiety Disorder (Social Phobia): A Meta-Analysis of Randomized Controlled Trials." International Clinical Psychopharmacology 15.2 Aug. 2000: S15-S23.
Walkup, J.T., M.J. Labellarte, M.A. Riddle, D.S. Pine, L. Greenhill, R. Klein,
et al. "Fluvoxamine for the Treatment of Anxiety Disorders in Children and Adolescents." New England Journal of Medicine 344.17 Apr. 26, 2001: 1279-1285.
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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