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Separation Anxiety Disorder: Diagnosis of the Week

Separation Anxiety Disorder is a mental health disorder that afflicts 4- 5% of children and adolescents. Separation anxiety is a normal part of childhood development, but by the age of 4 most children are able to maintain a sense of independence. Separation Anxiety Disorder is marked by excessive anxiety caused by the temporary separation from parents or other adult caregivers. It can be found in children between the ages of 4 and 18, but it generally begins in children between 7 to 9 years of age.

Normal childhood development

Anxiety caused by the approach of strangers or by separation from caregivers is a normal stage in the development of children. Once an infant learns to identify caregivers, the approach of an unfamiliar person can cause anxiety. According to the American Academy of Pediatrics, stranger anxiety is common in infants from 8 months to 2 years of age.

At about 7 months, infants usually learn that caretakers still exist even when they are out of sight. If they do not learn this, it may lead to an attachment to these adults and can cause anxiety. Separation Anxiety is usually strongest between 10 and 18 months of age and generally subsides by 3 years of age. It can manifest at bedtime or when leaving the child with other caretakers, and can cause the child to becomes anxious, cry or refuse to be separated from parents.

Factors that can influence the length and intensity of this stage may include the child’s personality, the routine parents and children go through as they separate and reunite and the parent’s personality. Anxiety in parents tends to be transmitted to their children. Diagnosis of Separation Anxiety Disorder

If a child fails to pass beyond the separation anxiety stage by the age of 4, this may indicate Separation Anxiety Disorder. To qualify for this diagnosis, three of the following symptoms must be present for more than a month, causing significant stress and problems:

• Excessive anxiety about loss of a loved one. • Excessive concern about getting lost or kidnapped. • Repeated refusal to go to school or to be otherwise separated from a loved one. • Constant fear of going to sleep, unless in the physical presence of caregivers. • Persistent nightmares about loss or separation from loved ones. • Physical complaints at the prospect of separation.

Certain other anxiety disorders can also display some of these symptoms so evaluation by health care professionals is important to eliminate the possibility of other underlying causes, such as schizophrenia and ADHD. Diagnosis and treatment is also important as Separation Anxiety Disorder can lead to other, lasting mental health problems later in life, including depression, anxiety and personality disorders.

Treatment of Separation Anxiety Disorder

A demonstrated that cognitive behavioral therapy and the antidepressant sertraline (Zoloft), a selective serotonin reuptake inhibitor, were both effective treatments. NIMH Director Thomas R. Insel, M.D. commented that, “This study provides strong evidence and reassurance to parents that a well-designed, two-pronged treatment approach is the gold standard, while a single line of treatment is still effective.”

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