Separation Anxiety Disorder in Children

Separation Anxiety Disorder in Children

Separation Anxiety Disorder (SAD) manifests itself in children as extreme anxiety based on unrealistic expectations of permanent disconnection when the child is separated from parents or other individuals with whom they are strongly emotionally attached. Separation anxiety is a normal part of the childhood development process in infants because they do not have the cognitive abilities to distinguish between temporary absence and permanent absence. Most children move past this separation anxiety by the time they reach pre-school age.

Separation anxiety becomes an actual mental disorder when the child continues to have irrational fears when separated from those to whom he or she is emotionally attached past pre-school age and even into adolescence. According to MedicineNet.com, "Approximately 4%-5% of children and adolescents suffer from separation anxiety disorder."

The symptoms for Separation Anxiety Disorder (309.21) as described by the DSM-IV-TR, involves three or more of the following indicators:

(1) recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated

(2) persistent and excessive worry about losing, or about possible harm befalling, major attachment figures

(3) persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped)

(4) persistent reluctance or refusal to go to school or elsewhere because of fear of separation

(5) persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings

(6) persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home

(7) repeated nightmares involving the theme of separation

(8) repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated (p. 391)

The diagnostic criteria for SAD, according to the DSM-IV-TR are:

(1) Developmentally inappropriate and excessive anxiety concerning separation from home or from those to whom the individual is attached, as evidenced by at least three of the symptoms described above.

(2) The duration of the disturbance is at least 4 weeks.

(3) The onset is before age 18 years.

(4) The disturbance causes clinically significant distress or impairment in social, academic (occupational), or other important areas of functioning.

(5) The disturbance does not occur exclusively during the course of a Pervasive Developmental Disorder, Schizophrenia, or other Psychotic Disorder and, in adolescents and adults, is not better accounted for by Panic Disorder With Agoraphobia (p. 391).

Treatment protocols for SAD can be therapy-based, pharmaceutical or a combination of both. One of the most popular therapeutic treatments for SAD is cognitive-behavioral therapy (CBT). The Cognitive Behavioral model is an amalgamation of three major psychology disciplines: behavior therapy, cognitive therapy and social psychology (Cooper & Lesser, 2008).

There are a series of steps that need to be undertaken to assess or intervene using Cognitive Behavioral Therapy. These are: 1) Specifying the problematic behaviors; 2) Data collection (monitoring and recording); 3) Goal setting; 4) Intervention; 5) Homework; 6) Reinforcement for Change; 7) Helping the client take credit for change; 8) Relapse prevention (Cooper & Lesser, 2008, pp. 167-168).

As is reported by Perwien & Bernstein (2004) Kendall (1994) conducted a study to examine the effectiveness of CBT on 47 children ages 9 through 13. The children's diagnoses were distributed as follows: anxiety disorder (64%), social phobia (19%) and separation anxiety disorder (17%). The study last for 16 weeks. During these weeks, five different CBT treatment strategies were used. These were: (1) awareness of anxious feelings and the physical correlates of anxiety, (2) identification of negative thoughts associated with anxiety-provoking situations, (3) coping strategies, (4) monitoring progress and reinforcing gains, and (5) implementing a strategic plan to manage anxious feelings.

According to Perwien & Bernstein (2004), the results of the Kendall study indicated that those children who had received the CBT treatments showed a decrease in anxiety related symptoms and an increase in coping abilities. The results held strong during the three-year follow-up period as well.

Another therapeutic approach to Separation Anxiety Disorder in children is Rational Emotive Behavior Therapy (REBT). REBT is a highly direct, action-oriented model for assessing problems and effecting change. REBT is an extension of the RET (Rational Emotive Therapy) model but seeks to include behavior into the equation. The inclusion of the behavioral component is a critical and essential step in helping to redirect irrational thinking to a reasonable perspective. This transition is designed not only to effect thought patterns but behaviors as well. As is stated by its originator, Albert Ellis, "unlike many counseling methods, REBT is both postmodern and active-directive" (Ellis, 2000, p. 97).

REBT is an important self-help strategy by itself or as a supplement to therapy in which the level of emotional involvement with sensitive issues may prevent the patient from solving problems without some form of constructive guidance. Overall, REBT is rooted in the notion that when clients display problems in constructing and organizing their lives, or in controlling themselves, they may be suffering from deficits in cognitive control of these functions. Many people, without the aid of therapists, have found that talking to themselves, thinking through the pros and cons of a dilemma, or setting goals for themselves are useful techniques (Ellis, 2000)