Separation Anxiety Disorder SAD

Abstract
Separation Anxiety Disorder (SAD) causes significant impairment in kindergarten studies, social functioning, and family relations among children. This paper is a case study of SAD in an eight-year-old African-American female child, named Chloe, under foster care. The paper includes an annotated bibliography and an evidence-based model recommending cognitive behavioral therapy (CBT) for the given case. The research question for this paper is: how effective is CBT in the treatment of SAD among preschool children diagnosed with SAD? Based on the findings of the annotated literature review, it is concluded that CBT is highly effective as a SAD treatment among preschool children diagnosed with anxiety disorder. Hence, it is recommended that Chloe should undergo a CBT counseling program. The initial treatment goal for Chloe is to help her recognize her anxious feelings and physical responses.
Part 3: Applying Research to a Case Study (Evidence-Based Practice)
Annotated Bibliography
Introduction
The manifestation of anxiety early in childhood is an indication of significant distress and disturbances in life. Separation Anxiety Disorder (SAD) causes significant impairment in kindergarten studies, social functioning, and family relations among children (Schneider et al., 2011). SAD has been shown to be a major risk factor for adulthood anxiety disorder, panic disorder, substance abuse, and depression. Even though SAD has an early onset, a favorable long-term prognosis, and high prevalence, the treatment of SAD in pediatric care settings remains significantly under-researched. Cognitive Behavior Therapy is recommended as the best-suited intervention for the treatment of SAD (Ruocco, Gordon & McLean, 2016; Schneider et al., 2011). This paper is a case study of SAD in an eight-year-old African-American female child, named Chloe, under foster care. The paper includes an annotated bibliography and an evidence-based model recommending CBT for the given case.
Research Question:
How effective is CBT in the treatment of SAD among preschool children diagnosed with an anxiety disorder?
Search Strategy:
The search was conducted on Google Scholar. Google Scholar was selected mainly because of its ease of access and reliability. The search was conducted through the use of the keywords/phrases: “Social Anxiety Disorder,” Cognitive Behavior Theory,” “clinical trial OR random allocation OR single-blind method.” The search results were further analyzed using the abstract, in order to ensure inclusion of the most relevant articles. The inclusion criteria were: English language articles published in and after 2010. Types of studies included randomized controlled trials and quasi-experimental researches. The type of intervention was cognitive behavioral intervention.
Annotations
Article 1: Schneider, S., Blatter-Meunier, J., Herren, C., Adornetto, C., In-Albon, T., & Lavallee, K. (2011). Disorder-specific cognitive-behavioral therapy for separation anxiety disorder in young children: a randomized waiting-list-controlled trial. Psychotherapy and psychosomatics, 80(4), 206-215.
Permalink: https://www.kli.psy.ruhr-uni-bochum.de/kkjp/team/public/Schneider Journals/2011/Schneider et al._Disorderspecific cognitive behavioral treatment.pdf
The purpose of this study was to evaluate the short-term effectiveness of a CBT program for treating SAD in children using RCT design and multi-informant approach. Additionally, the study sought to evaluate the long-term effectiveness of a SAD treatment program for children, aiming to reduce incidence of mental disorders. The sample included 43 children aged 5-7 years diagnosed with SAD. The study was reviewed and approved by the university ethics committee for medical research. Written parental informed consent and verbal child assent were required before inclusion in the sample. Besides SAD-diagnosed children, parents of SAD-diagnosed children were also included in the study. A randomized controlled study methodology was used. Data was collected on clinical diagnosis, overall success, separation anxiety, distress, impairment, manifest anxiety, quality of life, and treatment integrity. Both pre- and post- intervention results were compared using linear mixed models. The study results reveal short-term effectiveness of a SAD-focused CBT program among young children. One of the strengths of the study is that it utilizes a random method. One of the limitations of the study is that it does not address long-term maintenance. Also, there is no representative data on socio-demographic and clinical characteristics of the SAD-diagnosed children taking part in the study.
Article 2: Minde, K., Roy, J., Bezonsky, R., & Hashemi, A. (2010). The effectiveness of CBT in 3–7 years old anxious children: Preliminary data. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 19(2), 109.
Permalink: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2868557/
This study attempted to evaluate a cognitive treatment approach for young children suffering from anxiety disorder. The study hypothesized that preschool-aged children will show a significant reduction in anxiety symptoms as well as improvement in overall psychological functioning after 2-3 months of weekly CBT. The sample included 20 boys and 17 girls aged between 3 and 7 years, diagnosed with anxiety disorder. Parents were required to complete a written consent form, and they too were included as study participants. The study utilized a pretest-posttest methodology. Data collected included family background (using a questionnaire filled by parents), Strengths & Difficulties Questionnaire (SDQ), and Global Assessment of Functioning (GAF) score of the patient. The analysis was done by comparing the results of both the SDQ and the GAF score before and after the intervention. The study results show that a modified CBT, with active parental involvement, is a useful tool for the treatment of anxiety disorder in preschool and early school-aged children. The strength of the study is: it relied on family history and included a follow-up 4-6 weeks after removal from the waiting list. Its limitation is: it didn’t use a standardized diagnostic interview. Also, children were administered/prescribed drugs, in addition to CBT.
Article 3: van der Sluis, C. M. (2016). Anxiety disorders in young children: Parent and child contributions to the maintenance, assessment and treatment. (Ph.D. Thesis, University of Amsterdam).
Permalink: https://hdl.handle.net/11245/1.541298
The objective of the study was to test if a treatment directed at young children is effective in the reduction of anxiety. The study investigated child-focused group CBT and whether it would affect parenting behaviors and anxiety. Anxiety-diagnosed children's parents were included in the study for ethical consideration, and for informing on children's progress. Twenty-two children with a mean age of 6.14 years made up the study sample. All mothers and eighteen fathers participated in the study. A pretest-posttest method was used for this pilot study. Data measures included children’s as well as parents' anxiety levels using Anxiety Disorders Interview Schedule – Parent version, Preschool Anxiety Scale - Revised, Picture Anxiety Test, Koala Fear Questionnaire, Goal Attainment Scale, Behavioral Inhibition Questionnaire, Social Competence and Behavior Evaluation – The Short Form, Adult Self-Report, and Child Development Questionnaire. The analysis was done through a comparison of waitlist, pretest, posttest, and follow-up. The study outcome suggests that age-adapted group CBT for children is feasible and highly effective in treating anxiety in children, and also seems to improve parenting.
Evidence-Based Practice
In all the above-reviewed studies, the intervention was modified CBT, and the test samples were all children diagnosed with SAD, aged 7 years and below; also, study subjects' parents were involved. Furthermore, in all the above studies, the study results suggest that CBT program as an intervention for treating SAD in kindergarten/preschool children is highly effective. They also show that the programs helped improve parenting. Based on these findings, it may be concluded that CBT is highly effective as a SAD treatment among preschool children diagnosed with anxiety disorder.
Hence, it is recommended that Chloe should undergo a CBT counseling program. For treating Chloe, an example of a counseling session would be one that is school-oriented, with the school counselor and Chloe's foster parents included in the sessions. In addition, it is suggested that the swimming guide and daycare professionals participate in the sessions.
Treatment Goals (CMHC, MCFC Only)
The initial treatment goal for Chloe is to help her recognize her anxious feelings and physical responses. This will help to calm her down and stop hurting herself by biting her nails. This is vital, as it indicates that Chloe is suffering from severe SAD. Preventing her from injuring herself is the primary goal.
Action Plan (SC Only)
The first action is to help Chloe recognize her anxious feelings and her physical response to it. A recommended strategy is creating a transition plan from home to school.
The second action plan is to help Chloe reframe her feelings. This will require helping her engage in positive physical thoughts.
The third action plan is to create a schedule that is appropriate for Chloe’s psychological level and includes adequate sleep breaks. This will help Chloe to better understand her anxious feelings, manage them, and, with time, be able to block them. Once progress is shown, the schedule can be adjusted to a normal, and even spontaneous, lifestyle.
References
Minde, K., Roy, J., Bezonsky, R., & Hashemi, A. (2010). The effectiveness of CBT in 3–7 year old anxious children: Preliminary data. Journal of the Canadian Academy of Child and Adolescent Psychiatry, 19(2), 109.
Ruocco, S., Gordon, J., & McLean, L. A. (2016). Effectiveness of a school-based early intervention CBT group programme for children with anxiety aged 5–7 years. Advances in School Mental Health Promotion, 9(1), 29-49.
Schneider, S., Blatter-Meunier, J., Herren, C., Adornetto, C., In-Albon, T., & Lavallee, K. (2011). Disorder-specific cognitive-behavioral therapy for separation anxiety disorder in young children: a randomized waiting-list-controlled trial. Psychotherapy and psychosomatics, 80(4), 206-215.
Van der Sluis, C. M. (2016). Anxiety disorders in young children: Parent and child contributions to the maintenance, assessment and treatment. (Ph.D. Thesis, University of Amsterdam).