Separation Anxiety Disorder

Abstract

Separation anxiety disorder (SAD) is the only anxiety disorder that is specific to childhood; however, SAD has hardly ever been addressed as a separate disorder in clinical trials investigating outcome. So far, only parent training has been developed specifically for SAD. This particular training is well described but has only been evaluated in a multiple baseline design including six families, and therefore qualifies for a efficacious treatment; however, many large randomized controlled trials and systematic reviews have been conducted on heterogeneous samples, including children with any primary anxiety disorder. In 25 RCTs, a total of 1,855 anxious children have been studied, including 462 children (25%) with SAD as their primary diagnosis, with no study specifically consisting only of SAD children. The same cognitive behavior therapy (CBT) program was applied in all children. The conclusion with regard to effectiveness of these programs is that individual CBT fulfills the criteria for a treatment since it is supported by several good group-design experiments, by at least two independent research groups, and was found statistically significant superior over a placebo treatment. The other CBT-based interventions, including CBT with family involvement, group CBT, and family-based group CBT can be rated as efficacious, since their efficacy was supported by at least two studies by independent research teams. There is still insufficient evidence for the effectiveness of other psychological treatments, with some qualifying for possibly efficacious, such as parent bibliotherapy, Internet-based treatment, parent or parent-teacher training for school refusal, as well as CBT-based parent training for young children. If we assume that there is no reason to assume that the treatments were less effective for SAD than for the total sample, the conclusion that CBT is a well-established is probably equally true for children with SAD.