Childhood Separation Anxiety Research Articles

The Effect of intravenous Ketamine Versus Thiopental in the Preoperative Holding Area on the Separation Anxiety and Emergence Agitation in Children

Background: Pre-anesthetic medication is often required in children to provide anxiolysis and to lessen the psychological impact of hospitalization and procedures. In this study, we compared the effects of intravenous ketamine versus thiopental on the separation anxiety and emergence agitation in children undergoing tonsillectomy/adenoidectomy. Methods: Eighty-two children aged 2-8 years scheduled for adenotonsillectomy were enrolled in this prospective double-blind, randomized study. The children were divided into two groups to receive either intravenous ketamine 1 mg/kg (Group K) or thiopental sodium 3 mg/kg (Group T) to facilitate separation from their parents in the preoperative holding area. Anesthesia was induced using 5 mg/kg thiopental sodium in group K and 2 mg/kg in group T, and was maintained using sevoflurane. The separation anxiety score, emergence agitation score, time from stopping the anesthetics to eye opening, extubation time, and postoperative nausea and vomiting were assessed. Results: There were no significant differences between groups K and T in the preoperative separation anxiety score, emergence agitation score and postoperative nausea and vomiting. However, time to eye opening from stopping the anesthetics and extubation time were significantly delayed in group K compared with group T. Conclusions: Intravenous ketamine or thiopental in the preoperative holding area are equally effective decreasing anxiety upon separation from parents and may not affect incidence of emergence agitation. The administration of thiopental used to induce anesthesia appears to be a better choice for preanesthetic medication with careful monitoring.

Elevated childhood separation anxiety: An early developmental expression of heightened concern for kin in homosexual men?

This study presents data bearing on an evolutionary developmental model of male homosexuality. This model hypothesizes that a predisposition toward elevated kin-directed altruism among homosexual males is expressed in childhood as elevated concern for close attachment figures (e.g., parents) and proximally influenced by the concomitant behavioral expression of femininity. We examined whether homosexual males recalled such elevated concern for parents during childhood and considered its association with recalled childhood gender behavior. Heterosexual and homosexual males and females (N=524) provided measures of recalled childhood gender behavior, concern about parental wellbeing, and other potential sources of separation anxiety. Heterosexual males experienced significantly less anxiety about parental wellbeing than all other groups. Recalled separation anxiety was positively correlated with childhood femininity for heterosexual females and homosexual males. The heterosexual sex and male sexual orientation differences in concern about parental wellbeing were accounted for by childhood feminine behavior. These findings are consistent with the proposed evolutionary developmental model. We discuss possible proximate influences that facilitate the development of this putative evolved predisposition toward elevated kin-directed altruism among homosexual males as well as limitations and future directions.

Evidence That the Periaqueductal Gray Matter Mediates the Facilitation of Panic-Like Reactions in Neonatally-Isolated Adult Rats

Plenty of evidence suggests that childhood separation anxiety (CSA) predisposes the subject to adult-onset panic disorder (PD). As well, panic is frequently comorbid with both anxiety and depression. The brain mechanisms whereby CSA predisposes to PD are but completely unknown in spite of the increasing evidence that panic attacks are mediated at midbrain's dorsal periaqueductal gray matter (DPAG). Accordingly, here we examined whether the neonatal social isolation (NSI), a model of CSA, facilitates panic-like behaviors produced by electrical stimulations of DPAG of rats as adults. Eventual changes in anxiety and depression were also assessed in the elevated plus-maze (EPM) and forced-swimming test (FST) respectively. Male pups were subjected to 3-h daily isolations from post-natal day 2 (PN2) until weaning (PN21) allotting half of litters in individual boxes inside a sound-attenuated chamber (NSI, n = 26) whilst siblings (sham-isolated rats, SHAM, n = 27) and dam were moved to another box in a separate room. Non-handled controls (CTRL, n = 18) remained undisturbed with dams until weaning. As adults, rats were implanted with electrodes into the DPAG (PN60) and subjected to sessions of intracranial stimulation (PN65), EPM (PN66) and FST (PN67-PN68). Groups were compared by Fisher's exact test (stimulation sites), likelihood ratio chi-square tests (stimulus-response threshold curves) and Bonferroni's post hoc t-tests (EPM and FST), for P<0.05. Notably, DPAG-evoked panic-like responses of immobility, exophthalmus, trotting, galloping and jumping were markedly facilitated in NSI rats relative to both SHAM and CTRL groups. Conversely, anxiety and depression scores either did not change or were even reduced in neonatally-handled groups relative to CTRL, respectively. Data are the first behavioral evidence in animals that early-life separation stress produces the selective facilitation of panic-like behaviors in adulthood. Most importantly, results implicate the DPAG not only in panic attacks but also in separation-anxious children's predispositions to the late development of PD.

Symptoms and Development of Anxiety in Children With or Without Intellectual Disability

The purpose of this study was to examine group differences in presentation and trajectory of anxiety symptoms and disorders in children with moderate to borderline intellectual disability (ID) and children with typical cognitive development (TD). Examined anxiety disorders and symptoms in children with ID (n=74) or TD (n=116) annually from ages 5 through 9 using a parent structured interview and questionnaire. Logistic regression was used to examine odds of meeting anxiety criteria and hierarchical linear modeling was used to examine anxiety trajectory. Children with ID had significantly higher rates of clinical levels of anxiety on the Child Behavior Checklist at ages 8 and 9 and higher rates of separation anxiety disorder at age 5 compared to those with TD. Children with ID were also more likely to have externalizing problems co-occurring with anxiety. The rate of increase of anxiety symptoms over time was positive and similar in the two groups, and neither group showed sex differences in anxiety rates. Results suggest that children with ID have both higher rates of anxiety across time and are delayed in showing typical decreases in separation anxiety in early childhood. Implications for intervention are discussed in terms of the importance of screening for and treating anxiety in children with ID.

Childhood Separation Anxiety and the Pathogenesis and Treatment of Adult Anxiety

Clinically significant separation anxiety disorder in childhood leads to adult panic disorder and other anxiety disorders. The prevailing pathophysiological model of anxiety disorders, which emphasizes extinction deficits of fear-conditioned responses, does not fully consider the role of separation anxiety. Pathological early childhood attachments have far-reaching consequences for the later adult ability to experience and internalize positive relationships in order to develop mental capacities for self-soothing, anxiety tolerance, affect modulation, and individuation. Initially identified in attachment research, the phenomenon of separation anxiety is supported by animal model, neuroimaging, and genetic studies. A role of oxytocin is postulated. Adults, inured to their anxiety, often do not identify separation anxiety as problematic, but those who develop anxiety and mood disorders respond more poorly to both pharmacological and psychotherapeutic interventions. This poorer response may reflect patients' difficulty in forming and maintaining attachments, including therapeutic relationships. Psychotherapies that focus on relationships and separation anxiety may benefit patients with separation anxiety by using the dyadic therapist-patient relationship to recapture and better understand important elements of earlier pathological parent-child relationships.

Determinants of the development of post-traumatic stress disorder, in the general population

To assess (1) the lifetime prevalence of exposure both to trauma and post-traumatic stress disorder (PTSD); (2) the risk of PTSD by type of trauma; and (3) the determinants of the development of PTSD in the community. The Diagnostic Interview for Genetic Studies was administered to a random sample of an urban area (N = 3,691). (1) The lifetime prevalence estimates of exposure to trauma and PTSD were 21.0 and 5.0%; respectively, with a twice as high prevalence of PTSD in women compared to men despite a similar likelihood of exposure in the two sexes; (2) Sexual abuse was the trauma involving the highest risk of PTSD; (3) The risk of PTSD was most strongly associated with sexual abuse followed by preexisting bipolar disorder, alcohol dependence, antisocial personality, childhood separation anxiety disorder, being victim of crime, witnessing violence, Neuroticism and Problem-focused coping strategies. After adjustment for these characteristics, female sex was no longer found to be significantly associated with the risk of PTSD. The risk for the development of PTSD after exposure to traumatic events is associated with several factors including the type of exposure, preexisting psychopathology, personality features and coping strategies which independently contribute to the vulnerability to PTSD.

Child anxiety and parenting in England and Italy: the moderating role of maternal warmth

Parenting factors have been implicated in the aetiology and maintenance of child anxiety. Most research has been correlational with little experimental or longitudinal work. Cross-cultural comparison could be illuminating. A comparison of Italian and British children and their mothers was conducted. A sample of 8- to 10-year old children, 60 Italian and 49 English, completed the Spence Child Anxiety Scale. Mothers also completed two questionnaires of parenting: the Skills of Daily Living Checklist (assessing maternal autonomy granting) and the Parent-Child Interaction Questionnaire (assessing maternal intrusiveness). Parenting was assessed in two video-recorded blindly rated mother-child interaction tasks, the 'belt-buckling tasks and the 'etch-a-sketch', providing objective indices of overcontrol, warmth, lack of autonomy granting, and overprotection. There were no differences between the children in overall anxiety and specific forms of anxiety. Parenting, however, was markedly different for the two countries. Compared to English mothers, on the two questionnaires, Italian mothers were significantly less autonomy granting and more intrusive; and in terms of the observed indices, a significantly greater proportion of the Italian mothers displayed a high level of both overprotection and overcontrol, and a low level of autonomy granting. Notably, Italian mothers evidenced significantly more warmth than English mothers; and maternal warmth was found to moderate the impact of self-reported maternal intrusiveness on the level of both overall child anxiety and the level of child separation anxiety; and it also moderated the relationship between both observed maternal intrusiveness and overall child anxiety and observed maternal overprotectiveness and child separation anxiety. Although, compared to the British mothers, the Italian mothers were more likely to evidence high levels of parenting behaviours previously found to be anxiogenic, the high levels of warmth displayed by these mothers to their children appears to have neutralised the adverse impact of these behaviours.

The Separation Anxiety Hypothesis of Panic Disorder Revisited: A Meta-Analysis

Evidence suggests that childhood separation anxiety disorder may be associated with a heightened risk for the development of other disorders in adulthood. The authors conducted a meta-analysis to examine the relationship between childhood separation anxiety disorder and future psychopathology. PubMed, PsycINFO, and Embase were searched for studies published through December 2011. Case-control, prospective, and retrospective cohort studies comparing children with and without separation anxiety disorder with regard to future panic disorder, major depressive disorder, any anxiety disorder, and substance use disorders were included in the analysis. Effects were summarized as pooled odds ratios in a random-effects model. Twenty-five studies met all inclusion criteria (14,855 participants). A meta-analysis of 20 studies indicated that children with separation anxiety disorder were more likely to develop panic disorder later on (odds ratio=3.45; 95% CI=2.37-5.03). Five studies suggested that a childhood diagnosis of separation anxiety disorder increases the risk of future anxiety (odds ratio=2.19; 95% CI=1.40-3.42). After adjusting for publication bias, the results of 14 studies indicated that childhood separation anxiety disorder does not increase the risk of future depression (odds ratio=1.06; 95% CI=0.78-1.45). Five studies indicated that childhood separation anxiety disorder does not increase the risk of substance use disorders (odds ratio=1.27; 95% CI=0.80-2.03). Of the subgroup analyses performed, differences in comparison groups and sample type significantly affected odds ratio sizes. A childhood diagnosis of separation anxiety disorder significantly increases the risk of panic disorder and any anxiety disorder. These results support a developmental psychopathology conceptualization of anxiety disorders.

Patterns of Family Identification and Self-Congruence in Childhood Separation Anxiety Disorder

Background: Patterns of identification among family members may differ in families with children with separation anxiety disorder (SAD) as compared with healthy children. However, this has not been explored to date. Method: The present study examines identification processes in 199 families: 100 families of children with SAD, 43 families of children with other anxiety disorders, and 56 families of nondisordered children, using the Family Identification Test. Results: Children with SAD and their parents generally identify significantly less with each other and report less desire to be similar to each other than nondisordered children and their parents. Further, children with SAD are less self-congruent than healthy children. There were no significant differences between children with SAD and with other anxiety disorders. Conclusions: Identification and self-congruence distinguish families of children with SAD from families of healthy children. Future studies should aim to determine the direction of effects over time, as well as to determine the contribution of identification and coherence in explaining SAD after accounting for other factors such as attachment and self-esteem.

Maternal Anxiety, Overprotection and Anxious Personality as Risk Factors for Eating Disorder: A Sister Pair Study

Using a sister-pair design, we aimed to investigate the role of maternal anxiety in pregnancy and parental overprotection as risk factors for anorexia nervosa (AN) and bulimia nervosa (BN). We were also interested in investigating anxious personality traits in patients with AN and BN compared to their healthy sisters, and their possible association to overprotection. One-hundred-and-fifty-seven females (AN = 94; BN = 63) and their healthy sisters from four European centres were recruited. Data on temperament and childhood characteristics were obtained from cases and their sisters using the Temperament and Character Interview Revised (TCI-R) and the Oxford Risk Factor Interview (ORFI); maternal anxiety and overprotection were obtained from retrospective parental report. Both AN and BN women displayed significantly higher levels of separation anxiety in childhood in comparison to their sisters, but only women with AN showed anxious temperamental traits. Mothers of women with AN reported higher levels of anxiety during the index pregnancy (p < .01), compared to when pregnant with the healthy daughter. The age in months at which women with AN were first left with another adult for a night was also higher compared to their sisters (respectively medians: 12 (range 1–120), 9 (range 1–96), p < .05). This was not the case for women with BN. Maternal overprotection was not associated with index daughter temperament. This finding is suggestive of an association between AN and maternal stress and anxiety in utero and later overprotective care, whilst BN was not associated with maternal anxiety or overprotection.

2768 – Preliminary investigation of separation anxiety and gambling behaviour: age of onset and correlations of severity

Introduction Pathological Gambling (PG) includes extremely different types of game and many gamblers suffer from anxiety disorders. According to the self-medication hypothesis, Gambling Behaviour may be a strategy to tolerate suffering and compensate uneasiness; otherwise social problems related to gambling may lead to anxiety disorders, possibly unmasking an adult form of Separation Anxiety Disorder (SAD). Aims To investigate possible relationships between PG and SAD, considering the different games, the age of onset, the symptom severity, and the distinction between Adult and Child SAD. Methods 32 gamblers attending an outpatient psychiatric clinic completed the following tests: SOGS and ASI to investigate the kind of gambling, the age of onset and the social conditions of gamblers; SCI-SAS, SASI, ASA-27 to evaluate the Separation Anxiety in childhood and adulthood; HAM-A; GAF. Results There are statistically significant correlations between later age of onset of PG and development of SAD in adults. Higher scores in GAF are related to lower scores in Separation Anxiety scales and HAM-A. There is a strong inter-correlation among the Separation Anxiety scales. Higher scores in HAM-A correlate with higher scores in SASI and ASA-27. Male gamblers have an earlier onset and increasing with the age of onset increases the addiction to “dissociative” games instead of “active” ones. Conclusions Our preliminary data do not support self-medication hypothesis; possibly, a later-onset gambling is related to a more neurotic and less impulsive psychopathological pattern.

Maternal depression and treatment gains following a cognitive behavioral intervention for posttraumatic stress in preschool children

The evidence base for cognitive behavioral therapy (CBT) to treat child emotional and behavioral symptoms following exposure to trauma in youth is compelling, but relatively few studies are available on preschool children and on moderators of treatment outcomes. This paper examines maternal and child characteristics as moderators of posttraumatic stress (PTS) treatment outcomes in preschool children. Outcome data from a previously published randomized trial in three to six year old preschool children with diagnostic interview data from participating mothers were used. Hypotheses were tested via hierarchical linear modeling. Maternal depression was associated with higher initial child posttraumatic stress disorder (PTSD) symptoms, and was associated with increasing PTSD symptom trends at follow up suggesting potential child PTSD symptom relapse. Maternal PTSD symptoms similarly predicted differential child separation anxiety symptom change but not child PTSD symptom change. Targeting dyads with child PTSD symptoms and maternal depression or PTSD symptoms with enhanced interventions may be a useful strategy to improve treatment maintenance.

The Effect of Group Play Therapy on Reduction of Separation Anxiety Disorder in Primitive School Children

It is normal to be anxious in certain circumstances but the Anxiety disorders are when children are anxious when there is no reason to be fearful. The occurrence of childhood separation anxiety disorder puts the individual at increased risk of developing some other kind of psychological problem in adulthood. Play therapy is a good way to engage children in the therapeutic process. It provides a multiple intelligences perspective and may meet the specific needs of children more effectively than the traditional ‘talking’ therapies. The purpose of this research was to determine the effect of group play therapy on separation anxiety disorder in 7-9 years old children in Tehran. Sampling was purposeful in which 20 children, who were diagnosed as separation anxiety disorder, were selected, and randomly divided into two experimental and control groups (10 subjects each). Experimental group received 9 sessions of group play therapy once a week Tools were: 1) The Raven's Colored Progressive Matrices Test. A test of non-verbal intelligence for young children with36 matrix designs. 2) The Spence Children's Anxiety Scale (SCAS) with 44 questions and 6 subscale variance &covariance analysis were used for data analysis. The results of covariance analysis showed the significant effect of group play therapy on reduction of separation anxiety disorder in children in post test and follow up stage. (p<0.05).

Parental anxious expectations and child anxiety predicting homesickness during overnight summer camp

Although mild homesickness during summer camp is common, 10 to 20% of children report moderate to severe homesickness that can interfere with their functioning during camp. Previous research has considered many risk and protective factors for homesickness, including prior camp experience and coping strategies. Few studies have examined the role of parent or child anxiety. Both are associated with child adjustment difficulties in school and clinic settings, but have rarely been examined in the camp setting. This exploratory study examined parents' worries about sending their children to camp, and children's anxiety symptoms in predicting homesickness during overnight summer camp. Participants included 275 children and adolescents (7 to 14 years, 131 male and 144 female). At the beginning of camp, parents/guardians reported their anxious expectations, and children completed several items from the Screen for Child Anxiety and Related Emotional Disorders (SCARED). Near the end of camp, children reported the amount of homesickness they experienced using items from the Rate Your Day-Revised checklist. The regression model accounted for 36% of the variance in homesickness, with younger child age, less prior camp experience, higher parental anxious expectations, and greater child separation anxiety uniquely predicting homesickness. Implications for including strategies for parents in homesickness prevention programs are discussed.

Beliefs regarding child anxiety and parenting competence in parents of children with separation anxiety disorder

Background and objectivesDespite the fact that numerous developmental models have highlighted the role of parental cognitive processes in connection with anxiety disorders in children and adolescents, the role of parents' beliefs about their children and parenting remains largely unexplored. This study investigated the specific association between parental beliefs and child separation anxiety. MethodParents of children with a diagnosis of Separation Anxiety Disorder (SAD) reported on beliefs and expectations related to their child's fears and own parenting competence. To study the potential specificity of relationships, a clinical control group of mothers of children with social phobia (SoP) and a group of mothers of children without a mental disorder (healthy controls, HC) were included. ResultsResults indicated that parents of anxious children had significantly higher levels of dysfunctional beliefs than the parents in the HC group. Mothers of children with SAD showed lower levels of parenting self-efficacy than mothers of children with SoP. They also demonstrated lower parenting self-efficacy and satisfaction compared to mothers of healthy children. Parental dysfunctional beliefs about child anxiety and paternal parenting self-efficacy were significantly positively associated with child anxiety. The effects remained significant after controlling for parental anxiety and depression. LimitationsDue to the cross-sectional design of the study, causality of the found effects cannot be inferred. DiscussionData suggest that children's anxiety and parents' beliefs about their child's anxiety, coping skills and parenting are strongly associated. Further research is needed to investigate whether addressing parental cognitions in addition to parents' anxiety may improve prevention and intervention of child anxiety.

Separation Anxiety in Children as the Most Common Disorder Co-Occurring with School Refusal

Anxiety disorders form a part of the most common health disorders existing at the evolutional age. School refusal could be defined as a difficulty in attending school associated with emotional distress, especially anxiety and depression. Separation anxiety can be a meaningful factor of school attendance reluctance. Children suffering from separation anxiety usually experience unrealistic fear of being separated from their meaningful persons. The squeals of childhood anxiety disorders include social, family, and academic impairments. Anxiety separation disorders disrupt the normal psychosocial development of a child.

Childhood separation anxiety disorder and adult onset panic attacks share a common genetic diathesis.

Childhood separation anxiety disorder (SAD) is hypothesized to share etiologic roots with panic disorder. The aim of this study was to estimate the genetic and environmental sources of covariance between childhood SAD and adult onset panic attacks (AOPA), with the primary goal to determine whether these two phenotypes share a common genetic diathesis. Participants included parents and their monozygotic or dizygotic twins (n = 1,437 twin pairs) participating in the Virginia Twin Study of Adolescent Behavioral Development and those twins who later completed the Young Adult Follow-Up (YAFU). The Child and Adolescent Psychiatric Assessment was completed at three waves during childhood/adolescence followed by the Structured Clinical Interview for DSM-III-R at the YAFU. Two separate, bivariate Cholesky models were fit to childhood diagnoses of SAD and overanxious disorder (OAD), respectively, and their relation with AOPA; a trivariate Cholesky model also examined the collective influence of childhood SAD and OAD on AOPA. In the best-fitting bivariate model, the covariation between SAD and AOPA was accounted for by genetic and unique environmental factors only, with the genetic factor associated with childhood SAD explaining significant variance in AOPA. Environmental risk factors were not significantly shared between SAD and AOPA. By contrast, the genetic factor associated with childhood OAD did not contribute significantly to AOPA. Results of the trivariate Cholesky reaffirmed outcomes of bivariate models. These data indicate that childhood SAD and AOPA share a common genetic diathesis that is not observed for childhood OAD, strongly supporting the hypothesis of a specific genetic etiologic link between the two phenotypes.

Separation Anxiety in Children as the Most Common Disorder Co-Occurring with School Refusal

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The effect of ketamine on the separation anxiety and emergence agitation in children undergoing brief ophthalmic surgery under desflurane general anesthesia

BackgroundEmergence agitation (EA) frequently occurs after desflurane anesthesia in children. Ketamine, because of its sedative and analgesic properties, might be useful for the management of separation anxiety and EA. We investigated the preventive effect of ketamine on separation anxiety and EA after desflurane anesthesia in children for brief ophthalmic surgery.MethodsSixty children, ranging in age from 2-8 years old, undergoing brief ophthalmic surgery were randomly allocated to one of the 3 groups: group C received normal saline, group K1.0 received ketamine 1.0 mg/kg intravenously before entering the operating room, or group K0.5 received ketamine 0.5 mg/kg 10 min before the end of the surgery. Before induction, the separation anxiety score was evaluated. Extubation time, post-anesthesia care unit stay time, postoperative nausea and vomiting, emergence agitation, and pain were assessed.ResultsThe group K1.0 had a lower separation anxiety score compared with groups K0.5 and C. Extubation time in group K0.5 was significantly prolonged compared with groups K1.0 and C. The incidence of EA and the modified Children's Hospital of Eastern Ontario Pain Scale were significantly lower in group K1.0 and group K0.5 compared to group C, but there was no significant difference between groups K1.0 and K0.5.ConclusionsIn children undergoing brief ophthalmic surgery with desflurane anesthesia, ketamine 1.0 mg/kg administered before entering the operating room reduced separation anxiety, postoperative pain, and incidence of EA without delay in recovery.

P-120 - Adult separation anxiety disorder: clinical characteristics and attachment styles

Although separation anxiety disorder is recognized as a diagnostic category in the DSM-IV-TR only for childhood, an adult form of the disorder with a lifetime prevalence of 6.6% has also been described. In the present study we investigated, in a group of stabilized outpatients, the frequency of adult separation anxiety disorder (ASAD) as well as its clinical correlates and attachment styles. Patients with and without ASAD were compared on several clinical indices as well as on attachment styles. The associations of separation anxiety with psychopathology and attachment were investigated by means of multiple regression analysis. Thirty-six patients out of 53 were categorized as having ASAD. Three of them had no other axis I psychiatric disorder. Fourteen ASAD patients had an history of childhood separation anxiety disorder (CSAD). As compared with those without ASAD, patients with ASAD showed: higher frequency of alexithymia and higher scores on the “difficulty identifying feelings”; worse social functioning; greater behavioral inhibition during childhood; worse reaction to loss events; higher scores on insecure attachment styles. Independent predictors of the intensity of ASAD symptoms were an “anxious-ambivalent” attachment style, lifetime symptoms of panic disorder, difficulties in identifying feelings and behavioral inhibition during childhood. Our findings suggest that ASAD can both represent the evolution of a CSAD or be a primary condition in adulthood. The presence of ASAD in patients with mood or anxiety disorders is associated to insecure attachment styles, alexithymia, and impairment of social functioning.