Separation Anxiety Disorder Symptoms Research Articles

Psychological strains after the crisis: evaluating separation anxiety among Iranian children and adolescents in the post-COVID-19 era

ObjectivesThe objective of this study was to specifically investigate Separation Anxiety Disorder (SAD), as one of the noteworthy disorders within the spectrum of anxiety disorders, among children and adolescents, after overcoming the crises caused by the Coronavirus Disease 2019 (COVID-19) pandemic. Efforts were also made to identify socio-demographic factors that could be associated with changes in SAD level and also to assess the effect of different constituting dimensions of SAD on the severity of this disorder.MethodsIn this cross-sectional study, face-to-face interviews were conducted with the parents of 317 (7-13-year-old) Iranian students, who were selected through a multi-stage random sampling method in the city of Shiraz. During the interviews, socio-demographic data were collected, and subsequently, SAD symptoms and dimensions were assessed using the Separation Anxiety Assessment Scale (Parent Version) (SAAS-P) questionnaire. Later, employing the Partition Around Medoids (PAM) statistical method, the participants were categorized into two groups with low and high levels of SAD. Also, to understand the interaction between the different dimensions of SAD, the network analysis method was employed. Finally, univariate analysis and logistic regression were utilized, with a significance level of 0.05, to determine potential associating factors with the level of SAD.ResultsThe sample included 128 girls and 189 boys with a mean age of 9.63 ± 2.63 and 9.63 ± 1.95 years respectively. Based on the PAM method, 51.1% of the participants presented a high level of SAD. According to network analysis, it was demonstrated that the “fear of abandonment” dimension plays a central role in high levels of SAD. Based on logistic regression, female gender, age ≥ 10 years, parents’ unacademic educational background, mother’s employment, and child’s history of physical/mental problems were significantly associated with the high level of SAD.ConclusionsA considerable number of the participants in this study presented a high level of SAD with the “fear of abandonment” being a key influential dimension of elevated levels of this disorder. Maternal employment, female gender, child’s history of health issues, and low parental education were identified as important contributors to the high SAD level. Considering these factors allows for more effective diagnostic and therapeutic interventions. However, the need for further studies remains crucial.

Two universal school-based prevention programs for depression and anxiety: 24-Month follow-up of an RCT

Background and objectivesTransdiagnostic approaches have been promoted as a means of maximising preventative effects across multiple problems with depression and anxiety suitable targets as they appear to have highly interconnected systems in pathology development and maintenance. This study investigated long-term effects of two universal school-based programs, Emotion Regulation (ER) and Behavioral Activation (BA), that sought to prevent depression and anxiety by targeting worry (a transdiagnostic feature) to promote resilience. MethodsThis follow-up study captured data from 162 of 316 initial students (aged 8–13; 52.2% female), from six Australian schools. The original study design cluster randomised students by school into BA, ER, or a usual class control. Intervention conditions consisted of 8 × 50-min weekly sessions. This study measured the effects of these interventions after 24 months on resilience, worry, depression, and anxiety. Resilience was also examined as a potential mediator. ResultsAt 24-month follow-up, there was no significant effect of either intervention on depression, anxiety, worry, or resilience levels. Significantly fewer participants in ER and BA met clinical thresholds for separation anxiety disorder (SAD) and obsessive-compulsive disorder (OCD) in the 24-month follow-up compared with baseline. No mediation effects were found. LimitationsAlthough self-report measures are common in universal, school-based research, this represents a study limitation. ConclusionsBoth interventions may provide limited long-term protective effects on SAD and OCD symptoms, which appear to have a shelf-life shorter than 24 months. To maintain program effects, refresher sessions at shorter intervals may be a consideration for future research.

Measurement and Construct-Level Invariance of the Revised Child Anxiety and Depression Scale (RCADS)

Abstract: Measurement and construct-level invariance of the Dutch Revised Child Anxiety and Depression Scale’s test scores (RCADS) across gender and ethnic (minority) backgrounds of the four largest ethnic groups of children living in the Netherlands (i.e., native Dutch; Moroccan; Turkish; or Surinamese/Antillean) was evaluated. Symptoms of generalized anxiety disorder, social phobia, separation anxiety disorder, panic disorder, obsessive-compulsive disorder, and major depressive disorder were rated by 2,679 mainstream elementary schoolchildren ( Mage = 10.61). Results from discrete multiple-group confirmatory factor analyses showed that factor means were generally insensitive to gender bias. However, moderate violations of measurement invariance between native Dutch and the three ethnic minority groups were found for social phobia, panic disorder, and separation anxiety disorder symptoms. Girls had higher mean levels on all RCADS subscales compared to boys. Furthermore, with a few exceptions, children from ethnic minority groups reported higher levels of symptoms of panic disorder, generalized anxiety disorder, and obsessive-compulsive disorder compared to native Dutch children. Scores derived from the RCADS are largely comparable between elementary school boys and girls, but for three out of six subscales, caution is warranted when comparing mean level differences of native Dutch children with children of Turkish, Moroccan, and Surinamese/Antillean ethnic backgrounds.

Effectiveness of Group Therapy of Psychodrama on Reduce the Symptoms of Separation Anxiety Disorder in Children Aged 5 to 9 Years in Zahedan

Effectiveness of Group Therapy of Psychodrama on Reduce the Symptoms of Separation Anxiety Disorder in Children Aged 5 to 9 Years in Zahedan

The Impact of Separation Anxiety Disorientation on Children's Social Interaction

Anxiety is a form of the body's response to the environment as a form of pressure and one's inner turmoil. This anxiety can be overcome easily, but in some cases anxiety often occurs excessively, especially in babies who are about to start a long phase of separation from their parents. This journal aims to find out how the social interaction of children with symptoms of separation anxiety disorder. The method in this research is a literature study, namely analyzing journals, books and articles that discuss separation anxiety disorder in children. This neglected anxiety disorder can have an impact on how the child begins to interact in a new environment later. It takes understanding and sensitivity of parents to the child's condition.

The Effectiveness of Attachment-based Psycho-Educational Interventions on Reducing the Symptoms of Separation Anxiety Disorder in Preschool Children in Tehran

The Effectiveness of Attachment-based Psycho-Educational Interventions on Reducing the Symptoms of Separation Anxiety Disorder in Preschool Children in Tehran

The Effect of Parent-Child Interaction Therapy on Separation Anxiety in 3-6-Year-old Children of Nurses

Background: Separation anxiety disorder is considered as the most common anxiety disorder in childhood. Failure to treat this disorder in early age can be converted into a risk factor for childhood and adolescent psychiatric disorders. Objectives: This study aimed at investigating the effect of parent-child interaction therapy on reducing the symptoms of separation anxiety disorder among the nurses' children aged between 3 and 6 years old working in educational hospitals in Qazvin. Methods: The intervention was designed as pre- and post-test along with the control group. The sample included 67 children aged 3 - 6 years' old who were divided into intervention and control groups using the blocking method. The intervention consists of three steps: child directed interaction, bravery directed interaction and parent directed interaction which was performed for 8 sessions per weak. No intervention was performed for the control group. The obtained data were collected using the Spence questionnaire (parents' version) and the results were evaluated. Results: Intervention therapy significantly reduced the symptoms of separation anxiety in the intervention group at the post-test stage compared to the control group. The mean of separation anxiety decreased from 10.82 ± 0.62 to 7.69 ± 0.52 in the intervention group. Conclusions: Parent-child interaction therapy can be used as an effective treatment plan to reduce the symptoms of separation anxiety disorder among preschool children.

Anxiety Sensitivity and Intolerance of Uncertainty as Factors Related to Adult Separation Anxiety Disorder Symptoms

Anxiety Sensitivity and Intolerance of Uncertainty as Factors Related to Adult Separation Anxiety Disorder Symptoms

Effect of Time Perspective Therapy on Dark Tetrad Personality Traits of Mothers and Separation Anxiety Disorder of Their Preschool Children

Objectives: This study aimed to investigate the effect of Time Perspective Therapy (TPT) on dark tetrad personality traits of mothers and Separation Anxiety Disorder (SAD) of their preschool children. Methods: This is quasi-experimental clinical trial with pre-test, post-test, follow-up design. Participants were the mothers of 32 preschool children with SAD in Kazerun County, Iran in winter 2019 who were selected using a convenience sampling method and randomly assigned into intervention (n=16) and control (n=16) groups. Mothers in the intervention group received TPT at six 90-min sessions, once per week. The data were collected using the Dark Triad Dirty Dozen inventory, Short Sadistic Impulse Scale, and Children Symptom Inventory. The collected data were analyzed using repeated measures ANOVA in SPSS v. 22 software. Results: The TPT led to a significant decrease in SAD symptoms and narcissism (P≤0.05) at the post-test and follow-up phases, but had no any significant effect on other dark tetrad personality traits of mothers (P≥0.05). Conclusion: The TPT of mothers decreases their narcissism and the SAD symptoms of their children.

Pediatric anxiety associated with altered facial emotion recognition

Multiple psychiatric disorders are associated with difficulties in facial emotion recognition. However, generalized anxiety disorder may be associated with more accurate recognition of others’ emotional expressions, particularly expressions of happiness and fear, which index safety and threat. Children aged 9–14 from a community sample (N = 601) completed a facial emotion labeling task. Children’s symptoms of depressive and anxiety syndromes were assessed by self- and parent-report. Elevated symptoms of generalized anxiety disorder were associated with more accurate facial emotion recognition (β = 0.16, p = 0.007), specifically recognition of happiness (β = 0.17, p = 0.002) and fear (β = 0.15, p = 0.006). Elevated depressive symptoms were associated with less accurate facial emotion recognition (β = −0.12, p = 0.018), specifically happiness (β = −0.15, p = 0.002). Elevated symptoms of separation anxiety disorder were also associated with less accurate facial emotion recognition (β = −0.16, p = 0.003), specifically happiness (β = −0.15, p = 0.006) and fear (β = −0.15, p = 0.005), which highlights the importance of distinguishing between anxiety syndromes. Results held when adjusting for child age and sex. Evidence that symptoms of generalized anxiety disorder are associated with more accurate recognition of happiness and fear is consistent with theories of heightened social vigilance and support a transdiagnostic role of facial emotion recognition that may inform the psychosocial development of youth with anxiety and depressive symptoms.

Separation Anxiety Disorder in Panic Disorder Patients with and without Comorbid Agoraphobia

Objective: Previous studies have focused on the relationship between childhood separation anxiety disorder (SAD) and adult panic disorder (PD)-agoraphobia. It is not clear enough whether SAD, which continues into adulthood, is associated with PD with and without comorbid agoraphobia in adult patients. Our primary hypothesis was that PD patients with comorbid agoraphobia had a higher rate of SAD that continues into adulthood than those without agoraphobia. We also hypothesized that adulthood SAD symptoms were more likely to be associated with PD-agoraphobia than PD without agoraphobia. Method: 151 patients who were diagnosed with PD with (n = 106), and without comorbid agoraphobia (n = 45) were compared using Panic and Agoraphobia Scale, Structured Clinical Interview for Separation Anxiety Symptoms, Separation Anxiety Symptom Inventory, Adult Separation Anxiety Questionnaire, and State-Trait Anxiety Inventory. We performed Student’s t-test, Pearson correlation test, and multiple linear regression analysis in this study. Results: PD patients with comorbid agoraphobia were more likely to have SAD both in childhood and adulthood (p = .028), than those without agoraphobia. There were mild to moderate significant correlations between PD severity and state anxiety (p = .002), trait anxiety (p = .006), and SAD in childhood (p = .049), and in adulthood (p = .001). SAD in adulthood (β = 0.278, Exp(B) = 0.136, p = .003), and state anxiety (β = 0.236, Exp(B) = 0.164, p = .012) significantly predicted the severity of PD in patients with comorbid agoraphobia. Conclusion: SAD that continues in adulthood may be related to the severity of PD in patients with agoraphobia. Our findings might provide some evidence of the role of SAD in adulthood in patients with adult-onset PD-agoraphobia.

Separation Anxiety Symptom Profiles and Parental Accommodation Across Pediatric Anxiety Disorders.

Parental accommodation refers to ways in which caregivers modify their behavior to decrease child distress in the short-term. Accommodation is prevalent among anxious youth and related to decreased treatment and functional outcomes. Although separation anxiety disorder (SAD) is associated with increased accommodation, SAD is not a predictor of treatment response, suggesting that a diagnosis of SAD alone may not be enough to clarify the relationship between accommodation and separation anxiety symptoms within a clinical context. Participants were youth with a primary anxiety disorder (N = 186; aged 7-17) enrolled in an outpatient anxiety clinic. Latent class analysis was used to extract profiles from parent-reported SAD symptoms using the Anxiety Disorders Interview Schedule for DSM-IV/5. Profiles were compared on pre-treatment accommodation. Low, moderate, and interfering SAD classes emerged. Interfering SAD was associated with high accommodation. Results help to clarify the association between SAD and accommodation and has implications for personalized intervention.

Examining the Hierarchical Influences of the Big-Five Dimensions and Anxiety Sensitivity on Anxiety Symptoms in Children.

Anxiety sensitivity (AS), namely the fear of anxiety symptoms, has been described as a precursor of sub-threshold anxiety levels. Sexton et al. (2003) posited that increased AS would arise from an elevated neuroticism and that both would act as vulnerability factors for panic disorder (PD), obsessive-compulsive disorder (OCD), and generalized anxiety disorder (GAD) symptoms. Accordingly, this study aimed to (1) evaluate the applicability of this model to a pediatric population and (2) examine the influences of the other Big-Five personality dimensions on the four lower-order dimensions of AS (cognitive, physical, control, and physical) and on social phobia (SP), separation anxiety disorder (SAD) and depression symptoms. 200 children (104 girls) aged between 8 and 12 years old (mean age = 132.52 months, SD = 14.5) completed the Childhood Anxiety Sensitivity Index (Silverman et al., 1991), the Big Five Questionnaire for Children (Barbaranelli et al., 2003), and the Revised’s Children Anxiety and Depression Scale (Chorpita et al., 2000). Regression analyses confirmed that AS and neuroticism together significantly predicted the presence of PD, OCD, and GAD symptoms but also SP, SAD, and depression symptoms. Moreover, neuroticism interacted with extraversion, conscientiousness and agreeableness to significantly predict SP, GAD, and depression. Surprisingly, the global AS score was only predicted by agreeableness, while AS dimensions also specifically related to openness. Finally, AS dimensions did not predict the presence of specific anxiety symptoms. To conclude, the predicting model of anxiety symptoms in children sets neuroticism and AS on the same level, with an unexpected influence of agreeableness on AS, raising the importance of other trait-like factors in the definition of such models. Moreover, AS should be considered as a unitary construct when predicting the presence of anxiety symptoms in children. Future interventions must consider these associations to help children detect and recognize the symptoms of their anxiety and help them to interpret them correctly.

Posttraumatic Stress Disorder and Psychiatric Comorbidity among Adolescent Earthquake Survivors: a Longitudinal Cohort Study.

Although posttraumatic stress disorder (PTSD) is highly comorbid with psychiatric disorders, little longitudinal research has been conducted to determine the potentially causal links. This study aimed to investigate the prevalence and comorbidity patterns of posttraumatic stress disorder symptoms and psychiatric symptoms among adolescents exposed to the 2008 Wenchuan earthquake in China and to examine the bidirectional prospective associations between PTSD symptoms and other psychiatric symptoms. A sample of 1573 adolescent survivors (45.8% male; mean age at initial survey was 15.0years, SD = 1.3) completed a battery of standardized measures assessing symptoms of PTSD, depression, panic disorder, generalized anxiety disorder (GAD), separation anxiety disorder (SAD), social phobia, conduct disorder, and attention deficit hyperactivity disorder at 6 and 18months post-earthquake. Among participants with PTSD symptoms, 91.9 and 94.0% had at least one comorbid psychiatric disorder at 6 and 18months post-earthquake, respectively; however, among those without PTSD symptoms, 54.3 and 50.4% had at least one psychiatric disorder. PTSD symptoms were more likely to co-occur with subtypes of anxiety or depression symptoms than with behavior problems. Participants who were screened as having PTSD comorbid with depression or SAD at 6months were less likely to recover from PTSD over time. Longitudinal analyses showed that symptoms of depression, GAD and SAD predicted increases in PTSD symptoms. In turn, PTSD symptoms predicted increases in GAD and panic disorder symptoms. Overall, our results support causal hypotheses of PTSD comorbidity. Specific multi-modal assessments and treatments targeting to both PTSD and its comorbidity disorders are warranted.

Is surgery a risk factor for separation anxiety in children?

Postoperative anxiety symptoms are distressing for both family and child. The aim of this study was to examine the prevalence of postoperative anxiety symptoms in children. 60 children aged 6-12 undergoing surgery were included in the study group. The study group was assessed three times in terms of separation anxiety disorder (SAD), at the time of presentation, 1 and 3months postoperatively. A personal information form and the SAD section of the K-SADS-PL on the basis of DSM-IV diagnostic criteria for screening SAD symptoms were used. Study group consisted of 19 girls (31.7%) and 41 boys (68.3%) (mean age 8.9 ± 2.3). Four (6.6%) of the cases at the time of presentation and 13 (21.6%) in the study group met SAD diagnostic criteria in 1month and 21 (35.0%) in 3months. Anxiety disorder symptoms were significantly higher in the study group at 3months postoperatively (p < 0.05). There is significant correlation between both SAD symptoms and duration of hospitalization. There was also a positive correlation between duration of hospitalization and parental education and SAD symptoms. Greater SAD was observed in children undergoing surgical procedures. It will be useful to physicians to consider SAD after surgery in pediatric patients especially when the level of parental education and duration of hospitalization increase. Since SAD may persist long after surgery, it may cause constant fear in personality disorders and lead to psychological problems by significantly lowering quality of life.

Interaction between the Opioid Receptor OPRM1 Gene and Mother-Child Language Style Matching Prospectively Predicts Children’s Separation Anxiety Disorder Symptoms

Recent research suggests that lower mother-child language style matching (LSM) is associated with greater physiological reactivity and insecure attachment in school-aged children, but to date no studies have explored this measure of parent-child behavioral matching for its association with children’s anxiety symptoms, a well-known correlate of attachment insecurity and heightened physiological reactivity. There is also considerable evidence of genetic risk for anxiety, including possession of the OPRM1 minor allele, 118G. In the current study (N = 44), we expand upon what is known about children’s genetic and environmental risk for anxiety by examining the unique and interactive effects of mother-child LSM and the OPRM1 polymorphism A118G on school-aged children’s separation anxiety disorder (SAD) symptoms. SAD symptoms were measured both concurrently with LSM and OPRM1 genotype and two years later through self-report. No significant associations emerged between LSM or OPRM1 and concurrent Time 1 SAD symptoms. However, lower LSM and 118G minor allele possession were both associated with greater SAD symptoms at Time 2; further, the interaction between LSM and OPRM1 genotype significantly predicted SAD symptoms beyond the main effects of the two variables. Possession of the minor allele was only associated with greater SAD symptoms among children in low LSM dyads, whereas children with the minor allele in high LSM dyads showed non-significantly lower SAD symptoms. These findings and a proportion affected analysis provide support for a differential susceptibility model of gene by environment interactions for the OPRM1 gene. We discuss the implications for predicting children’s separation anxiety across development.

A Cross-Cultural Comparison of Parental Perceptions of Childhood Separation Anxiety Disorder Symptoms and Likelihood to Seek Help

This study examined cross-cultural differences in parental interpretations of childhood separation anxiety disorder (SAD) symptoms and their subsequent likelihood to seek help or advice. It also as...

An examination of separation anxiety disorder symptoms in adults from a clinical population

Objective: Since major research has only recently begun into adult SepAD in clinical populations, this study examined the phenomenology of patients at-risk for adult SepAD. Method: A sample of 95 adult patients receiving CBT for either mood or anxiety disorders at a mental health outpatient clinic were included in this study. Results: It was found that one-fifth of the patients were at-risk for adult SepAD at the start of therapy. The large majority of the at-risk patients were female, were diagnosed at intake with another anxiety disorder, had a diagnosed DSM-IV-TR Axis-IV psychosocial and environmental problem. It was also found that adult SepAD symptom severity decreased after CBT. Lastly, it was found that adult SepAD symptom severity at the start of therapy reduced the effectiveness of CBT for depression, but not for anxiety. Conclusion: The findings may provide a better insight into phenomenology and possible improvement of the treatment of adult SepAD.

Effects of a parent training programme for the treatment of young children with separation anxiety disorder

AbstractCognitive behavioural therapy (CBT) has been shown to be an effective treatment for anxiety disorders in children. However, the majority of studies conducted to date have included heterogeneous samples of children combining social anxiety disorder, generalized anxiety disorder and separation anxiety disorder (SAD) together. Few studies have examined the efficacy of CBT to specifically treat SAD. Moreover, research on the impact of CBT for SAD in children younger than 7 years old has been very limited. To address these issues, we examined the effects of a CBT parent training programme with six children with SAD aged between 4 and 7 years using a non-concurrent multiple baseline design. Parents completed semi-structured interviews, questionnaires and daily diaries to assess their child's anxiety symptoms, parental practices and parental stress. Results indicated that five of six children no longer met the criteria for SAD diagnosis after treatment and at 3-month follow-up. Moreover, the daily diaries showed that four of six children presented a systematic favourable change of the total weekly frequency of SAD symptoms. Finally, four mothers reported a decrease in overprotection, but we observed no changes in parental stress.

Associations between Disorder-Specific Symptoms of Anxiety and Error-Monitoring Brain Activity in Young Children.

Anxiety disorders are among the earliest emerging disorders and most common mental health problem across the lifespan. A common characteristic of individuals with anxiety is poor attentional and cognitive control. Therefore, researchers are interested in how cognitive functioning relates to anxiety in young children. In particular, research has demonstrated associations between anxiety and electrophysiological markers of cognitive control skills such as the error-related negativity (ERN). The nature of the anxiety-ERN relationship is not well understood, however. The purpose of the present study was to examine: 1) the association between the ERN and diagnostically-defined symptoms of different anxiety disorders; and 2) the extent to which disorder-specific symptoms of anxiety moderated the association between ERN and behavioral performance on a Go/No-Go task in a sample of 139 children 5-8years of age (70 females and 69 males). Results suggest that more separation anxiety disorder (SAD) symptoms are associated with a smaller ΔERN, even after controlling for other anxiety disorder symptoms. Children with more SAD symptoms showed higher error rates and failed to exhibit the expected association between ΔERN and behavioral performance, suggesting ineffective error-monitoring in young children with SAD problems.