Separation Anxiety Symptoms Research Articles

Developmental trajectories of anxiety and depression in early adolescence.

Adolescence is a period of heightened vulnerability for the onset of internalizing psychopathology. Characterizing developmental patterns of symptom stability, progression, and co-occurrence is important in order to identify adolescents most at risk for persistent problems. We use latent growth curve modeling to characterize developmental trajectories of depressive symptoms and four classes of anxiety symptoms (GAD, physical symptoms, separation anxiety, and social anxiety) across early adolescence, prospective associations of depression and anxiety trajectories with one another, and variation in trajectories by gender. A diverse sample of early adolescents (N = 1,065) was assessed at three time points across a one-year period. All classes of anxiety symptoms declined across the study period and depressive symptoms remained stable. In between-individual analysis, adolescents with high levels of depressive symptoms experienced less decline over time in symptoms of physical, social, and separation anxiety. Consistent associations were observed between depression and anxiety symptom trajectories within-individuals over time, such that adolescents who experienced a higher level of a specific symptom type than would be expected given their overall symptom trajectory were more likely to experience a later deflection from their average trajectory in other symptoms. Within-individual deflections in GAD, physical, and social symptoms predicted later deflections in depressive symptoms, and deflections in depressive symptoms predicted later deflections in GAD and separation anxiety symptoms. Females had higher levels of symptoms than males, but no evidence was found for variation in symptom trajectories or their associations with one another by gender or by age.

Separation anxiety disorder across the lifespan: DSM-5 lifts age restriction on diagnosis

DSM-5 has lifted the age criterion in the definition of separation anxiety disorder thereby overturning the long-standing convention of restricting the diagnosis to childhood. Previously, adults with separation anxiety symptoms were assigned to other conventional categories such as panic disorder, agoraphobia or generalized anxiety disorder. Over the past two decades, an evolving body of research has identified separation anxiety disorder in adulthood, with 20–40% of adult psychiatric outpatients being assigned that diagnosis. In the US, the lifetime prevalence of the disorder in adulthood is 6.6%. The removal of the age restriction on diagnosis has important implications for clinical practice. Whereas parents (particularly mothers) of children with separation anxiety disorder commonly attracted the diagnosis of agoraphobia, the latter are more likely now to be diagnosed with the adult form of separation anxiety disorder, focusing attention on the importance of intervening with both members of the dyad to overcome mutual reinforcement of symptoms. In addition, adults with separation anxiety disorder have been found to manifest high levels of disability and they tend to show a poor response to conventional psychological and pharmacological treatments. There is an urgent need therefore to devise novel psychological and pharmacological interventions for the adult form of the disorder. The reformulation of separation anxiety disorder in DSM-5 therefore requires a paradigm shift in which clinicians are alerted to identifying and treating the condition in all age groups. Research across countries is needed to examine the new formulation of separation anxiety disorder amongst populations of diverse ethnic and cultural backgrounds.

Childhood anxiety trajectories and adolescent disordered eating: findings from the NICHD Study of Early Child Care and Youth Development.

The goal of the present article was to examine whether childhood anxiety trajectories predict eating psychopathology. We predicted that girls with trajectories of increasing anxiety across childhood would have significantly greater risk of disordered eating in adolescence in comparison to girls with stable or decreasing trajectories of anxiety over childhood. Data were collected as part of the prospective longitudinal NICHD Study of Early Child Care and Youth Development (N = 450 girls). Childhood anxiety was assessed yearly (54 months through 6th grade) via maternal report on the Child Behavior Checklist. Disordered eating behaviors were assessed at age 15 via adolescent self-report on the Eating Attitudes Test (EAT-26). We conducted latent growth mixture modeling to define girls' childhood anxiety trajectories. Maternal sensitivity, maternal postpartum depression, maternal anxiety, and child temperament were included as predictors of trajectory membership. The best fitting model included three trajectories of childhood anxiety, the low-decreasing class (22.9% of girls), the high-increasing class (35.4%), and the high-decreasing class (41.6%). Mothers with more symptoms of depression and separation anxiety had girls who were significantly more likely to belong to the high-increasing anxiety trajectory. There were no significant differences in adolescent disordered eating for girls across the three childhood anxiety trajectories. Childhood anxiety, as captured by maternal report, may not be the most robust predictor of adolescent disordered eating and may be of limited utility for prevention programs that aim to identify children in the community at greatest risk for disordered eating.

Childhood internalizing symptoms are negatively associated with early adolescent alcohol use.

The relationship between childhood internalizing problems and early adolescent alcohol use has been infrequently explored and remains unclear. We employed growth mixture modeling of internalizing symptoms for a large, population-based sample of U.K. children (the Avon Longitudinal Study of Parents and Children Cohort) to identify trajectories of childhood internalizing symptoms from age 4 through age 11.5. We then examined the relationship between membership in each trajectory and alcohol use in early adolescence (reported at age 13.8). Overall, children experiencing elevated levels of internalizing symptoms were less likely to use alcohol in early adolescence. This finding held true across all internalizing trajectories; that is, those exhibiting increasing levels of internalizing symptoms over time, and those whose symptoms desisted over time, were both less likely to use alcohol than their peers who did not exhibit internalizing problems. We conclude that childhood internalizing symptoms, unlike adolescent symptoms, are negatively associated with early adolescent alcohol experimentation. Additional studies are warranted to follow up on our preliminary evidence that symptoms of phobia and separation anxiety drive this effect.

Psychological Difficulties among Children and Adolescents with Ethnic Danish, Immigrant, and Refugee Backgrounds

Abstract Objective: This study investigated and compared the prevalence of psychological difficulties among Danish, immigrant, and refugee children. Methods: We enrolled 332 children between the ages of 8 and 18 years (148 Danish children, 81 immigrant children, and 67 children with refugee backgrounds), all from low-income areas of residence. The Health Behaviour in School-aged Children Symptoms Checklist, the Strengths and Difficulties Questionnaire, and the Revised Children’s Anxiety and Depression Scale were applied. Results: We found significant differences among the groups, with Danish children reporting lower levels of conduct problems than both immigrant children (P ` .01) and refugee children (P ` .05). Refugee children also reported more peer problems (P ` .05), more symptoms of obsessive-compulsive disorder (P ` .01), and more separation anxiety symptoms (P ` .05) than the Danish children. No significant differences with regard to age or gender were found among the groups. Conclusions: Our data suggest that, although immigrant children had higher levels of conduct problems than ethnic Danish children, they did not suffer from higher levels of internalizing psychological difficulties. However, refugee children were at higher risk for psychological difficulties associated with both externalizing and internalizing.

Depression in young adult psychiatric outpatients: delimiting early onset

The aim of this study was to examine differences in childhood, adolescent and adult onset of depression. Young psychiatric outpatients (n = 156) diagnosed with a lifetime depressive episode were divided into three groups according to age of onset of their first depressive episode: childhood (≤12 years, n = 21), adolescent (13-17 years, n = 58) and early adult onset (18-25 years, n = 77). Participants were assessed by diagnostic interviews and by questionnaires measuring previous life events and childhood developmental delays. Clinical characteristics and various risk factors were compared between groups. This clinical sample was dominated by women, with onset of their first depressive episode occurring during adolescence. Childhood onset was related to an increased number of depressive episodes, higher prevalence of personality disorders, more current social problems and more reported development delays during childhood regarding literacy learning, social skills and memory. They also reported more separation anxiety symptoms and neglect during childhood and more experiences of teenage pregnancies and abortions. Childhood onset of depression is associated with more severe symptoms, more psychosocial risk factors and childhood developmental delays. Because all onset groups shared many features, the results are inconclusive if there are distinct subgroups according to age of onset.

Maternal Depressive Symptoms and Children’s Emotional Problems

Maternal depression is a major risk factor for the development of children's mental health problems. No population-based study to date has examined whether early child care spanning the full preschool period from infancy onward is protective for children of depressed mothers. To examine whether early child care moderates associations between maternal depressive symptoms (MDSs) and child internalizing problems (emotional problems [EPs], separation anxiety symptoms, and social withdrawal symptoms [SWSs]) during the preschool period. Population-based prospective cohort study within the Québec Longitudinal Study of Child Development. Québec Longitudinal Study of Child Development participants (n = 1759) assessed repeatedly between ages 5 and 60 months. High-level trajectories of EPs, SWSs, and separation anxiety symptoms between ages 17 and 60 months. Child care age at entry moderated associations between MDSs and child internalizing problems. Among children of mothers with elevated MDSs, reduced odds ratios for EPs and SWSs were found for those entering child care early (0.24; 95% CI, 0.09-0.66 for EPs and 0.29; 95% CI, 0.09-0.92 for SWSs) or late (0.29; 95% CI, 0.11-0.77 for EPs and 0.21; 95% CI, 0.07-0.65 for SWSs) compared with those remaining in maternal care. Child care type moderated the association between MDSs and child EPs; children of mothers with elevated MDSs who received group-based child care had lower odds ratios for EPs than those who remained in maternal care (0.21; 95% CI, 0.09-0.48) or those who were cared for by a relative or babysitter (0.40; 95% CI, 0.17-0.94). Regulated early child care services reduced the risks for internalizing problems for children of mothers with elevated MDSs. Regulated child care services may be used as a public health intervention to buffer the negative effect of maternal depression on children's internalizing problems.

Emotional psychopathology and increased adiposity: Follow-up study in adolescents

Based on data from a three-year longitudinal study, we assess the effect, according to gender, of emotional psychopathology in preadolescence on anthropometric and body composition parameters in adolescence (N = 229). Psychopathology was assessed using the Screen for Childhood Anxiety and Related Emotional Disorders, the Children's Depression Inventory and the MINI-International Neuropsychiatric Interview for Kids. Body fat percentage (%BF), waist circumference (WC) and body mass index (BMI) were also determined. Following analysis with adjusted multiple regression models, the results indicated that symptoms of depression and separation anxiety were significantly associated with increased WC and BMI in boys, and that somatic symptoms were associated with increased WC and %BF in girls. Diagnosis of social phobia, panic disorder or dysthymia led to significantly increased WC and/or BMI in boys and dysthymia increased WC in girls. These findings suggest that emotional psychopathology in preadolescence is associated with increased weight gain and abdominal fat in adolescence.

Treating Comorbid Anxiety in Adolescents With ADHD Using a Cognitive Behavior Therapy Program Approach

Objective: To evaluate an 8-week cognitive behavior therapy (CBT) treatment specifically designed for adolescents with ADHD and comorbid anxiety. Method: Using a multiple baseline design, nine adolescents (13 years to 16 years 9 months) received a weekly CBT, which focused on four identified anxiety-arousing times. Participants self-recorded their levels of anxiety for each of the four times during baseline, intervention, and a maintenance phase. Anxiety was also assessed using the Multidimensional Anxiety Scale for Children (MASC). Results: Paired samples t tests supported the success of the intervention. Interrupted time-series data for each participant revealed varying rates of success across the four times, however. The MASC data revealed significant reductions in Physical Symptoms of Anxiety, Social Anxiety, Separation Anxiety, Harm Avoidance, and Total Anxiety. Conclusion: The data demonstrate the efficacy of a CBT program for the treatment of comorbid anxiety in adolescents with ADHD.

The role of parental anxiety sensitivity in parent reports of child anxiety in treatment seeking families

Recent research has examined the contribution of parental anxiety sensitivity to child anxiety, suggesting only a modest relationship between these two variables. No study to date, however, has examined the role of parental anxiety sensitivity in parent reports of the child's anxiety. It was hypothesized that anxiety sensitivity, a cognitive risk factor for the development of anxiety, would be significantly correlated with parents' reports of their child's anxiety, specifically with respect to panic and separation anxiety. The present study employed a sample of 56 treatment-seeking children and their parents. Parent and child reports of the child's anxiety were obtained, and self-reports of anxiety sensitivity were obtained from parent and child. Parent reports of their child's panic and separation anxiety symptoms were significantly related to not only parental anxiety sensitivity (r = .39 and r = .29, respectively) but also the child's self-reported level of anxiety sensitivity (r = .35 and r = .37, respectively). These findings suggest that anxiety sensitivity, a significant predictor of panic symptomatology amongst both adults and children, might be related to parents' perceptions of their child's symptoms of panic and separation anxiety. These findings further suggest taking into consideration parental levels of anxiety sensitivity when interpreting parent reports of child anxiety in clinical settings.

Separation Distress in Obsessive-Compulsive Disorder

Four iterative studies tested the hypothesis that separation distress is a significant component of obsessive-compulsive disorder (OCD). Separation distress and separation trauma were measured in nonclinical undergraduate university participants who scored at the high end of the spectrum of obsessionality and low mood; in patients clinically diagnosed with OCD and major depression disorder (MDD); and in control groups. The Meta-Cognitions Questionnaire, Padua Inventory, Major Depression Inventory, and Positive and Negative Affect Scales were used to distribute participants on spectrums of obsessionality and low mood (Studies 1 and 2) and classify them in terms of clinical OCD and MDD (Study 3). Participants were evaluated on measures of separation distress, using the Separation Anxiety Symptom Inventory, the Structured Clinical Interview for Separation Anxiety Symptoms, the Adult Separation Anxiety Checklist, and the Affective Neuroscience Personality Scales. To measure separation trauma, participants were asked to indicate whether they had been physically separated from their primary caregiver during specific time frames based on widely established work. Analyses confirmed that separation distress is strongly implicated in both OCD and MDD and that it accounts for the well-established comorbidity of these disorders. Chi-square contingency analysis indicated that OCD and/or MDD in adulthood are contingent upon early separation trauma.

2100 – Parental contributions and effects in adolescents’ cannabis users: a preliminary study based on french high school students

Behavior disorders (addiction, eating disorders) which the teenagers suffer would come from a dysfunction from the early relations and an installation of mental representations of the attachment relations marked by insecurity, discontinuity and Separation Anxiety (SA). Quality of the early and current relations of attachment is going to influence the process of adolescence, which is connected to a second period of separation-individuation. Nevertheless, the SA of the adolescents remains a very rare and unknown diagnosis. This study evaluated the relationship between cannabis abuse or dependence (A/D) and family functioning in adolescent cannabis users. A sample of 336 adolescents filed up the questionnaires about frequency of their cannabis use, SA symptoms in adult populations, dysfunctional separation-individuation process in early adolescents, parental types perceived by the children and depression symptoms. Cannabis A/D adolescents got significantly higher scores than non-cannabis A/D adolescents at the Anxiety Separation Adulthood (p < 0,005) and lower scores at the “care” subscale about parents representations (“mother” p < 0,01; “father” p < 0,001). The logistic regression analysis highlighted that SA disorders and care were significantly encouraging cannabis A/D. The cannabis use would be a solution hindering the SA disorder's unbearable feeling. If a successful separationindividuation allows autonomy, the results have shown that cannabis would dress the individuation problem. Thanks to the substance the adolescent can express his personality and differentiate himself from the others by a marginal behavior.

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.

Early Evidence for Factorial Structure of the Separation Anxiety Symptom Inventory in Italian Children

The aim of this study was to explore the internal consistency and confirm the factor structure of the separation anxiety symptom inventory for children (SASI-C) in a community sample of 329 Italian children, ages 6 to 10 years. A confirmatory factor analysis yielded two interpretable factors. Correlations between scores for the SASI-C and the Italian Fear Survey Schedule for Children were calculated to estimate convergent validity; medium effect sizes are hypothesized. Implications regarding the clinical utility of the SASI-C are discussed.

Assessing Separation Anxiety in Italian Youth: Preliminary Psychometric Properties of the Separation Anxiety Assessment Scale

This study examined the internal consistency and construct validity of the Separation Anxiety Assessment Scale for Children in a non-clinical Italian sample of 358 children ages 6 to 10 years. Statistically significant differences were examined by sex and age. Two exploratory factor analyses were carried out: (a) on the symptom sub-dimensions which led to three interpretable factors of Fear of Abandonment and of Physical Illness, Fear of Calamitous Events, Fear of Being Alone and (b) on all Separation Anxiety Assessment Scale for Children items, which led to three interpretable factors: Fear of Abandonment and Safety Signals, Fear of Calamitous Events, and Fear of Being Alone and Left Alone. Preliminary findings for validity were described with the Separation Anxiety Symptoms Inventory for Children and the Italian Fear Schedule for Children (convergent validity). Implications regarding the clinical utility of the Separation Anxiety Assessment Scale for Children are discussed.

Symptoms of prolonged grief, depression, and adult separation anxiety: Distinctiveness and correlates

Research has shown that prolonged grief disorder (PGD) is a disorder distinct from other disorders including major depression and posttraumatic stress disorder (PTSD). This study aimed to extend this research by examining the distinctiveness of symptoms of PGD relative to symptoms of adult separation anxiety disorder, also taking into account depression. Data were available from 205 bereaved individuals who completed measures tapping these symptoms together with a complementary measure of mental and physical health. Findings showed that symptoms of PGD, depression, and adult separation anxiety disorder were better conceptualized as distinct dimensions instead of a unitary dimension of distress. Correlations between the three symptom clusters were moderate to large. Cause of loss was the single variable that was associated with all three symptom clusters with loss due to violent cause giving rise to more severe symptoms. All three symptom clusters were associated with lower concurrent mental and physical health.

Separation anxiety disorder: evidence of literature and clinical implications

Since the mid-90s several studies have proven the existence of an Adult form of the Separation Anxiety Disorder (ASAD) not yet nosologically recognized by the international psychiatric classification systems (DSM and ICD). An increasing amount of evidence showed that the separation anxiety disorder may arise at any age, not always in continuation with the correspondent childhood disorder. So, a revision of the diagnostic criteria for this disorder is brought into question, as the onset is currently limited before 18 years of age. Different tools have been developed for the assessment of ASAD: 1) the Adult Separation Anxiety Structured Interview (ASA-SI), a semi-structured interview with items derived and adapted from the DSM-IV-TR childhood disorder; 2) the Adult Separation Anxiety-27 (ASA-27), a self-administered rating scale containing the same items of ASA-SI; 3) the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS), a structured interview including two specific forms for childhood and adulthood. However, according to available evidence, the separation anxiety may be a dimension with cross-nosographical presentation in nearly all the commonest mood and anxiety disorders; moreover, it is connected to greater personal dysfunction and lower responsiveness to treatment. Furthermore, a deeper comprehension of the psychobiological nature of separation anxiety should lead to newer and more effective therapeutic intervention. Literature is reviewed awaiting the publication of DSM-V.

Attention deficit hyperactivity disorder characteristics: II. Clinical correlates of irritable mood

BackgroundThis study describes the relationship of irritable mood (IRR) with affective disorders in youths with attention deficit hyperactivity disorder (ADHD). MethodsFive hundred ADHD subjects were assessed with the childhood version of the Schedule for Affective Disorder & Schizophrenia. Subjects were in a genetic ADHD protocol and limited to those of Caucasian/European descent. ResultsThe most prevalent concurrent diagnoses were oppositional defiant disorder (ODD) (43.6%), minor depression/dysthymic disorder (MDDD) (18.8%), and generalized anxiety (13.2%)/overanxious disorder (12.4%). IRR subjects (21.0%) compared to the non-IRR (NIRR) group had higher rates of all affective disorders (76.2% vs. 9.6%) and ODD (83.8% vs. 32.9%) but lower rates of hyperactive ADHD (1.9% vs. 8.9%). Among those without comorbidities, 98.3% were NIRR. Logistic regression found IRR mood significantly associated with major depressive disorder (odds ratio [OR]: 33.4), MDDD (OR: 11.2), ODD (OR: 11.6), and combined ADHD (OR: 1.7) but not with anxiety disorders. Among symptoms, it associated IRR mood with a pattern of dysthymic and ODD symptoms but with fewer separation anxiety symptoms. Diagnostic and symptomatic parameters were unaffected by demographic variables. LimitationsPotential confounders influencing these results include patient recruitment from only one clinical service; a cohort specific sample effect because some presumed affective disorders and non-Caucasians were excluded; and the young mean age (10.2 years) limiting comorbid patterns. ConclusionsThe prominence of an MDDD pattern suggests this IRR group is appropriate in the DSM V's proposed chronic depressive disorder, possibly with or without temper dysregulation. A new diagnosis of disruptive mood dysregulation disorder may be unwarranted.

The relationship between adult separation anxiety disorder and complicated grief in a cohort of 454 outpatients with mood and anxiety disorders

Recent epidemiological studies indicate that separation anxiety disorder occurs more frequently in adults than children. Data from literature suggest that Adult Separation Anxiety Disorder (ASAD) may develop after a bereavement or threat of loss. Research has demonstrated that bereaved persons may present a clinically significant grief reaction, defined as Complicated Grief (CG) that causes a severe impairment in the quality of life. The aim of this study was to evaluate the relationship between ASAD and CG in a large cohort of outpatients with mood and anxiety disorders. Study participants comprised 454 adult psychiatric outpatients with DSM-IV mood or anxiety disorders diagnoses. Diagnostic assessments were performed using the SCID-I; ASAD was assessed using an adapted version of the Structured Clinical Interview for Separation Anxiety Symptoms (SCI-SAS-adult). Complicated grief symptoms were assessed by the Inventory of Complicated Grief (ICG). Social and work impairments were evaluated using the Sheehan Disability Scale (SDS). Adult attachment styles were assessed by the Relationship Questionnaire (RQ). The overall frequency of ASAD in our sample was 43% and that of CG was 23%. Individuals with CG had a greater frequency of ASAD (56%) with respect to those without CG (40%). Subjects with CG plus ASAD reported higher scores on ICG and greater impairment on quality of life, as measured with SDS, than CG patients without ASAD. Adult separation anxiety disorder occurs in a high proportion of adult psychiatric outpatients with complicated grief. The association between these two conditions should be further investigated in light of their clinical implications.

Anxiety and inattention as predictors of achievement in early elementary school children

The objective of this study was to examine the relations among anxiety, inattention, and math/reading achievement, as well as the mediating/moderating role of inattention in the anxiety-achievement association both concurrently and longitudinally. Participants included 161 ethnically diverse children (aged 6–8) and their teachers. At the middle and end of first grade (approximately 5 months apart), students completed measures of anxiety and achievement while their teachers completed a measure of inattention. For the concurrent analyses, greater harm avoidance anxiety was associated with better attention, which was in turn related to better achievement. For the longitudinal analyses, mid-year inattention interacted with harm avoidance and separation anxiety to predict end of year reading fluency. For those rated as more attentive, greater separation anxiety symptoms were associated with decreased fluency performance while greater harm avoidance symptoms were associated with increased performance. Findings were discussed in terms of the importance of considering socioemotional variables in the study of children's academic achievement and the potential utility of early anxiety prevention/intervention programs, especially for children experiencing academic difficulties who also show internalizing behaviors.