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Separation Anxiety Disorder

Introduction

  • Children who are very young are likely to experience separation anxiety as a normal part of growing up

  • There is a high prevalence of separation anxiety and clinginess to some degree among children aged 18 months to 3 years

  • Around 4-5% of children between ages 7 and 11 in the US suffer from separation anxiety

  • Separation anxiety is less prevalent in teenagers, with about 1.3% suffering from it


What is SAD?

  • Separation anxiety disorder (SAD) is one of the most prevalent childhood anxiety disorders

  • It is characterised by excessive worries, concerns, and even dread in response to the actual or anticipated separation from an individual

  • SAD is influenced by both genetic and environmental factors, including an imbalance of 2 chemicals in the brain (norepinephrine and serotonin), a family history of mental health issues, parenting disruptions, parental loss, and birth complications.


Symptoms

  • Symptoms typically come to light in preschool and early elementary school (they may come to light later in some rare cases)

  • Whenever the child is not with their family, they may feel anxious and worry that something bad may happen to a family member

  • The fear of separation causes great distress to the child and may interfere with their daily activities, like sleeping alone, going to school or playing with other children

  • Some children also develop physical symptoms, such as headaches, muscle aches and stomach aches

  • There is evidence that separation anxiety disorder may be associated with panic disorders and panic attacks (sudden episodes of intense anxiety and fear or terror)

  • Teenagers and adults may also suffer from SAD, causing significant difficulty leaving home or reaching work


Diagnosis

  • Before a child can be diagnosed with SAD, they must exhibit symptoms for at least four weeks, and experience symptoms that are more severe than those associated with separation anxiety in general

  • The diagnosis is based on DSM-5 criteria (3 out of 8 symptoms) and can be assessed using the SAAI tool for both children and adults - this is a self and parent-report measure

  • There is a wide range of differential diagnoses to be considered, including other anxiety disorders, mood disorders, behavioural pathologies, personality disorders, and medical causes of somatic complaints


Triggers

  • In the absence of treatment, individuals diagnosed with SAD are at an increased risk of developing other anxiety disorders, such as generalised anxiety disorder, panic attacks, phobias, social anxiety disorder or agoraphobia

  • SAD can also be associated with depressive disorders, poor academic performance, social isolation, and poor physical and mental health outcomes


Treatment

  • A combination of therapy and medication is used to treat SAD.

  • Both of these treatments are effective in reducing anxiety and in developing a sense of security in the child, but they are affected by symptoms, age, general health, and the severity of the condition.


Cognitive behavioural therapy (CBT)

  • CBT is the primary treatment method for separation anxiety disorder, also known as talking therapy

  • The primary objective is to assist children in identifying the thoughts and behaviours that contribute to their separation anxiety as well as how to handle being separated from their caregiver without causing distress or interfering with their functioning

  • Relaxation and deep breathing are commonly used techniques

  • It is also possible for parents to learn additional parenting techniques that can help them reduce their separation anxiety


Medication

  • Currently, there are no specific medications available for the treatment of SAD

  • Antidepressants may be prescribed by a doctor to help a person through the more acute symptoms of separation anxiety

  • A selective serotonin reuptake inhibitor (SSRI) will typically be included in these treatments

  • Medication is not a long-term solution to the underlying disorder, and this is a decision that must be carefully considered by a child's parent or guardian as well as their doctors

  • There should be close monitoring of side effects in children.


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