Separation anxiety disorder in children and adolescents: Epidemiology, diagnosis and management. CNS Drugs, 15(2), 93-104
Division of Child Neurology and Psychiatry, University of Pisa--IRCCS Stella Maris, Calambrone, Italy. CNS Drugs
(Impact Factor: 5.11).
02/2001; 15(2):93-104. DOI: 10.2165/00023210-200115020-00002
This paper provides an overview of the phenomenology, longitudinal outcome data, assessment and management of separation anxiety disorder (SAD) in children and adolescents.
SAD is qualitatively different from early worries, and is characterised by an abnormal reactivity to real or imagined separation from attachment figures, which significantly interferes with daily activities and developmental tasks. Different epidemiological studies indicate a prevalence of 4 to 5% in children and adolescents. In contrast to other anxiety disorders, 50 to 75% of children with SAD come from homes of low socioeconomic status. The severity of symptomatology ranges from anticipatory uneasiness to full-blown anxiety about separation, but children are usually brought to the clinician when SAD results in school refusal or somatic symptoms. School refusal is reported in about 75% of children with SAD, and SAD is reported to occur in up to 80% of children with school refusal. Longitudinal studies have suggested that childhood SAD may be a risk factor for other anxiety disorders, but whether this link is specific to, for example, panic disorder and agoraphobia, or whether SAD represents a general factor of vulnerability for a broad range of anxiety disorders is still debated.
Most relevant data are reported on nonpharmacological treatments (psychoeducational, behavioural, cognitive-behavioural, family and psychodynamic), and these are the first choice approach in SAD. Controlled studies show efficacy of cognitive-behavioural therapy in children with anxiety disorders and specifically in SAD-school phobia, supporting this approach as the best proven treatment. Pharmacotherapy should be used in addition to behavioural or psychotherapeutic intervention when the child’s symptoms have failed to respond to those treatments, and he/she is significantly impaired by the symptoms. Selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRI) have a good adverse effect profile and may be considered as first choice drugs in SAD. When different SSRIs fail to improve symptomatology, a trial with a tricyclic antidepressant (TCA) is indicated, with careful monitoring of cardiac functioning. Because of the adverse effect profile and the potential for abuse and dependence, benzodiazepines should be used only when a rapid reduction of symptomatology is needed, until the SSRI or the TCA have begun to be effective (few weeks). Buspirone should be considered in children who have not responded to other treatments. Further research is needed to confirm efficacy of newer antidepressants (venlafaxine, mirtazapine, nefazodone) in childhood anxiety disorders.
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- "Les plus populaires sont les inhibiteurs sélectifs de la recapture de la sérotonine ( ISRS ) ; ceux - ci sont des traitements de première ligne pour l ' ensemble des troubles anxieux hormis les phobies spécifiques qui , sauf exceptions ( voir plus bas ) , sont strictement traitées via thérapie cognitivo - comportementale ( Bandelow et al . , 2002 ; Masi , Mucci , & Millepiedi , 2001 ) . En général , les ISRS produisent moins d ' effets secondaires que les autres anxio - lytiques et peuvent être prescrits aux enfants et adolescents . "
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- "; ayrılma anksiyetesi bozukluğu tanısı alan çocuk, daha önceki gelişim dönemlerinden geçişinde sorunlar (bağlanma sorunları, önceki ayrılma güçlükleri gibi) yaşamış ve başarısız olmuştur (Field 1996). AAB olgularının annelerinde anksiyete bozuklukları ve depresif bozukluklar (Depresif sendrom, Major Depresyon, Distimik Bozukluk) sık görülmektedir (Masi ve ark. 2001). Özellikle panik bozukluk tanısı alan annelerin çocuklarında AAB toplum örnekleminden daha yüksek bulunmuştur. Ayrılma Anksiyetesi Bozukluğu olan çocukların, birinci derece akrabalarında da AAB görülme oranı yüksektir. Bu ruhsal bozukluklar , erken dönemde anne-çocuk ilişkisini bozarak çocukta anksiyete gelişimine neden olabilir ya da "
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ABSTRACT: Yöntem: AAB tanisi konan 4-7 yaş arasi 60 çocuğun ve herhangi bir hastalik nedeniyle tedavi görmeyen sosyo- demografik özellikler açisindan birebir eşleştirilmiş 60 çocuğun anneleri çalişmaya alinmiştir. Tüm olgular için sosyodemografik veri formu, Çocuklar için Davraniş Değerlendirme Ölçeği (ÇDDÖ), Mizaç Değerlendirme Ölçeği (TEMPS-A) uygulanmiştir. Bulgular: Hastalarin yaş ortalamalari 5,12 (±.0,85) olup 32'si kiz, 28'i erkektir. AAB olan grubun ÇDDÖ'de tüm dav- raniş sorunlari skorlarinin kontrol grubundan daha yüksek olduğu saptanmiştir. AAB olan çocuklarin annelerinin, kontrol grubuna oranla depresif, siklotimik, irritabl ve anksiyöz mizaç alanlarinda daha yüksek puanlari olduğu belirlenmiştir. Sonuç: AAB olan çocuklarin annelerinin depresif, siklotimik, irritabl ve anksiyöz mizaç puanlarinin kontrol grubun- dan yüksek olduğu bulunmuştur. Bu çalişmanin toplum tabanli, daha fazla sayida çocuğu kapsayacak ileriye dönük çalişmalarin başlangici olabileceği düşünülmüştür. Anahtar Sözcükler: Ayrilma Anksiyetesi Bozukluğu, Mizaç, Çocuk SUMMARY: Temperamental Characteris�ü cs of Mothers of Preschool Children With Separa�ü on Anxiety Disorder Objective: It is reported that there are many risk factors for the development of separation anxiety disorder (SAD) in children and adolescents. One of the most important factors is the mother-child relationship. It is thought that the temperamental characteristics of the mother have an important role to play in the quality of this relationship. The present study aimed to determine the temperamental characteristics of mothers whose preschool children were diagnosed with separation anxiety disorder. Method: The study included 60 mothers of children with separation anxiety disorder (diagnosed between 4 and 7years of age) and 60 mothers of healthy children who were matched by sociodemographic factors with children with SAD. All cases were evaluated with a sociodemographic form, the Child Behavior Check List (CBCL) and The Temperament Evaluation of Memphis, Pisa, Paris and San-Diego Autoquestionnaire (TEMPS-A). Results: Mean age of the children (32 female, 28 male) was 5.12±.0.85 years. The children with an anxiety disorder had higher behavioral problem CBCL scores than the control group. The mothers of the children with anxiety disorders had higher depressive, cyclothymic, irritabl and anxious temperament scores than the control group mothers. Conclusion: The mothers of the children with separation anxiety disorder had higher scores on depressive, cyclothymic, irritability and anxious temperament scores than the control group mothers. We think that this study can be used to inform future community based, prospective studies.
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ABSTRACT: Objective: To assess the clinical features of children with school refusal and discuss them in the light of the resources reviewed. Methods: Fifty-five children with school refusal have been included in the study. Firstly, we gave information about study and got informed consent. Detailed clinical interviews were made with child and parents. A sociodemographic information form and a Symptom Check List for Separation Anxiety Disorder were applied to the parents. Definitive statistics were employed in the evaluation of the data. Results: It was found that among children who presented with complaints of school refusal the number of boys was higher; the average age of children was 9.1±3.0; school refusal was more frequently seen in children who go through important transition periods such as starting primary school (5-7 years) and junior high school (10-11 years); most of the families had either one child or two children; school refusal was more frequently seen in the first child of the family; the most frequently seen psychiatric disorder was separation anxiety disorder; and the most frequently seen accompanying diagnosis in children with separation anxiety disorder was another anxiety disorder. Conclusions: School refusal should be considered as an important problem due to its effects that could be permanent in the social, emotional,
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