Psychological disorders in children can result from physiological or genetic components and at times both these components can be observed during the diagnosis. There are other disorders which occur in children and never seem to be caused by any physical effect but are instead caused by problems of physiology and biology perspectives and are more likely to be detected in early stages of life. Examples of such disorders include mental retardation, communication skills disorders, and learning disorders. These types of disorders are always identified early in life with the exceptions of a few which can be identified later in the adulthood stage. Some of these disorders from another perspective contribute to other disorders which only manifest when the child is in the middle stages of growth. One disorder affiliated with mental retardation is separation anxiety disorder (SAD), which is defined as a state of excess tension that arises when a child is isolated from home or from the family breadwinner. This paper intends to develop more understanding into the separation anxiety disorder from the perspectives of DSM 5 criteria for the disorder and the risk factors associated with it and which contribute to depression.
SAD occurs in children between 3 and 4 years old and becomes problematic to families during the elementary schooling of children. The child develops an abnormal fear of the thought that something horrible might happen to them or their parent while they are not around. At times, the child responds to circumstances leading to the separation by expressing anger to the adult and even crying in an attempt to manipulate the situation to his or her favor. Given that schooling is inevitable, the child is compelled to attend school, but with time, his or her distress is displaced by other maladaptive forms of behavior. For example, he or she may begin showing behavioral problems within the school setting or at home yet initially there were no such problems in him or her (“Separation Anxiety Disorder,” 2016). This situation is caused by the child’s attempt to seek a new peer group only to unfortunately land in negative peer groups hoping to get attention in the pursuit of solving the mysteries of separation.
History of Anxiety Disorder
The history of anxiety disorders dates as far back as 1978 when the first phobia meeting took place in New York. At that time, the term “phobia” was used in place of “anxiety disorder” because the latter was yet to be coined. Those who attended early meetings of a similar nature agreed that there was need to be formed a national organization for promoting treatments awareness for phobias. This owed to the promising nature of the then new treatments, which were known as exposure or contextual therapies. This journey led to the founding of Phobia Society of America in 1980 by a small dedicated group. As researchers continued to unravel the causes and health consequences of the disorders, the Anxiety Disorders Association of America was formed in 1990, later to be known as the Anxiety and Depression Association of America as from 2012. The diagnosis of the disorders has since advanced tremendously. Today, “Between 15% and 30% of youths are diagnosed as having an anxiety disorder before adulthood” (Freidl et al., 2017). This is according to the Great Smoking Mountains Study.
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The DSM 5 Criteria for the Disorder
Over the past few decades, the SAD criteria have been noticed to shift as research on its phenomenology continues to advance. Initially, the disorder was associated with DSM-3 based on a particular social situation contributing to specific phobia. The diagnostic criteria, however, underwent significant changes with the introduction of DSM-4 as it became clear that children who met criteria for social phobia experienced anxiety that manifested from different social situations. DSM-4 seemed to work proficiently. However, Kerns, Comer, Pincus and Hofmann (2013) note that with the dissatisfaction that was experienced in the limitations of the non-generalized and generalized SAD, there was need to base the disorder in the DSM-5 with the future research about it.
According to The American Psychiatric Association (2013), there is a total of about nine diagnostic criteria for SAD with special reference to DSM-5. They include:
- The anxiety that relates to different kinds of social settings in which a child feels someone is observing and scrutinizing them. This occurs in settings that involve peer and will be exhibited with respect to particular age involving actions such as lacrimation, flinching or to some extent, expressing some level of discomfort.
- Individuals will show fear towards experiencing their anxiety which will lead to rejection from a social platform.
- There will be consistency in provoking distress caused by social interaction.
- There is a high avoidance of social interaction as the child views it as painful or something that involves endurance.
- There will be disproportionate reaction to the actual situation grossly caused by fear and anxiety.
- The disorder will persist for four weeks around social circumstances.
- Impairment of functioning in various domains is experienced in the form of personal distress.
- The anxiety cannot be affiliated with a medical disorder, use of a substance, or adverse effects of medication or another mental disorder.
In the presentation of another medical condition which may lead to an individual being excessively self-conscious, a clinician may be prompted to include a more specific form of social anxiety determined by performance situation such as oral presentations.
The risk factors associated with this disorder can broadly be looked at from two broad perspectives, namely environmental risk factors and biological risk factors. Dabkowska and Dabkowska-Mika (2015) argue that SAD is a complex interplay that combines the vulnerabilities that arise as a result of biological factors, environmental influences, and parental psychopathology among other factors. The two aforementioned broad categories consist of numerous factors. However, this paper only focuses on three forms of risk factors.
- Parental loss
Parental loss has been associated with different kinds of psychopathologic characteristics. Kendler (2001) reports that several studies have managed to assess the relations between the loss of a parent at an early stage of growth and psychopathology in adults for 1018 pairs of different kinds of twins with female characteristic. The study showed that there is an impact that leads to anxiety in case of loss of a parent. Noteworthy, parental loss here can be as a result of parental separation from a child. It could also result from the death of a parent or divorce. The loss of a parent through death can lead to higher development of social phobia especially if the parent lost is the mother.
- Sexual abuse
Sometimes children grow in an environment where there is a high level of moral decadence within the society. For instance, research done in New Zealand featuring children found that children who reported sexual abuse had greater levels of separation anxiety disorder compared to those who never reported the same (Fergusson, Horwood & Lynskey, 2006). Sexual abuse in childhood has been discovered to escalate the vulnerability for panic disorders and GAD in adults as well as other mental and substance abuse disorders. In a nutshell, sexual abuse that is based on self-reporting has positively been associated with almost all the disorders.
- Parental factors
This has to do with genetics, whereby infants who seem to be anxiously attached in infancy develop more anxiety during childhood compared to those who were securely attached. Parents who were affected by anxiety disorders in their childhood generally cannot manage the anxiety in their children effectively as they lack the abilities to discharge adequately such a service. Hirshfeld-Becker and Biederman (2002) point out children brought up by such parents develop anxiety disorders more frequently and at times at quite early stages of growth. Offspring of parents who suffered from childhood anxiety also manifest the same kind of anxiety the parent experienced. Parental psychopathology and the rearing of children are always associated with offspring social phobia. Observations have shown that there is continuity in the grading of the relationship between the risk factors that arise from within a family setting and the SAD portrayed by an offspring (Knappe, Beesdo, Fehm, Lieb & Wittchen, 2008; Knappe et al., 2009).
The three risk factors discussed above are just but a few of the ones available regarding separation anxiety disorder. The question that needs to be answered is whether there are mediation factors that can help children cope up with the harsh situations they undergo as a result of the risk factors. Taking for example parent loss as a risk factor, children who fall victims to such a factor could be helped by being encouraged to join children psychoeducational groups which can assist in the provision of powerful support, the opportunity to express emotions, and education about loss. This would encourage them in a way that would show them that they can effectively cope with the massive anxiety changes they undergo (Moody & Moody, 2003; Zambelli & DeRosa, 2000). They can get involved in storytelling sessions, play games, or indulge in more structured activities that would help realize the mind they need for forward propulsion.
Separation anxiety disorder poses a serious risk of recurrent disorders of anxiety from childhood to adulthood. If proper care is not taken to address this issue then in future, as children transition into adolescence, they will likely suffer depression and dependence on illicit drugs and could even end up with underachievement in their education as young adults. Clinical practitioners have a role to play in terms of providing preventive and survival techniques as well as prediction mechanisms that may detect unfavorable course of anxiety. Sufficient knowledge about the risk factors that cause SAD would enable preventive actions with respect to developing anxiety in children. Having a substantial knowledge would call for effective mediation techniques in the pursuit of building resilience in children as far as anxiety related actions are concerned. Therefore, more emphasis should be put on acting fast in order to avoid worst case scenario as would arise in adulthood as a result of high anxiety levels that are never controlled during childhood.
American Psychiatric Association, (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Washington, D.C.: American Psychiatric Association.
Dabkowska, M., & Dabkowska-Mika, A. (2015). Risk factors for anxiety disorders in children. IntechOpen. Retrieved July 30, 2018 from https://www.intechopen.com/books/a-fresh-look-at-anxiety-disorders/risk-factors-of-anxiety-disorders-in-children
Fergusson, D., Horwood, L., & Lynskey, M. (2006). Childhood sexual abuse and psychiatric disorder in young adulthood: II. Psychiatric outcomes of childhood sexual abuse. Journal of the American Academy of Child & Adolescent Psychiatry, 35(10), 1365-1374. http://dx.doi.org/10.1097/00004583-199610000-00024
Freidl, E. K., Stroeh, O. M., Elkins, R. M., Steinberg, E., Albano, A. M., & Rynn, M. (2017). Assessment and treatment of anxiety among children and adolescents. Focus (American Psychiatric Publishing), 15(2), 144-156.
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Knappe, S., Beesdo, K., Fehm, L., Lieb, R., & Wittchen, H. (2008). Associations of familial risk factors with social fears and social phobia: Evidence for the continuum hypothesis in social anxiety disorder? Journal of Neural Transmission, 116(6), 639-648. http://dx.doi.org/10.1007/s00702-008-0118-4
Knappe, S., Lieb, R., Beesdo, K., Fehm, L., Ping Low, N., Gloster, A., & Wittchen, H. (2009). The role of parental psychopathology and family environment for social phobia in the first three decades of life. Depression and Anxiety, 26(4), 363-370. http://dx.doi.org/10.1002/da.20527
Moody, R., & Moody, C. (2003). A family perspective: Helping children acknowledge and express grief following the death of a parent. Death Studies, 15(6), 587-602. http://dx.doi.org/10.1080/07481189108252547
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