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* * * * * * * * * * * * * * * * Anxiety Disorders: Separation Anxiety Disorder Prof. Debbie van der Westhuizen Head: Child and Adolescent Units Weskoppies Hospital Separation anxiety is very normal among preschoolers, especially those who are going to school for the first time Separation anxiety (SA) SA is a developmentally appropriate response in young children on separation from primary caregivers (normal between 6 -30 months; intensifies 13-18months; declines between 3-5 years due to cognitive maturation) Separation anxiety Disorder (SAD) SAD is a developmentally inappropriate excessive distress (worry/fear) associated with separation from primary caregiver; 4% of school-aged children, common in 7- 8 year olds Only anxiety disorder in DSM-IV-TR included under disorders: “usually first diagnosed in infancy, childhood or adolescence” SAD: shadowing parents SAD is a developmentally inappropriate distress (excessive worry/fear) associated with separation from primary caregiver Anxiety may present prior to, during, and/or in anticipation of separation Fear that harm may come to themselves or parents- which will result in permanent separation Difficulty going to places without parents Specific themes: nightmares of kidnap or being taken away To avoid separation: complaints of stomach-aches/headaches Case: Living in her parents shadow Susan is a 7 year old referred due to concerns regarding anxiety and school refusal Chief complaint: “Susan is afraid I will forget her at school,” her mother stated History of present illness: For the past 3 months Susan had fears about separating from her parents to go to school, becoming progressively worse She has extreme distress on Sunday nights, trouble falling asleep with worries about bad things happening to her parents while at school; a burglar will break into their house and kill her mother History of present complaint When in time for school, Susan actively resist by hiding under the bed or clinging to her mother while co