Risk for separation anxiety disorder among girls: paternal absence, socioeconomic disadvantage, and genetic vulnerability

A neurobiological framework of separation anxiety and related phenotypes

In the DSM-5, separation anxiety disorder (SAD) is newly classified in the chapter on anxiety, renewing research efforts into its etiology. In this narrative review, we summarize the current literature on the genetic, endocrine, physiological, neural and neuropsychological underpinnings of SAD per se, SAD in the context of panic disorder, separation anxiety symptoms, and related intermediate phenotypes. SAD aggregates in families and has a heritability of ~43%. Variants in the oxytocin receptor, serotonin transporter, opioid receptor µ1, dopamine D4 receptor and translocator protein genes have all been associated with SAD. Dysregulation of the hypothalamus-pituitary-adrenal axis, dysfunctional cortico-limbic interaction and biased cognitive processing seem to constitute further neurobiological markers of separation anxiety. Hypersensitivity to carbon dioxide appears to be an endophenotype shared by SAD, panic disorder and anxiety sensitivity. The identification of biological risk markers and its multi-level integration hold great promise regarding the prediction of SAD risk, maintenance and course, and in the future may allow for the selection of indicated preventive and innovative, personalized therapeutic interventions.

Psychological development and educational problems of left-behind children in rural China

With China’s rapidly developing economy and increasing urbanization, many adults from rural areas migrate to urban areas for better paid jobs. A side effect of this migration is that parents frequently leave their children behind (left-behind children). This research investigated left-behind children’s and non-left-behind children’s psychological, behavioral, and educational functioning. Survey participants included 1,708 adolescents (54.8% female; mean age = 15.03 ± 1.93 years) from rural areas in Central China. Additionally, 32 left-behind children and 32 head teachers were interviewed. Data indicated that in comparison to non-left-behind children, left-behind children were at a disadvantage in regard to emotional adjustment (i.e. lower life satisfaction, lower self-esteem, and higher depression), but fared better in educational adjustment (greater school engagement). Mitigating factors which positively influenced outcomes of certain subgroups of left-behind children included the presence of one parent, increased parental contact, and shorter length of time since parental migration. Information gathered from interviews with LBC also indicated adverse effects of parent absence on children’s development. Teachers identified education measures and support offered to left-behind children and reported difficulties in communicating with parents. Based on this study’s findings, and considering the perspective of educators, implications for school-based interventions are explored.

Separation Anxiety in Children Ages 4 through 9 with Oral Clefts

Background

Psychosocial research on children with oral clefts (OCs), i.e., clefts of the lip, palate, or lip and palate, has suggested that these children may have higher rates of anxiety in general, but overall results have been equivocal. In this study we estimated the prevalence of separation anxiety disorder (SAD) in a population-based sample of children with OCs and identified associated risk factors.

Methods

Parents of 279 children with OCs, identified through three state birth defect registries, responded to a postal survey that included the Separation Anxiety subscale of the Screen for Child Anxiety-Related Emotional Disorders (SCARED) and items regarding the child's OC and its sequelae, parent and child health, parent mental health, family structure, and socioeconomic status indicators. Associations with SA were evaluated using bivariate and multivariate statistics.

Results

One quarter (24%) of the children screened positive for SAD, which was substantially higher than the U.S. child population estimates of 3% to 5%. OC-related impairments in speaking and eating more than doubled the risk of SAD, as did lower socioeconomic status and lower maternal health rating. Maternal mental health and marital status remained in the logistic model but were not significant.

Conclusions

Children with OCs appear to be at increased risk for SAD as measured by the SCARED instrument. OC-related problems with speech and eating more than doubled the risk of SAD. The use of targeted screening tools may help refine our understanding of psychosocial adjustment in children with OCs.

Beliefs regarding child anxiety and parenting competence in parents of children with separation anxiety disorder

BACKGROUND AND OBJECTIVES

Despite the fact that numerous developmental models have highlighted the role of parental cognitive processes in connection with anxiety disorders in children and adolescents, the role of parents' beliefs about their children and parenting remains largely unexplored. This study investigated the specific association between parental beliefs and child separation anxiety.

METHOD

Parents of children with a diagnosis of Separation Anxiety Disorder (SAD) reported on beliefs and expectations related to their child's fears and own parenting competence. To study the potential specificity of relationships, a clinical control group of mothers of children with social phobia (SoP) and a group of mothers of children without a mental disorder (healthy controls, HC) were included.

RESULTS

Results indicated that parents of anxious children had significantly higher levels of dysfunctional beliefs than the parents in the HC group. Mothers of children with SAD showed lower levels of parenting self-efficacy than mothers of children with SoP. They also demonstrated lower parenting self-efficacy and satisfaction compared to mothers of healthy children. Parental dysfunctional beliefs about child anxiety and paternal parenting self-efficacy were significantly positively associated with child anxiety. The effects remained significant after controlling for parental anxiety and depression.

LIMITATIONS

Due to the cross-sectional design of the study, causality of the found effects cannot be inferred.

DISCUSSION

Data suggest that children's anxiety and parents' beliefs about their child's anxiety, coping skills and parenting are strongly associated. Further research is needed to investigate whether addressing parental cognitions in addition to parents' anxiety may improve prevention and intervention of child anxiety.

Preschool anxiety disorders: comprehensive assessment of clinical, demographic, temperamental, familial, and life stress correlates

This study examined correlates of preschoolers' anxiety disorders using a comprehensive, multimethod design. Participants included a community sample of 541 three-year-old children, of whom 106 (19.6%) met criteria for at least 1 anxiety disorder. Child and parental psychopathology and life stress were assessed with clinical interviews. Child temperament and parenting behavior were assessed with laboratory observations. Mothers and fathers reported on their parenting styles. Compared to preschoolers with no anxiety disorder, preschoolers with an anxiety disorder were more likely to meet criteria for comorbid depressive and oppositional defiant disorders and to exhibit greater temperamental behavioral inhibition and lower positive affectivity, and more sleep problems. Children with anxiety disorders also experienced more stressful life events in the previous 6 months, and their mothers had a higher rate of current anxiety disorders. Compared to children with other anxiety disorders, children with only specific phobia exhibited a somewhat different pattern of associations than children with other anxiety disorders. Overall, the findings suggest that many of the correlates observed in older youth with anxiety disorders are also observed in preschoolers.

Associations between household and neighborhood income and anxiety symptoms in young adolescents

BACKGROUND

A better understanding of the role of both family- and neighborhood-level socioeconomic characteristics in the development of anxiety disorders is important for identifying salient target populations for intervention efforts. Little research has examined the question of whether associations between anxiety and socioeconomic status (SES) differ depending upon the level at which SES is measured or way in which anxiety manifests. We studied associations between both household- and neighborhood-level income and four different manifestations of anxiety in a community sample of young adolescents.

METHODS

We conducted a cross-sectional analysis of data on 498 subjects aged 11-13 from a cohort study of Seattle-area middle school students. Generalized estimating equations were used to examine the association between both annual household income and neighborhood median income and each of four anxiety subscale scores from the multidimensional anxiety scale for children (MASC): physical symptoms, harm avoidance, social anxiety, and separation/panic anxiety.

RESULTS

A negative association was found between household income and scores on two of the four MASC subscales--physical symptoms and separation/panic anxiety. In contrast, at equivalent levels of household income, adolescents living in higher income neighborhoods reported higher physical and harm avoidance symptom scores.

CONCLUSION

The role that SES plays in the development of childhood anxiety appears to be complex and to differ depending on the specific type of anxiety that is manifest and whether income is evaluated at the household or neighborhood level.

The direction of effects between perceived parental behavioral control and psychological control and adolescents' self-reported GAD and SAD symptoms

This study examined the direction of effects and age and sex differences between adolescents' perceptions of parental behavioral and psychological control and adolescents' self-reports of generalized anxiety disorder (GAD) and separation anxiety disorder (SAD) symptoms. The study focused on 1,313 Dutch adolescents (early-to-middle cohort n = 923, 70.3%; middle-to-late cohort n = 390, 29.7%) from the general population. A multi-group, structural equation model was employed to analyze the direction of the effects between behavioral control, psychological control and GAD and SAD symptoms for the adolescent cohorts. The current study demonstrated that a unidirectional child effect model of the adolescents' GAD and SAD symptoms predicting parental control best described the data. Additionally, adolescent GAD and SAD symptoms were stronger and more systematically related to psychological control than to behavioral control. With regard to age-sex differences, anxiety symptoms almost systematically predicted parental control over time for the early adolescent boys, whereas no significant differences were found between the late adolescent boys and girls.

Genetic and environmental influences on internalizing psychopathology vary as a function of economic status

BACKGROUND

Different theories of the link between socio-economic status (SES) and mental illness have been postulated. In particular, two theories of this association, social causation and social selection, differ in the implied causal pathway. The authors employ behavior genetic modeling to consider evidence for both social selection and social causation in the relationship between income variation and internalizing disorders.

METHOD

Behavior genetic modeling was used to estimate the presence of gene-environment interaction (GxE, social causation) in the presence of gene-environment correlation (rGE, social selection). Participants were members of a sample of 719 twin pairs from the Midlife in the United States study. Four internalizing (INT) syndromes were assessed: major depression (MD); generalized anxiety disorder (GAD); panic attacks (PA); neuroticism (N). SES was measured with total family household income.

RESULTS

One factor best accounted for the variance shared between MD, GAD, PA and N. The etiology of variation in INT changed from high to low levels of income, with unique environmental factors playing a larger role in INT variation at lower levels of income. Across levels of income, rGE between income and INT was modest (low income ra=0.39 to high income ra=0.54), implying a selection process operating through genetic effects linking lower income with INT psychopathology.

CONCLUSIONS

Findings support social causation by suggesting that low income contributes significantly to environmental variation in INT. Modest support was found for social selection, but should be extended using longitudinal designs. Effective interventions for internalizing psychopathology may differ depending on income.

Genetic influences on anxiety in children: what we've learned and where we're heading

Anxiety is a common problem, typically beginning early in life. This article explores reasons for individual differences in levels of anxiety among children, by reviewing the genetic literature. The plethora of research to date has demonstrated clearly that both genes and environmental influences play important roles in explaining differences in levels of anxiety of various types among children. This has encouraged researchers to search for specific genes and environmental influences upon anxiety. Despite important progress in identifying links between anxiety and specific genes--including associations between serotonin and dopamine genes and different symptoms of anxiety--overall, progress has been slow because multiple genes of small effect size are likely to influence anxiety. This article explains how the hunt for genes involved in anxiety is likely to benefit from genetically sensitive research, which examines the co-occurrence of symptoms; includes measures of the environment; and examines endophenotypes and risk pathways.

The relationship of maternal separation anxiety and differentiation of self to children's separation anxiety and adjustment to kindergarten: a study in Druze families

The study explores relationships between preschoolers' separation anxiety and adjustment to kindergarten and their mothers' separation anxiety and levels of differentiation. It also examines the universality of several theoretical and clinical notions in Bowen's [Bowen, M. (1978). Family therapy in clinical practice. Aronson: New York] Family Systems Theory, by testing them in the Eastern-collectivist Israeli-Druze society. The main findings were positive correlations between mothers' and children's separation anxiety, as well as negative correlations between children's separation anxiety and maternal differentiation (for total DSI score and for emotional cutoff), so that lower differentiation and higher cutoff were associated with higher levels of anxiety. Another interesting finding was that teachers perceived the children of Druze working mothers as having more problematic behaviors than non-working mothers, pointing to poorer adjustment to kindergarten. Results suggest that a crucial balance of separation and closeness provides an optimal context for meeting the needs and promoting the healthy development of both mother and child. The present study is the first to indicate relations between mothers' differentiation and preschoolers' separation anxiety among Druze participants, partially supporting the universality of Bowen's theory "in all families and in all cultures" [Kerr, M., & Bowen, M. (1988). Family evaluation. New York: Norton, p. 202].

Genetic and environmental contributions to common psychopathologies of childhood and adolescence: a study of twins and their siblings

We report findings based on analyses of self-reports of six common adolescent psychopathologies (attention deficit/hyperactivity disorder, ADHD; conduct disorder, CD; oppositional defiant disorder, ODD; generalized anxiety disorder, GAD; separation anxiety disorder, SAD; and major depressive disorder, MDD) in a sample of 1,162 male and female adolescent (12-19 years) twin pairs and 426 siblings. Prevalence statistics for past year and lifetime reports confirm differences between genders for CD, GAD, SAD, and MDD, and a lack of differences between twins and their non-twin siblings. Biometrical modeling was conducted to ascertain the relative influences of genes, and shared and non-shared environments contributing to these disorders. A more robust estimate of these parameters was obtained by including non-twin siblings. Age-specific thresholds were integrated into the analyses to appropriately model the developmental patterns of behavior. We found evidence for both genetic and non-shared environmental influences for all disorders. Shared environmental influences also seem to be important for MDD and lifetime GAD.

Separation anxiety disorder, panic disorder, and school refusal

Studies attest to the chronic nature of anxiety in youth. Consequently, there is a growing literature examining causative pathways to these disorders and efficacious treatments for them. This review examines separation anxiety disorder, a commonly occurring childhood anxiety disorder, and panic disorder, a more rare anxiety disorder in youth. Finally, school refusal, which may be tied to an internalizing or externalizing disorder or no disorder at all, is examined.

Separation anxiety disorder

SAD is a disorder that can cause a great deal of distress and impairment. Children with the disorder often miss school, as well as many other important social opportunities like playing with friends and participating in extracurricular activities. It is quite likely that, if untreated, SAD can lead to numerous negative psychosocial outcomes. Luckily, effective treatments for SAD are available, including CBT and SSRI pharmacotherapy. Pediatricians can play an important role in identifying SAD and other anxiety disorders and providing parents with information about appropriate treatments.