Childhood Disorders 671
- Some children may, from time to time, exhibit repetitive movements, such as ab-
normally frequent eye blinking or repetitive vocal sounds such as throat clearing
or odd noises.These behaviors or constellations of behaviors are common enough to be consid-
ered normal patterns of infancy, childhood, and adolescence, but sometimes they
may indicate any of a number of disorders. In the following sections we discuss the
circumstances in which such behaviors would lead a clinician to diagnose a disorder.
First, we’ll explore an anxiety disorder that most typically arises in children—
separation anxiety disorder. Then, we’ll briefl y review other types of disorders that
can arise in children. Most of these disorders come to the attention of a pediatri-
cian, who may treat the problem or, if needed, recommend a specialist; depending
on the nature of the problem, the pediatrician might refer the child to a speech
therapist, urologist, nutritionist, gastroenterologist, mental health clinician, or some
other type of specialist.
Separation Anxiety Disorder
Although anxiety disorders form a distinct category in DSM-IV-TR (see Chap-
ter 7), one anxiety disorder is placed among disorders pertaining to infancy,
childhood, and adolescence because DSM-IV-TR specifi es that it must begin in
childhood. That disorder is separation anxiety disorder, which is characterized
by excessive anxiety about separation from home or from someone to whom the
child has become attached. In this section the word parent refers to the individual
from whom the child fears separation; that individual may be the mother, father,
some other family member, caretaker, or other person involved in the child’s life.
We’ll examine separation anxiety disorder in detail, then turn to its causes and
treatment.
What Is Separation Anxiety Disorder?
During different phases of development, an infant or toddler will normally become
distressed on separating (or even thinking about separating) from a parent. To
qualify for a diagnosis of separation anxiety disorder, the anxiety, distress, or im-
paired functioning must be excessive and must be exhibited over a period of at least
4 weeks (see Table 14.16).
Separation anxiety is more than a child’s getting upset about temporarily say-ing goodbye to a parent. Children with separation anxiety disorder may become so
homesick when away from home that activities—such as a sleepover at a friend’s or
a stay at overnight camp—are interrupted in order to return home. Or these children
may want to know the parent’s whereabouts at all times, using a cell phone to make
frequent contact during any physical separation. And when away from the parent,
they may also manifest physical symptoms of anxiety (see Chapter 7): dizziness,
stomachaches, nausea and vomiting, and feeling faint (American Psychiatric Asso-
ciation, 2000). When the disorder emerges in children younger than 6 years old, the
clinician can specify “early onset.”
Some children with separation anxiety disorder fear that they will get perma-nently “lost” from their parents, and their dreams have similar themes. And like
people with agoraphobia (see Chapter 7), they may be unable to leave the house
alone (at an age when it would be appropriate to do so) or even to be in their
room alone. Such children often try to stay within a few feet of the parent, moving
from room to room as the parent moves from room to room. At bedtime, they may
be unable to fall asleep unless someone else is in the room with them, and during
the night, they may crawl into bed with parents or a sibling. If parents lock their
bedroom door at night, the child may sleep on the fl oor right outside the door. If
children with this disorder are separated from their parent, they may have persistent
Separation anxiety disorder
A psychological disorder that typically arises
in childhood and is characterized by excessive
anxiety about separation from home or from
someone to whom the individual has become
attached.