674 CHAPTER 14
or “high maintenance,” which can lead to tension and frustration for all concerned.
In some cases, the child’s behavior may resemble that of those with oppositional de-
fi ant disorder; however, children with separation anxiety disorder, unlike those with
oppositional defi ant disorder, generally comply with requests that do not require
them to be separated from the parent.
Finally, we note that refusal to attend school is not always caused by separation
anxiety disorder, however. It may arise because of a mood disorder, social phobia,
or oppositional defi ant disorder. Clinicians must thoroughly evaluate the reasons
for the school refusal before diagnosing separation anxiety disorder.Understanding Separation Anxiety Disorder
Separation anxiety disorder most commonly arises in children who are part of tight-
knit families (American Psychiatric Association, 2000). Separation anxiety disorder is
more common among fi rst-degree relatives (parents and siblings) than in the general
population, and the disorder is considered to be moderately heritable (Cronk et al.,
2004). However, the heritability probably refl ects a heritability of anxiety in general:
Separation anxiety is more common among children whose mothers have panic disor-
der than among children whose mothers don’t have that disorder (Cronk et al., 2004).
But other factors create feedback loops: Tight-knit families may reinforce behav-
iors associated with anxiety about separation and may punish behaviors associated
with actual separation. If so, then children in such families who have temperaments
that are high in harm avoidance and reward dependence may be especially vulnera-
ble, because they will be relatively responsive to reward and punishment. Moreover,
separation anxiety disorder is more common in children whose fathers are absent
(Cronk et al., 2004), perhaps because that absence leads the child to have a height-
ened fear of losing the remaining parent.Treating Separation Anxiety Disorder
As with other anxiety disorders, treatment of separation anxiety disorder may
involve CBT (with exposure and cognitive restructuring; see Chapter 7). Family therapy
is often another component of treatment; the therapist identifi es any family patterns
that maintain the disorder and helps parents change their interaction patterns to
encourage and reinforce their child for engaging in appropriate separation behaviors
(Siqueland, Rynn, & Diamond, 2005).Other Types of Disorders of Childhood, in Brief
Let’s now consider four subcategories of DSM-IV-TR disorders that typically arise
in childhood: communication disorders, feeding and eating disorders, elimination
disorders, and tic disorders. Disorders in these subcategories involve behaviors that
are on an extreme end of a continuum, and thus represent abnormal rather than
normal behaviors.Communication Disorders
Some children evidence communication disorders, which are disorders characterized
by signifi cant problems in understanding language or in expressing themselves with
language. (Children with hearing problems are not considered to have problems in
understanding language unless they have clear diffi culty learning sign language or
other forms of language that do not require hearing.) A mental health clinician may
be asked to help determine whether a child’s apparent diffi culty comprehending lan-
guage or expressing himself or herself is abnormal—outside the normal range—and,
if so, whether a disorder other than a communication disorder might better account
for the problems. For instance, a child might willfully refuse to speak or appear to
misunderstand others (oppositional defi ant disorder) or might be so anxious that
he or she is “scared speechless.” Alternatively, a child might exhibit problems with
coherently expressing himself or herself because of childhood-onset schizophrenia,Communication disorders
A set of psychological disorders characterized
by signifi cant problems in understanding
language or using language to express
oneself.
P SN