This slide contains information regarding Childhood Psychiatric Disorders (Emotional disorder: Separation anxiety and school phobia). This can be helpful for proficiency level and bachelor level nursing students. Your feedback is highly appreciated. Thank you!

1. Emotional Disorders in
Children
Nabina Paneru

2. Separation Anxiety
• Separation anxiety disorder is a medical condition that is
characterized by significant distress when a person is
away from parents, another caregiver, or home.
• SAD is characterized by an abnormal reaction to real or
imaginary separation from attachment figures that
significantly interferes with daily activities and
developmental tasks.
(Ono & Saito, 2012)

3. Epidemiology
• The prevalence of school refusal and separation anxiety disorder
ranges from 2-5%
• One third of children with separation anxiety disorder have
comorbid depressive disorder
• Increased incidence among families of lower socio economic status,
as well as among single – parent families
• Separation anxiety symptoms usually peak between 9 and 13
months of age, decrease usually after two years of age, with
increasing levels of autonomy by the age of three.

4. Etiology
Genetic causes Change in environment Stress
Over protective parents

5. Clinical Features
• The cardinal symptom is a significant distress, or
excessive and unrealistic fears, upon separation from
parents of the home. (APA, 2000)
• The child worries that something may happen to his
parents (e.g., that they will disappear, get lost or forget
about him) or the child will get lost, kidnapped or killed
if he is not near his parents.

6. Contd.
• Behavioral
- Crying
- Clinging
- Complaining upon separation
- Searching or calling for parent after their departure.
- Reluctant or refusal to go out, away from home

7. Contd.
• Physical Signs
- Headaches
- Abdominal pain
- Lightheadedness, dizziness
- Nightmares, sleep difficulties
- Nausea, vomiting
- Cramps, muscle aches
- Palpitations, chest pain

8. Common Situations
• Situations when separation anxiety symptoms can appear are when the child;
- Is left at day care
- Enters school
- Gets on the school bus
- Being bullied
- Is left at home with baby sitters
- Change of school
- Confronts parental separation or divorce

9. Diagnostic Criteria (DSM V)
• Presence of at least 3 out of 8 possible anxiety
symptoms that appear during separation situation
• Symptoms must be present during at least 4 weeks and
must dtart before the age of 18
• Symptoms cause clinically significant level of distress or
impairment in social, academic, occupational and other
areas of functioning that is not explained by another
disorder.

10. Treatment
• Psychological treatment
• Pharmacological treatment

11. Psychological Treatment
• Relaxation technique with participant modeling and
subsequent reinforced practice
• CBT: systematic desensitization, exposure and operant
behavioral techniques, modeling, role playing, reward
system
• Psychological Therapy
- Family therapy
- Social therapy

12. Pharmacological Treatment
• Tricyclic antidepressants: Imipramine
• Selective serotonin reuptake Inhibitor (SSRI) –
fluoxetine, sertraline
• Beta adrenergic blocking agents: propranolol
• Benzodiazepine: alprazolam, buspirone

13. School Phobia

14. School Phobia
• Refusal to attend school due to emotional distress.
• According to American Academy of Child and
Adolescent Psychiatry, refusal to go to school is most
common in the period from pre school through second
grade.

15. Prevalence
• Approx. 1 to 5% of school –aged children have school
refusal
• Most common in 5 - 6 years olds and in 10 – 11 year
olds

16. Etiology
• History of separation anxiety, or other personality
disturbances
• Poor parent child bonding
• Fear of teachers, fear of failing exam
• Discrimination based on arce, dress, physical defect
• Bullying in school
• Pressure from study (heavy assignments, less break time
etc)

17. Clinical Features
• Refuses to attend school, cried or protest every morning
before school
• Trauncy (absent from school without permission)
• Distress
• Develop some type of physical symptoms when its time to go
to school
• Physical symptoms: nausea, vomiting, anorexia, headache,
dizziness, abdominal pain, leg pain even low grade fever

18. Treatment
• Psychological Treatment
 CBT
- Systematic desensitization
- Exposure therapy
- Operant behavioral techniques
- Therapeutic techniques: modeling, role playing
- Individual and group therapy
- Close monitoring

19. Contd.
• Pharmacological treatment
 Anti anxiety medicine
 Serotonin Reuptake inhibitors: Fluoxetine (Prozac) may
be useful for underlying depression
 Propranolol to treat depression and anxiety symptoms

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