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Separation Anxiety and Selective Mutism Disorder (Separation Anxiety…
Separation Anxiety and Selective Mutism Disorder
Separation Anxiety Disorder
Diagnostic Criteria
C.
Significant distress or impairment in important areas of functioning.
D.
Not better explained by another mental disorder
B.
Persistent, 4 weeks+ in children/adolescents and 6 months+ in adults.
A.
Developmentally inappropriate and excessive fear of separation from attachments evidenced by at least 3 of:
Recurrent, excessive distress anticipating or experiencing separation
Persistent, excessive worry about losing major attachment figures or harm coming to them
Persistent, excessive worry about experiencing an event that causes separation.
Persistent reluctance or refusal to go places because of fear of separation.
Persistent, excessive fear or reluctance about being alone or without major attachment figures
Persistent reluctance or refusal to sleep away
Repeated nightmares involving separation
Physical symptoms when separation occurs or is anticipated.
Prevalence and culture-related issues
Children (6-12months) - 4%
Adolescence - 1.6%
Most common anxiety disorder in children aged under 3 years. In community sample, higher in females but clinical sample it is the same
Cultural variations in the degree to which it is considered desirable to tolerate separation. E.g. differing values on the expected time for children to leave the parental home
Risk and Prognostic Factors
Environmental - overprotective and intrusive parents. Onset usually after ALE (i.e. loss, divorce, pet died).
Genetic - Heritability was estimated at 73% in a community sample of 6-year-old twins, higher in females. Also show enhanced sensitivity to respiratory stimulation using C02-enriched air.
Differential Diagnosis
GAD
- SAD is predominantly fears of sep. from attachment figure.
Panic disorder and Agoraphobia
- SAD indivs are not anxious about being trapped or incapacitated in situations from which es cape is perceived as difficult in the event of panic-like symptoms
Conduct disorder
Social anxiety disorder
PTSD
- (PTSD), the central symptoms concern intrusions about, and avoidance of, memories associated with the traumatic event itself
Illness anxiety disorder
Bereavement
Depressive and bipolar disorders
.
Oppositional defiant disorder
.
Psychotic disorders
Personality disorders
- Dependent personality disorder is characterized by an indis criminate tendency to rely on others, whereas separation anxiety disorder involves con cern about the proximity and safety of main attachment figures. BPD is concerned with fear of abandonment, however impulsivity and self-identity are crucial to this disorder, not in SAD.
Development and Course
Onset of separation anxiety disorder may be as early as preschool age and may occur at any time during child hood and more rarely in adolescence. Periods of exacerbation and re mission
Manifestation of Sx vary - Younger children are more reluctant/avoid going to school, may not express worries/fears. As children age, worries emerge; these are often worries about specific dangers or vague concerns about not being reunited.
Selective Mutism
Risk and Prognostic Factors
Temperamental -
Negative affectivity (neuroticism) or behavioral inhibition may play a role, as may parental history of shyness, social isolation, and social anxiety
Environmental -
parents may act as a model to show social reticence
Genetic
- may be shared genes with social anxiety disorder
Development and Course
Onset usually before 5 years and becomes more evident in school when tasks like reading aloud are required. Most indivs may outgrow SM but those with social anxiety, symptoms may persist
Prevalence and culture-related issues
Prev. unknown
Children who has immigrated to a country where they do not know the language may refuse to speak the new language. If comprehension of the new language is adequate but refusal to speak persists, SM diagnosis is warranted.
Differential Diagnosis
ASD, schizophrenia or other psychotic disorders -
SM should only be diagnosed when the child has developed the capacity to speak in other situations (i.e. at home)
Social anxiety disorder
- social anxiety and social avoidance may be present, thus can co-diagnose.
Communication Disorders
- children with SM may have difficulties in their receptive language abilities , however in comm. disorders, lack of speech is not limited to certain social situations
Diagnostic Criteria
B.
Disturbance interferes with educational or occupational achievement and social communication
C.
Duration 1+ months
A.
Consistent failure to speak in social settings in which speaking is expected (at school), despite speaking in other places
D.
Failure to speak is not attributable to lack of knowledge or comfort with the spoken language
E.
Not better explained by a communication disorder and does not exclusively occur as an episode in ASD, schizophrenia or other psychotic disorders