eMedicine Specialties > Pediatrics: Developmental and Behavioral > Medical Topics

Anxiety Disorder, Separation Anxiety and School Refusal: Differential Diagnoses & Workup

Author: Bettina E Bernstein, DO, Assistant Professor, Department of Psychiatry, Philadelphia College of Osteopathic Medicine; Private Practice at the Wynnewood House; Consultant, Child Guidance Resource Centers, Early Elementary Education Program, Clinical Affiliate, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia
Contributor Information and Disclosures

Updated: Dec 3, 2008

Differential Diagnoses

Anxiety Disorder: Generalized Anxiety
Anxiety Disorder: Social Phobia and Selective Mutism

Other Problems to Be Considered

Posttraumatic stress disorder
Specific phobias
Inappropriate academic placement
Avoidance of school because of fear of violence (eg, gang-related violence) or teasing
Truancy
Conduct disorder
Substance abuse or dependence
Depression (Note that depressed or anxious children are commonly teased.)
Grief reaction
Brain tumor (especially if associated with vision or coordination impairment)
Communication disorder (Not otherwise specified)
Oppositional defiant disorder
Generalized anxiety disorder
Panic disorder

Workup

Laboratory Studies

  • Consider the following tests to rule out possible conditions in patients with suspected separation anxiety, school refusal, or both only when clinically pertinent and age relevant.
    • Triiodothyronine (T3), thyroxine (T4), thyroid-stimulating hormone (TSH) - To rule out thyroid abnormalities
    • Two-hour postprandial glucose - To rule out type I or type II diabetes mellitus
    • Titers (especially with a history that includes fever, rash, or sore throat with incomplete or no treatment [with antibiotics] and history of acute change in personality or anxiety or obsessive features) - For antistreptococcal antibodies (ASO titer), Babesia (to rule out babesiosis), Lyme disease, and rickettsial illness (eg, Rocky Mountain spotted fever)
  • Blood level of lead and other heavy metals such as mercury - To rule out lead or heavy metal poisoning (abdominal pain)
  • CBC count, hematocrit (Hct) level, hemoglobin (Hgb) concentration - To rule out the presence of anemia, for example, as a cause of abdominal pain
  • Drug screen of urine for drugs of abuse - To rule out stimulant or steroid abuse

Imaging Studies

  • If other information suggests brain tumor or seizure disorder, perform appropriate imaging studies (eg, MRI, CT scanning, positron emission tomography [PET] scanning).
  • Obtain an echocardiogram with functional examination to rule out mitral valve prolapse or other structural cardiac abnormalities (eg, regurgitation).

Other Tests

  • Functional behavioral assessment should include specific observations of the child's symptoms and behaviors; note frequency, intensity, location, and proximity to caregiver.
  • Family assessment is often extremely helpful. Family therapy can reveal whether intergenerational factors maintain or worsen symptoms as well as improve dysfunctional patterns of family communication and interaction. In the family assessment, the style of relatedness of the family should be described; enmeshed versus disengaged family stressors, including losses (especially if proximate to the start of symptoms), and family history of anxiety, alcoholism, somatoform, or mood disorders should be noted.
  • Family history of school refusal (especially in mothers) is also helpful because it may correlate with separation anxiety disorders in the child.
  • History of prominent anxiety symptoms in either the child or parents in certain situations (eg, preanesthesia, perianesthesia) may correlate with phobic or anxious symptoms in the child at a different time (ie, postanesthesia).
  • Perform a structured or semistructured interview to determine whether a risk of suicidal ideation is present.
  • Structured or semistructured interview scales are extremely helpful in confirming the clinical diagnosis and should be administered by clinically experienced personnel (eg, child and adolescent psychiatrists, developmental and behavioral pediatricians, clinical psychologists, social workers). The following are examples of structured or semistructured interview scales to assess anxiety disorders in children and adolescents:
    • Schedule for Affective Disorders and Schizophrenia for School-Age Children–Epidemiologic Version-5 (K-SADS-E5)
    • Schedule for Affective Disorders and Schizophrenia for School-Age Children–Present and Lifetime Version (K-SADS-PL)
    • Diagnostic Interview for Children and Adolescents Revised (DICA-R)
    • National Institute of Mental Health Diagnostic Interview Schedule for Children (DISC)
    • Anxiety Disorders Interview Schedule for Children (ADIS)
    • The Hamilton Anxiety Rating Scale
    • The Anxiety Rating Scale for Children (Revised)
    • Multidimensional Anxiety Scale for Children (MASC)
    • Revised Children's Manifest Anxiety Scale
    • Visual Analogue Scale for Anxiety (Revised)
    • Interview Schedule for Anxiety Disorders for DSM-IV (Child Version)
    • Social Anxiety Scale for Children (Revised)
    • Child Behavior Checklist
    • Selective Mutism Questionnaire

More on Anxiety Disorder, Separation Anxiety and School Refusal

Overview: Anxiety Disorder, Separation Anxiety and School Refusal
Differential Diagnoses & Workup: Anxiety Disorder, Separation Anxiety and School Refusal
Treatment & Medication: Anxiety Disorder, Separation Anxiety and School Refusal
Follow-up: Anxiety Disorder, Separation Anxiety and School Refusal
References
[ CLOSE WINDOW ]

References

  1. American Psychiatric Association. Diagnostic & Statistical Manual of Mental Disorders: DSM-IV. 4th ed. Washington, DC: American Psychiatric Press; 1994:110-6, 411-6.

  2. Burke AE, Silverman WK. The prescriptive treatment of school refusal. Clin Psychol Rev. 1987;7(4):353-362.

  3. Egger HL, Costello EJ, Angold A. School refusal and psychiatric disorders: a community study. J Am Acad Child Adolesc Psychiatry. Jul 2003;42(7):797-807. [Medline].

  4. McShane G, Walter G, Rey JM. Characteristics of adolescents with school refusal. Aust N Z J Psychiatry. Dec 2001;35(6):822-6. [Medline].

  5. Battaglia M, Bertella S, Politi E, et al. Age at onset of panic disorder: influence of familial liability to the disease and of childhood separation anxiety disorder. Am J Psychiatry. Sep 1995;152(9):1362-4. [Medline].

  6. Kearney CA, Sims KE, Pursell CR, Tillotson CA. Separation anxiety disorder in young children: a longitudinal and family analysis. J Clin Child Adolesc Psychol. Dec 2003;32(4):593-8. [Medline].

  7. Bowen RC, Offord DR, Boyle MH. The prevalence of overanxious disorder and separation anxiety disorder: results from the Ontario Child Health Study. J Am Acad Child Adolesc Psychiatry. Sep 1990;29(5):753-8. [Medline].

  8. Meadow R. Mothering to death. Arch Dis Child. Apr 1999;80(4):359-62. [Medline].

  9. Granell de Aldaz E, Vivas E, Gelfand DM, Feldman L. Estimating the prevalence of school refusal and school-related fears. A Venezuelan sample. J Nerv Ment Dis. Dec 1984;172(12):722-9. [Medline].

  10. Viana AG, Beidel DC, Rabian B. Selective mutism: A review and integration of the last 15 years. Clin Psychol Rev. Sep 30 2008;[Medline].

  11. Suveg C, Aschenbrand SG, Kendall PC. Separation anxiety disorder, panic disorder, and school refusal. Child Adolesc Psychiatr Clin N Am. Oct 2005;14(4):773-95, ix. [Medline].

  12. Manassis K, Tannock R. Comparing interventions for selective mutism: a pilot study. Can J Psychiatry. Oct 2008;53(10):700-3. [Medline].

  13. Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry. Jan 2006;163(1):41-7. [Medline]. [Full Text].

  14. Achenbach TM. Manual for the Child Behavior Checklist 4-18 and 1991 Profile. Burlington: University of Vermont Dept of Psychiatry; 1991:4-18.

  15. Barrett PM. Evaluation of cognitive-behavioral group treatments for childhood anxiety disorders. J Clin Child Psychol. Dec 1998;27(4):459-68. [Medline].

  16. Barrett PM, Dadds MR, Rapee RM. Family treatment of childhood anxiety: a controlled trial. J Consult Clin Psychol. Apr 1996;64(2):333-42. [Medline].

  17. Barrett PM, Rapee RM, Dadds MM, Ryan SM. Family enhancement of cognitive style in anxious and aggressive children. J Abnorm Child Psychol. Apr 1996;24(2):187-203. [Medline].

  18. Berg I, Jackson A. Teenage school refusers grow up: a follow-up study of 168 subjects, ten years on average after in-patient treatment. Br J Psychiatry. Oct 1985;147:366-70. [Medline].

  19. Bernstein GA, Borchardt CM, Perwien AR. Anxiety disorders in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. Sep 1996;35(9):1110-9. [Medline].

  20. Bernstein GA, Garfinkel BD. The visual analogue scale for anxiety - Revised: Psychometric properties. J Anxiety Disord. 1992;6(3):223-239.

  21. Bernstein GA, Garfinkel BD, Borchardt CM. Comparative studies of pharmacotherapy for school refusal. J Am Acad Child Adolesc Psychiatry. Sep 1990;29(5):773-81. [Medline].

  22. Bernstein GA, Hektner JM, Borchardt CM, McMillan MH. Treatment of school refusal: one-year follow-up. J Am Acad Child Adolesc Psychiatry. Feb 2001;40(2):206-13. [Medline].

  23. Bernstein GA, Layne AE, Egan EA, Nelson LP. Maternal phobic anxiety and child anxiety. J Anxiety Disord. 2005;19(6):658-72. [Medline].

  24. Bernstein GA, Massie ED, Thuras PD, et al. Somatic symptoms in anxious-depressed school refusers. J Am Acad Child Adolesc Psychiatry. May 1997;36(5):661-8. [Medline].

  25. Biederman J. The diagnosis and treatment of adolescent anxiety disorders. J Clin Psychiatry. May 1990;51 Suppl:20-6; discussion 50-3. [Medline].

  26. Birmaher B, Brent DA, Chiappetta L, et al. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry. Oct 1999;38(10):1230-6. [Medline].

  27. Call JD. Extraordinary changes in behavior in an infant after a brief separation. J Dev Behav Pediatr. Dec 1998;19(6):424-8. [Medline].

  28. Cantwell DP, Lewinsohn PM, Rohde P, Seeley JR. Correspondence between adolescent report and parent report of psychiatric diagnostic data. J Am Acad Child Adolesc Psychiatry. May 1997;36(5):610-9. [Medline].

  29. [Best Evidence] Cheung AH, Emslie GJ, Mayes TL. The use of antidepressants to treat depression in children and adolescents. CMAJ. Jan 17 2006;174(2):193-200. [Medline].

  30. Chorpita BF, Albano AM, Heimberg RG, Barlow DH. A systematic replication of the prescriptive treatment of school refusal behavior in a single subject. J Behav Ther Exp Psychiatry. Sep 1996;27(3):281-90. [Medline].

  31. Clark DB, Donovan JE. Reliability and validity of the Hamilton Anxiety Rating Scale in an adolescent sample. J Am Acad Child Adolesc Psychiatry. Mar-Apr 1994;33(3):354-60. [Medline].

  32. Coffey BJ. Review and update: benzodiazepines in childhood and adolescence. Psychiatr Ann. 1993;23:332-339.

  33. Cohan SL, Chavira DA, Shipon-Blum E, Hitchcock C, Roesch SC, Stein MB. Refining the classification of children with selective mutism: a latent profile analysis. J Clin Child Adolesc Psychol. Oct 2008;37(4):770-84. [Medline].

  34. Croghan LM. Conceptualizing the critical elements in a rapid desensitization to school anxiety: a case study. J Pediatr Psychol. Jun 1981;6(2):165-70. [Medline].

  35. Dashiff CJ. Understanding separation anxiety disorder. J Child Adolesc Psychiatr Nurs. Apr-Jun 1995;8(2):27-38. [Medline].

  36. Desombre H, Fourneret P, Revol O, de Villard R. [School refusal anxiety]. Arch Pediatr. Jan 1999;6(1):97-101. [Medline].

  37. Diaz JH. Intranasal ketamine preinduction of paediatric outpatients. Paediatr Anaesth. 1997;7(4):273-8. [Medline].

  38. Elliott JG. School refusal: issues of conceptualisation, assessment, and treatment. J Child Psychol Psychiatry. Oct 1999;40(7):1001-12. [Medline].

  39. Flakierska-Praquin N, Lindstrom M, Gillberg C. School phobia with separation anxiety disorder: a comparative 20- to 29- year follow-up study of 35 school refusers. Compr Psychiatry. Jan-Feb 1997;38(1):17-22. [Medline].

  40. Foley DL, Pickles A, Maes HM, Eaves LJ. Course and short-term outcomes of separation anxiety disorder in a community sample of twins. J Am Acad Child Adolesc Psychiatry. Sep 2004;43(9):1107-14. [Medline].

  41. Green RJ, Werner PD. Intrusiveness and closeness-caregiving: rethinking the concept of family "Enmeshment". Fam Process. Jun 1996;35(2):115-36. [Medline].

  42. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol. 1959;32(1):50-5. [Medline].

  43. Hanna GL, Fischer DJ, Fluent TE. Separation anxiety disorder and school refusal in children and adolescents. Pediatr Rev. Feb 2006;27(2):56-63. [Medline].

  44. Hanna GL, Fluent TE, Fischer DJ. Separation anxiety in children and adolescents treated with risperidone. J Child Adolesc Psychopharmacol. 1999;9(4):277-83. [Medline].

  45. Harter MC, Conway KP, Merikangas KR. Associations between anxiety disorders and physical illness. Eur Arch Psychiatry Clin Neurosci. Dec 2003;253(6):313-20. [Medline].

  46. Herschkowitz N, Kagan J, Zilles K. Neurobiological bases of behavioral development in the first year. Neuropediatrics. Dec 1997;28(6):296-306. [Medline].

  47. Hertsgaard L, Gunnar M, Erickson MF, Nachmias M. Adrenocortical responses to the strange situation in infants with disorganized/disoriented attachment relationships. Child Dev. Aug 1995;66(4):1100-6. [Medline].

  48. Hirshfeld DR, Biederman J, Brody L, et al. Associations between expressed emotion and child behavioral inhibition and psychopathology: a pilot study. J Am Acad Child Adolesc Psychiatry. Feb 1997;36(2):205-13. [Medline].

  49. Ialongo N, Edelsohn G, Werthamer-Larsson L, et al. The significance of self-reported anxious symptoms in first grade children: prediction to anxious symptoms and adaptive functioning in fifth grade. J Child Psychol Psychiatry. Mar 1995;36(3):427-37. [Medline].

  50. Kagan J, Reznick JS, Snidman N. Biological bases of childhood shyness. Science. Apr 8 1988;240(4849):167-71. [Medline].

  51. Kain ZN, Mayes LC, Wang SM, et al. Parental presence during induction of anesthesia versus sedative premedication: which intervention is more effective?. Anesthesiology. Nov 1998;89(5):1147-56; discussion 9A-10A. [Medline].

  52. Kain ZN, Wang SM, Mayes LC, et al. Distress during the induction of anesthesia and postoperative behavioral outcomes. Anesth Analg. May 1999;88(5):1042-7. [Medline].

  53. Kaufman J, Birmaher B, Brent D, et al. Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry. Jul 1997;36(7):980-8. [Medline].

  54. Kearney CA, Albano AM. The functional profiles of school refusal behavior. Diagnostic aspects. Behav Modif. Jan 2004;28(1):147-61. [Medline].

  55. Kearney CA, Albano AM. The functional profiles of school refusal behavior. Diagnostic aspects. Behav Modif. Jan 2004;28(1):147-61. [Medline].

  56. Keen DV, Fonseca S, Wintgens A. Selective mutism: a consensus based care pathway of good practice. Arch Dis Child. Oct 2008;93(10):838-44. [Medline].

  57. Kendall PC. Treating anxiety disorders in children: results of a randomized clinical trial. J Consult Clin Psychol. Feb 1994;62(1):100-10. [Medline].

  58. King N, Ollendick T, Heyne D, Tonge B. Treatment of school refusal. Strategies for the family physician. Aust Fam Physician. Jul 1995;24(7):1250-3. [Medline].

  59. King N, Tonge BJ, Heyne D, Ollendick TH. Research on the cognitive-behavioral treatment of school refusal: a review and recommendations. Clin Psychol Rev. Jun 2000;20(4):495-507. [Medline].

  60. King NJ, Bernstein GA. School refusal in children and adolescents: a review of the past 10 years. J Am Acad Child Adolesc Psychiatry. Feb 2001;40(2):197-205. [Medline].

  61. Last CG, Francis G, Hersen M, et al. Separation anxiety and school phobia: a comparison using DSM-III criteria. Am J Psychiatry. May 1987;144(5):653-7. [Medline].

  62. Last CG, Hersen M, Kazdin A, et al. Anxiety disorders in children and their families. Arch Gen Psychiatry. Oct 1991;48(10):928-34. [Medline].

  63. Last CG, Perrin S, Hersen M, Kazdin AE. A prospective study of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry. Nov 1996;35(11):1502-10. [Medline].

  64. Letamendi AM, Chavira DA, Hitchcock CA, Roesch SC, Shipon-Blum E, Stein MB. Selective Mutism Questionnaire: Measurement Structure and Validity. J Am Acad Child Adolesc Psychiatry. Aug 8 2008;[Medline].

  65. Levine S, Lyons DM, Schatzberg AF. Psychobiological consequences of social relationships. Ann N Y Acad Sci. Jan 15 1997;807:210-8. [Medline].

  66. Linet LS. Tourette syndrome, pimozide, and school phobia: the neuroleptic separation anxiety syndrome. Am J Psychiatry. May 1985;142(5):613-5. [Medline].

  67. Lutz WJ, Hock E. Maternal separation anxiety: relations to adult attachment representations in mothers of infants. J Genet Psychol. Mar 1995;156(1):57-72. [Medline].

  68. Malone CA. Family therapy. In: Jerry M, ed. Textbook of Child and Adolescent Psychiatry. Washington, DC: American Psychiatric Press; 1991:605-16.

  69. March JS, Parker JD, Sullivan K, et al. The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry. Apr 1997;36(4):554-65. [Medline].

  70. Martin C, Cabrol S, Bouvard MP, et al. Anxiety and depressive disorders in fathers and mothers of anxious school-refusing children. J Am Acad Child Adolesc Psychiatry. Jul 1999;38(7):916-22. [Medline].

  71. Mathew MC. A child returns to her mother.... Pediatr Rehabil. Jan-Mar 1997;1(1):59-61. [Medline].

  72. McDermott JF, Werry J, Petti T, Combrinck-Graham L. Anxiety disorders of childhood or adolescence. In: Karasu TB, ed. Treatments of Psychiatric Disorders. Vol 1. Washington, DC: American Psychiatric Press; 1989:401-46.

  73. McNamara E. The self-management of school phobia: a case study. Behav Psychother. 1988;16:217-229.

  74. Michelsson K, Christensson K, Rothganger H, Winberg J. Crying in separated and non-separated newborns: sound spectrographic analysis. Acta Paediatr. Apr 1996;85(4):471-5. [Medline].

  75. Mikkelsen EJ, Detlor J, Cohen DJ. School avoidance and social phobia triggered by haloperidol in patients with Tourette's disorder. Am J Psychiatry. Dec 1981;138(12):1572-6. [Medline].

  76. Miller LC, Barrett CL, Hampe E, Noble H. Comparison of reciprocal inhibition, psychotherapy, and waiting list control for phobic children. J Abnorm Psychol. Jun 1972;79(3):269-79. [Medline].

  77. Muratori F, Picchi L, Apicella F, et al. Psychodynamic psychotherapy for separation anxiety disorders in children. Depress Anxiety. 2005;21(1):45-6. [Medline].

  78. Nowicki S Jr, Duke MP, Sisney S, Stricker B, Tyler MA. Reducing the drop-out rates of at-risk high school students: the Effective Learning Program (ELP). Genet Soc Gen Psychol Monogr. Aug 2004;130(3):225-39. [Medline].

  79. Ollendick TH. Reliability and validity of the Revised Fear Surgery Schedule for Children (FSSC-R). Behav Res Ther. 1983;21(6):685-92. [Medline].

  80. Orvaschel H. Schedule for Affective Disorders and Schizophrenia for School Age Children-Epidemiological Version-5 (K-SADS-E-5). Ft. Lauderdale, Fla: Nova Southeastern University; 1995.

  81. Patterson GR. A learning theory approach to the problem of the school phobic child. In: Ullman LP, Krasner L, eds. Case Studies in Behavior Modification. New York, NY: Holt Rinehard & Winston; 1965.

  82. Pine DS, Grun J. Childhood anxiety: integrating developmental psychopathology and affective neuroscience. J Child Adolesc Psychopharmacol. 1999;9(1):1-12. [Medline].

  83. Reich W. Diagnostic Interview for Children and Adolescents: DSM-IV. Toronto: 1997.

  84. Reynolds CR, Richmond BO. What I think and feel: a revised measure of children's manifest anxiety. J Abnorm Child Psychol. Jun 1978;6(2):271-80. [Medline].

  85. Roseby V, Johnston JR. Children of Armageddon. Common developmental threats in high-conflict divorcing families. Child Adolesc Psychiatr Clin N Am. Apr 1998;7(2):295-309, vi. [Medline].

  86. Rossen BE, McKeever PD. The behavior of preschoolers during and after brief surgical hospitalizations. Issues Compr Pediatr Nurs. Apr-Jun 1996;19(2):121-33. [Medline].

  87. Scher A, Sharabany R. Parenting anxiety and stress: does gender play a part at 3 months of age?. J Genet Psychol. Jun 2005;166(2):203-13. [Medline].

  88. Schwartz CE, Snidman N, Kagan J. Adolescent social anxiety as an outcome of inhibited temperament in childhood. J Am Acad Child Adolesc Psychiatry. Aug 1999;38(8):1008-15. [Medline].

  89. Schwartz RH, Freedy AS, Sheridan MJ. Selective mutism: are primary care physicians missing the silence?. Clin Pediatr (Phila). Jan-Feb 2006;45(1):43-8. [Medline].

  90. Shaffer D, Fisher P, Dulcan MK, et al. The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC-2.3): description, acceptability, prevalence rates, and performance in the MECA Study. Methods for the Epidemiology of Child and Adolescent Mental Disorders Study. J Am Acad Child Adolesc Psychiatry. Jul 1996;35(7):865-77. [Medline].

  91. Silove D, Manicavasagar V, Curtis J, Blaszczynski A. Is early separation anxiety a risk factor for adult panic disorder?: a critical review. Compr Psychiatry. May-Jun 1996;37(3):167-79. [Medline].

  92. Silverman WK, Albano AM. Anxiety Disorders Interview Schedule for DSM-IV: Child Version-Child Interview Schedule. San Antonio, TX: The Psychological Corporation; 1996.

  93. Speilberger CD. Manual for the State-Trait Anxiety Inventory for Children. Palo Alto, CA: 1973.

  94. Spence SH. Structure of anxiety symptoms among children: a confirmatory factor- analytic study. J Abnorm Psychol. May 1997;106(2):280-97. [Medline].

  95. Stevenson W, Maton KI, Teti DM. School importance and dropout among pregnant adolescents. J Adolesc Health. May 1998;22(5):376-82. [Medline].

  96. Thurber CA. The experience and expression of homesickness in preadolescent and adolescent boys. Child Dev. Aug 1995;66(4):1162-78. [Medline].

  97. Thurber CA. The phenomenology of homesickness in boys. J Abnorm Child Psychol. Apr 1999;27(2):125-39. [Medline].

  98. Thurber CA, Sigman MD. Preliminary models of risk and protective factors for childhood homesickness: review and empirical synthesis. Child Dev. Aug 1998;69(4):903-34. [Medline].

  99. Thurber CA, Weisz JR. "You can try or you can just give up": the impact of perceived control and coping style on childhood homesickness. Dev Psychol. May 1997;33(3):508-17. [Medline].

  100. Tramontina S, Martins S, Michalowski MB, et al. School dropout and conduct disorder in Brazilian elementary school students. Can J Psychiatry. Dec 2001;46(10):941-7. [Medline].

  101. Trampush JW, Miller CJ, Newcorn JH, Halperin JM. The Impact of Childhood ADHD on Dropping Out of High School in Urban Adolescents/Young Adults. J Atten Disord. Aug 29 2008;[Medline].

  102. Wagner KD. Pharmacotherapy for major depression in children and adolescents. Prog Neuropsychopharmacol Biol Psychiatry. Jun 2005;29(5):819-26. [Medline].

  103. Weems CF, Costa NM. Developmental differences in the expression of childhood anxiety symptoms and fears. J Am Acad Child Adolesc Psychiatry. Jul 2005;44(7):656-63. [Medline].

  104. Wegner L, Flisher AJ, Chikobvu P, Lombard C, King G. Leisure boredom and high school dropout in Cape Town, South Africa. J Adolesc. Jun 2008;31(3):421-31. [Medline].

  105. Wright JC, Binney V, Smith PK. Security of attachment in 8-12-year-olds: a revised version of the Separation Anxiety Test, its psychometric properties and clinical interpretation. J Child Psychol Psychiatry. Jul 1995;36(5):757-74. [Medline].

  106. Zimmerberg B, McDonald BC. Prenatal alcohol exposure influences the effects of neuroactive steroids on separation-induced ultrasonic vocalizations in rat pups. Pharmacol Biochem Behav. Dec 1996;55(4):541-7. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

school phobia, separation anxiety disorder, excessive anxiety, severe distress, tantrums, nightmares, extreme homesickness, psychosomatic symptoms, clinging behavior, daycare, depression, suicide, truancy, skipping school, school refusal, learned helplessness, transient developmental fears, posttraumatic stress disorder, anhedonia, insomnia, feelings of worthlessness, occult serologic streptococcal infection, hyperthyroidism, hypothyroidism, mitral valve prolapse, asthma, depressive-spectrum disorders, diabetes mellitus, Lyme disease, Rocky Mountain spotted fever

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Bettina E Bernstein, DO, Assistant Professor, Department of Psychiatry, Philadelphia College of Osteopathic Medicine; Private Practice at the Wynnewood House; Consultant, Child Guidance Resource Centers, Early Elementary Education Program, Clinical Affiliate, Department of Child and Adolescent Psychiatry, Children's Hospital of Philadelphia
Bettina E Bernstein, DO is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry and American Psychiatric Association
Disclosure: Nothing to disclose.

Medical Editor

Angelo P Giardino, MD, PhD, Clinical Associate Professor, Department of Pediatrics, Baylor College of Medicine; Medical Director, Texas Children's Health Plan, Inc
Angelo P Giardino, MD, PhD is a member of the following medical societies: Academic Pediatric Association, American Academy of Pediatrics, American Professional Society on the Abuse of Children, Harris County Medical Society, Helfer Society, and International Society for Prevention of Child Abuse and Neglect
Disclosure: Nothing to disclose.

Pharmacy Editor

Mary L Windle, PharmD, Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy, Pharmacy Editor, eMedicine
Disclosure: Pfizer Inc Stock Investment from financial planner; Avanir Pharma Stock Investment from financial planner ; WebMD Salary and stock Employment and investment from financial planner

CME Editor

Carrie Sylvester, MD, MPH, Director of Education in Child and Adolescent Psychiatry, Professor, Departments of Psychiatry and Pediatrics, Northwestern University Medical School
Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, American Academy of Pediatrics, American Medical Women's Association, American Psychiatric Association, and American Society for Adolescent Psychiatry
Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD, Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Director of Training, Child and Adolescent Psychiatry Residency Program, University of Southern California Keck School of Medicine
Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.