It's common for young children to feel distressed when separated from a parent or caregiver, but these feelings typically wane around the age of three. Yet some children continue to experience serious separation anxiety past this stage.
A new CAMH study explored this issue in more depth. It showed that children aged one-and-a-half to six years, who had high and increasing, levels of separation anxiety were more likely to have worse physical and mental health in their early teens. The study, which tracked 1,290 young children and their families, was published in the August 2017 issue of Depression and Anxiety.
Gateway to other health conditions
Specifically, these children were up to three times more likely to experience headaches and asthma by age 13 than those with milder or more typical separation anxiety. They were also more likely to show symptoms of anxiety or depression, and do worse in school in terms of overall academic achievement relative to their peers. A family history of panic disorder or agoraphobia was also more common among these children.
“Early separation anxiety disorder may be a gateway to multiple health conditions,” says Dr. Marco Battaglia, Associate Chief of the Child, Youth and Emerging Adult Program at CAMH. “You can see the impact on physical health as early as age eight.”
As part of the Quebec Longitudinal Study of Children, this group was first assessed between the ages of 18 months and six years. They were then monitored at five additional time points until age 13. Interviews or questionnaires involved caregivers, teachers and the children themselves. About seven per cent of these children were identified as having high and increasing separation anxiety.
Separation anxiety is considered a disorder when children are overwhelmed with worry about separation from a caregiver beyond the age of three, to the point where it affects their daily routines. It’s one of several types of anxiety disorders, which together are the most common mental health condition, affecting about 12 per cent of people aged 15 to 64.
“Separation anxiety disorder can be treated successfully in children,” says Dr. Battaglia, who is also Clinician Scientist in CAMH’s Margaret and Wallace McCain Centre for Child, Youth & Family Mental Health. Early identification and treatment in young children could ease or prevent both the mental and physical conditions that develop in future. The usual treatment is cognitive behaviour therapy involving the family, and in some cases, antidepressants.
Connections with physical illnesses
The study adds to growing evidence of the link between anxiety disorders and physical health. “We are beginning to see the underlying biological mechanisms that connect anxiety with physical illnesses in later years,” says Dr. Battaglia.
When a child who is anxious complains of pain, this should be taken seriously, rather than being perceived as an excuse to stay home from school, he points out. “Children who report pain are probably experiencing actual pain, not faking it.”
Ongoing research is exploring this connection. Separation events and separation anxiety may affect how pain is processed in the body, by lowering the pain perception threshold. This would make children more sensitive to experiencing headache and other forms of pain. Separation events could also alter the physiology of respiration – in other words, change the way breathing occurs – which is tied to asthma.
“Our parallel work with preclinical models indeed indicates that hypersensitive respiration physiology, altered sensitivity to pain and separation anxiety have common, adjacent genetic networks that become altered following separation events,” says Dr. Battaglia. “Similar altered mechanisms could apply to humans, as indicated by this latest study. We are actively working at validating this hypothesis, which could pave the way to new diagnostic tools and treatments.”
Also of note is that children with severe separation anxiety were more likely to have a mother with panic disorder or agoraphobia, two other types of anxiety disorder. This further validates the familial-genetic link between a child’s and mother’s anxiety.
Given the connections among childhood separation anxiety disorder, anxiety and pain in adolescence, and the presence of panic or agoraphobia in families, having families closely involved in assessment and treatment and ensuring a smooth transition of care from children to adult services are essential, says Dr. Battaglia.