Academic journal article Education & Treatment of Children

Adapting Parent-Child Interaction Therapy for Young Children with Separation Anxiety Disorder

Academic journal article Education & Treatment of Children

Adapting Parent-Child Interaction Therapy for Young Children with Separation Anxiety Disorder

Article excerpt


Separation Anxiety Disorder (SAD) is currently the most prevalent, yet most under-researched anxiety disorder in childhood. To date, there have been few studies investigating the efficacy of interventions for young children with SAD. The primary purpose of this paper is to describe the process of tailoring Parent Child Interaction Therapy (PCIT) for young children aged 4-8 with SAD. The paper provides a theoretical rationale for using PCIT to treat young children with SAD. The first randomized clinical trial for young children with SAD is then described. The paper focuses on the process of adapting PCIT to make it most relevant for children with SAD. The specific challenges and rewards of conducting PCIT with anxious children and their parents are presented.


Over the past decade, there has been burgeoning interest in the study of the etiology, maintenance and effective treatment of anxiety disorders in childhood. Of the anxiety disorders experienced by children, separation anxiety disorder (SAD) has been shown to be the most prevalent, accounting for approximately one-half of the children seen for mental health treatment of anxiety disorders (Bell-Dolan, 1995). Despite the growing evidence that SAD is so prevalent in early childhood and may be linked to later psychopathology (Lease & Strauss, 1993), there has been a paucity of empirical studies investigating the efficacy of interventions for SAD in young children. Although treatment studies have typically included children aged seven and above, thus far, treatment research of children under aged seven with anxiety disorders has been limited to case reports with expected methodological limitations (Ollendick, Hagopian, & Huntzinger, 1991). Existing treatment studies and case studies that have been conducted with children with SAD have not typically included children in the preschool and early childhood years (aged 4-7), despite the frequent early onset of SAD (Eisen, Engler, & Geyer, 1998; Eisen & Kearney, 1995). This may be due to the fact that it is more difficult to assess young children using standard self report questionnaires, or due to the fact that many of the intervention strategies currently being evaluated with older children contain large cognitive components, which would likely be developmentally inappropriate and beyond the capabilities of a very young preschooler with SAD. Furthermore, the young preschooler may not yet have developed the cognitive and communicative abilities to verbalize their fears or to engage in self control procedures that would be commonly taught to older children (Eisen & Kearney, 1995). To date, there are no known interventions that have been designed or tested specifically to treat SAD in the preschool and early childhood years. The development of such an intervention seems critical to promoting young children's healthy functioning and positive developmental trajectories.

Phenomenology of Separation Anxiety Disorder in Early Childhood

Children with SAD experience developmentally inappropriate distress and unrealistic fear when confronted with separation from a caregiver, and experience significant interference in daily functioning (American Psychiatric Association, 2000). Children often display excessive and persistent worry about separation, behavioral and somatic distress when faced with separation situations, and persistent avoidance or attempts to escape from such situations (Albano, Chorpita, & Barlow, 1996; Bell-Dolan, 1995). Separation worries commonly reported by children include worries about harm befalling either an attachment figure or themselves, worry that a parent may never return, or worries that they themselves will be lost, kidnapped, or killed. Particularly for young children, nightmares with themes of separation are quite common (Francis, Last, & Strauss, 1987). Young children with SAD often display disruptive, oppositional behaviors as well as avoidance behaviors that cause significant interference in child and family functioning. …

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