Objective: The present study seeks to extend research on the etiology of separation anxiety disorder (SAD) in a German-speaking sample by examining differences between children with SAD and healthy comparisons, using a retrospective-reporting paradigm. Method: The sample included 106 children with SAD and 44 healthy children between the ages of 4 and 14 years. Parents completed questionnaires and structured clinical interviews to assess parental pathology, pregnancy variables and strong early stranger anxiety. Results: Children with SAD were more likely than healthy children to have had a phase of stronger stranger anxiety in infancy. Further, early stranger anxiety remained a significant predictor of SAD after controlling for maternal depression. Meaningful effects were not found for the influence of parental age at birth or other pregnancy factors. Conclusion: This study provides beginning evidence of the potential predictive value of strong stranger anxiety in distinguishing children with SAD from those with no disorder, above and beyond the influence of parental pathology.

Keywords:
Separation anxiety disorder, Parental pathology, Prenatal risk factors, Pregnancy, Stranger anxiety
1.
Last CG, Perrin S, Hersen M, Kazdin AE: DSM-III-R anxiety disorders in children: sociodemographic and clinical characteristics. J Am Acad Child Adolesc Psychiatry 1992;31:1070–1076.
2.
Cartwright-Hatton S, McNicol K, Doubleday E: Anxiety in a neglected population: prevalence of anxiety disorders in pre-adolescent children. Clin Psychol Rev 2006;26:817–833.
3.
Costello EJ, Mustillo S, Erkanli A, Keeler G, Angold A: Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 2003;60:837–844.
4.
Ford T, Goodman R, Meltzer H: The British Child and Adolescent Mental Health Survey 1999: the prevalence of DSM-IV disorders. J Am Acad Child Adolesc Psychiatry 2003;42:1203–1211.
5.
Steinhausen HC, Winkler Metzke C, Meier M, Kannenberg R: Prevalence of child and adolescent psychiatric disorders: the Zürich epidemiological study. Acta Psychiatr Scand 1998;98:262–271.
6.
Lewinsohn PM, Holm-Denoma JM, Small JW, et al: Separation anxiety disorder in childhood as a risk factor for future mental illness. J Am Acad Child Adolesc Psychiatry 2008;47:549–556.
7.
Manicavasagar V, Silove, D, Hadzi-Pavlovic D: Subpopulations of early separation anxiety: relevance to risk of adult anxiety disorders. J Affect Disord 1998;48:181–190.
8.
Zitrin C, Ross DC: Early separation anxiety and adult agoraphobia. J Nerv Mental Dis 1988;176:621–625.
9.
Brückl TM, Wittchen H-U, Höfler M, et al: Childhood separation anxiety and the risk for subsequent psychopathology: results from a community study. Psychother Psychosom 2007;76:47–56.
10.
Aschenbrand SG, Kendall PC, Webb A, Safford SM, Flannery Schroeder E: Is childhood separation anxiety disorder a predictor of adult panic disorder and agoraphobia? a seven-year longitudinal study. J Am Acad Child Adolesc Psychiatry 2003;42:1478–1485.
11.
Manassis K, Bradley SJ: The development of childhood anxiety disorders: toward an integrate model. J Appl Dev Psychol 1994;15:345–366.
12.
Rapee RM: The development of generalized anxiety; in Vasey MW, Dodds MR (eds): The Developmental Psychopathology of Anxiety. New York, Oxford University Press, 2001.
13.
Talge NM, Neal C, Glover V, Early Stress Translational Research and Prevention Science Network: Fetal and neonatal experience on child and adolescent mental health. Antenatal maternal stress and long-term effects on child neurodevelopment: How and why? J Child Psychol Psychiatry 2007;48:245–261.
14.
Unnewehr S, Schneider S, Margraf J, Florin I: Psychopathology in children of patients with panic disorder or animal phobia. Psychopathology 1998;31:69–84.
15.
Warner V, Mufson L, Weissman MM: Offspring at high and low risk for depression and anxiety: mechanisms of psychiatric disorder. J Am Acad Child Adolesc Psychiatry 1995;34:786–797.
16.
Biederman J, Faraone SV, Hirshfeld-Becker DR, Friedman D, Robin JA, Rosenbaum JF: Patterns of psychopathology and dysfunction in high-risk children of parents with panic disorder and major depression. Am J Psychiatry 2001;158:49–57.
17.
Capps L, Sigman M, Sena R, Henker B, Whalen C: Fear, anxiety and perceived control in children of agoraphobic parents. J Child Psychol Psychiatry 1996;37:445–452.
18.
Poulton R, Milne BJ, Craske MG, Menzies RG: A longitudinal study of the etiology of separation anxiety. Behav Res Ther 2001;39:1395–1410.
19.
Havighurst RJ: Developmental Task and Education. New York, McKay, 1948.
20.
Sroufe LA, Rutter M: The domain of developmental psychopathology. Child Dev 1984;55:17–29.
21.
Biederman J, Rosenbaum JF, Bolduc-Murphy EA, Faraone SV, Chaloff J, Hirshfeld DR, et al: A 3-year follow-up of children with and without behavioral inhibition. J Am Acad Child Adolesc Psychiatry 1993;32:814–821.
22.
Huizink AC, Mulder EJH, Buitelaar JK: Prenatal stress and risk for psychopathology: special effects or induction of general susceptibility? Psychol Bull 2004;130:115–142.
23.
O’Connor TG, Heron J, Glover V, Alspac Study Team: Antenatal anxiety predicts child behavioral/emotional problems independently of postnatal depression. J Am Acad Child Adolesc Psychiatry 2002;412:1470–1477.
24.
Bergman K, Sarkar P, O’Connor TG, Modi N, Glover V: Maternal stress during pregnancy predicts cognitive ability and fearfulness in infancy. J Am Acad Child Adolesc Psychiatry 2007;46:1454–1463.
25.
Herrmann M, King K, Weitzman M: Prenatal tobacco smoke and postnatal secondhand smoke exposure and child neurodevelopment. Curr Opin Pediatr 2008;20:184–190.
26.
Weissman MM, Warner V, Wickramaratne PJ, Kandel DB: Maternal smoking during pregnancy and psychopathology in offspring followed to adulthood. J Am Acad Child Adolesc Psychiatry 1999;38:892–899.
27.
Hellemans KGC, Sliwowska JH, Verma P, Weinberg J: Prenatal alcohol exposure: fetal programming and later life vulnerability to stress, depression and anxiety disorders. Neurosci Biobehav Rev 2010;34:791–807.
28.
Frost AK, Reinherz HZ, Pakiz-Camras B, Giaconia RM, Lefkowitz ES: Risk factors for depressive symptoms in late adolescence: a longitudinal community study. Am J Orthopsychiatry 1999;69:370–381.
29.
Hille ETM, Dorrepaal C, Perenboom R, Gravenhorst JB, Brand R, Verloove-Vanhorick SP: Social lifestyle, risk-taking behavior, and psychopathology in young adults born very preterm or with a very low birth weight. J Pediatr 2008;152:793–800.
30.
Simon E, Bögels S, Stoel R, De Schutter S: Risk factors occurring during pregnancy and birth in relation to brain functioning and child’s anxiety. J Anxiety Disord 2009;8:1024–1030.
31.
Allen NB, Lewinsohn PM, Seeley JR: Prenatal and perinatal influences on risk for psychopathology in childhood and adolescence. Dev Psychopathol 1998;10:513–529.
32.
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Text Revision, ed 4. Washington, American Psychiatric Association, 2000.
33.
Schneider S, Unnewehr S, Margraf J: Diagnostisches Interview bei psychischen Störungen im Kindes- und Jugendalter (Kinder-DIPS), ed 2. Heidelberg, Springer, 2009.
34.
Beck AT, Epstein N, Brown G, Steer RA: An inventory for measuring clinical anxiety: psychometric properties. J Consult Clin Psychol 1988;56:891–893.
35.
Margraf J, Ehlers A: Beck-Angst-Inventar (BAI). Testhandbuch. Göttingen, Hogrefe, 2002.
36.
Beck A, Steer R, Brown G: Manual for Beck Depression Inventory-II. San Antonio, Psychological Corporation, 1996.
37.
Hautzinger M, Bailer M, Worall H, Keller F: Beck-Depressions-Inventar (BDI). Testhandbuch, ed 3. Bern, Huber, 2000.
38.
Schneider S, Margraf J: Diagnostisches Interview bei psychischen Störungen (DIPS für DSM-IV-TR), ed 3, rev. Berlin, Springer, 2006.
39.
In-Albon T, Suppiger A, Schlup B, Wendler S, Margraf J, Schneider S: Validität des Diagnostischen Interviews bei psychischen Störungen (DIPS für DSM-IV-TR). Z Klin Psychol Psychother 2008;37:33–42.
40.
Suppiger A, In-Albon T, Herren C, Bader K, Schneider S, Margraf J: Reliabilität des Diagnostischen Interviews bei Psychischen Störungen (DIPS für DSM-IV-TR) unter klinischen Routinebedingungen. Verhaltenstherapie 2008;18:237–244.
41.
Faul F, Erdfelder E, Lang AG, et al: G*Power 3: a flexible statistical power analysis program for the social, behavioral, and biomedical sciences. Behav Res Methods 2007;39:175–191.
42.
Cohen J: Statistical Power Analysis for the Behavioral Sciences. Hillsdale, Erlbaum Associates, 1988.
43.
Sroufe LA: Emotional Development: The Organization of Emotional Life in the Early Years. Cambridge, Cambridge University Press, 1997.
44.
Chess S, Thomas A: Goodness of Fit: Clinical Applications, from Infancy through Adult Life. Philadelphia, Brunner/Mazel, 1999.
45.
Brennan P: Tobacco consumption during pregnancy and its impact on psychosocial child development; in Tremblay RE, Barr RG, Peters RDeV (eds): Encyclopedia on Early Childhood Development. Montreal, Centre of Excellence for Early Childhood Development, 2005, pp 1–5.
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2011
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