<unk>  anxiety occurs in many infants and young children as they are becoming acclimated with their surroundings. This anxiety is viewed as a normal developmental phase between the months of early infancy until age two.<unk>  anxiety is normal in young children, until they age 3–4 years, when children are left in a daycare or preschool, away from their parent or primary caregiver. Other sources note that a definite diagnosis of SAD should not be presented until after the age of three. Some studies have shown that hormonal influences during pregnancy can result in lower cortisol levels later in life, which can later lead to psychological disorders, such as SAD. It is also important to note significant life changes experienced by the child either previous to or present at the onset of the disorder. For example, children who emigrated from another country at an early age may have a stronger tendency for developing this disorder, as they have already felt displaced from a location they were starting to become accustomed to. It is not uncommon for them to incessantly cling to their caregiver at first upon arrival to the new location, especially if the child is unfamiliar with the language of their new country. These symptoms may diminish or go away as the child becomes more accustomed to the new surroundings. Other sources note that a definite diagnosis of SAD should not be presented until after the age of three.<unk>  anxiety may be diagnosed as a disorder if the child's anxiety related to<unk>  from the home or attachment figure is deemed excessive; if the level of anxiety surpasses that of the acceptable caliber for the child's developmental level and age; and if the anxiety negatively impacts the child's everyday life. Many psychological disorders begin to emerge during childhood. Nearly two-thirds of adults with psychological disorder show signs of their disorder earlier in life. However, not all psychological disorders are present before adulthood. In many cases, there are no signs during childhood. Behavioral inhibition (BI) plays a large role in many anxiety disorders, SAD included. Compared to children without it, children with BI demonstrate more signs of fear when experiencing a new stimulus, particularly those that are social in nature. Children with BI are at a higher risk for developing a mental disorder, particularly anxiety disorders, than children without BI.<unk>  anxiety is normal in young children, until they age 3–4 years, when children are left in a daycare or preschool, away from their parent or primary caregiver. To be diagnosed with SAD, one must display at least three of the following criteria: * Recurrent excessive distress when anticipating or experiencing<unk>  from home or from major attachment figures * Persistent and excessive worry about losing major attachment figures or about possible harm to them, such as illness, injury, disasters, or death * Persistent and excessive worry about experiencing an untoward event (e.g., getting lost, being kidnapped, having an accident, becoming ill) that causes<unk>  from a major attachment figure * Persistent reluctance or refusal to go out, away from home, to school, to work, or elsewhere because of fear of<unk>  * Persistent and excessive fear of or reluctance about being alone or without major attachment figures at home or in other settings * Persistent reluctance or refusal to sleep away from home or to go to sleep without being near a major attachment figure * Repeated nightmares involving the theme of<unk>  * Repeated complaints of physical symptoms (e.g., headaches, stomachaches, nausea, vomiting) when<unk>  from major attachment figures occurs or is anticipated Classification<unk>  anxiety is common for infants between the ages of eight and fourteen months and occurs as infants begin to understand their own selfhood—or understand that they are separate persons from their primary caregiver. Infants oftentimes look for their caregivers to give them a sense of comfort and familiarity, which causes<unk>  to become challenging. Subsequently, the concept of object permanence emerges—which is when children learn that something still exists when it cannot be seen or heard, thus increasing their awareness of being separated from their caregiver. Consequently, during the developmental period where an infant's sense self, incorporating object permanence as well, the child also begins to understand that they can in fact be separated from their primary caregiver. They see this<unk>  as something final though, and don't yet understand that their caregiver will return causing fear and distress for the infant. It is when an individual (infant, child, or otherwise) consistently reacts to<unk>  with excessive anxiety and distress and experiences a great deal of interference from their anxiety that a diagnosis of<unk>  (SAD) can be warranted. One of the difficulties in the identification of<unk>  in children is that it is highly comorbid with other behavioral disorders, especially generalized anxiety disorder. Behaviors such as refusal or hesitancy in attending school or homesickness for example, can easily reflect similar symptoms and behavioral patterns that are commonly associated with SAD, but could be an overlap of symptoms. The prevalence of co-occurring disorders in adults with<unk>  is common and includes a much broader spectrum of diagnostic possibilities. Common co-morbidities can include specific phobias, PTSD, panic disorder, obsessive-compulsive disorder, and personality disorders. It is very common for psychological disorders to overlap and even lead to the manifestation of another, especially when it comes to anxiety disorders. Because of the variation and overlap in symptoms a proper, thorough evaluation of the individual is critical to distinguish the differences and significance. An important signifier to establish a difference between SAD and other anxiety or psychological disorders is to investigate where the individual's fear of<unk>  is stemming from; this can be accomplished by asking "what they fear will occur during a<unk>  from their significant other". What stands out about SAD, as mentioned above, are the avoidance behaviors which present within an individual. Individuals "typically exhibit excessive distress manifested by crying, repeated complaints of physical symptoms (e.g., stomach aches, headaches, etc.), avoidance (e.g., refusing to go to school, to sleep alone, to be left alone in the home, to engage in social events, to go to work, etc.), and engagement in safety behaviors (e.g., frequent calls to or from significant others, or primary caregivers)". Assessment methods Assessment methods include diagnostic interviews, self-report measures from both the parent and child, observation of parent-child interaction, and specialized assessment for preschool-aged children. Various facets of a child's development including social life, feeding and sleep schedules, medical issues, traumatic events experienced, family history of mental or anxiety health issues are explored. The compilation of aspects of a child's life aids in capturing a multi-dimensional view of the child's life. Additionally, while much research has been done in efforts to further understand<unk>  anxiety in regards to the relationship between infants' and their caregivers, it was behavioral psychologist, Mary Ainsworth, who devised a behavioral evaluation method, The Strange Situation (1969), which, at the time, was considered to be the most valuable and famous body of research in the study of<unk>  anxiety. The Strange Situation process assisted in evaluating and measuring the individual attachment styles of infants between the ages of 9 and 18 months. In this observational study an environment is created that fluctuates between familiar and unfamiliar situations that would be experienced in everyday life. The variations in stressfulness and the child's responses are observed and, based on the interaction behavior that is directed towards the caregiver, the infant is categorized into one of four different types of attachment styles: 1. Secure, 2. Anxious-avoidant, insecure, 3. Anxious-ambivalent/resistant, insecure and 4. Disorganized/disoriented. Clinicians may utilize interviews as an assessment tool to gauge the symptomatic occurrences to aid in diagnosing SAD. Interviews may be conducted with the child and also with the attachment figure. Interviewing both child and parent separately allows for the clinician to compile different points of view and information. Commonly used interviews include: * Anxiety Disorders Interview Schedule for the DSM-IV, Child Parent Versions (ADIS-IV-C/P) * Diagnostic Interview Schedule for Children, Version IV (DISC-IV) * Schedule for Affective Disorders and Schizophrenia for School-aged Children-Present and lifetime version IV (K-SADS-IV) Self-report measures This form of assessment should not be the sole basis of a SAD diagnosis. It is also important to verify that the child who is reporting on their experiences has the cognitive and communication skills appropriate to accurately comprehend and respond to these measurements. An example of a self-report tool that has been tested is: The<unk>  Anxiety Assessment Scale for Children (SAAS-C). The scale contains 34 items and is divided into six dimensions. The dimensions in order are: Abandonment, Fear of Being Alone, Fear of Physical Illness, Worry about Calamitous Events, Frequency of Calamitous Events, and Safety Signal Index. The first five dimensions have a total of five items while the last one contains nine items. The scale goes beyond assessing symptoms; it focuses on individual cases and treatment planning. Observation As noted by Altman, McGoey & Sommer,
Separation anxiety disorder
Hodophobia
Social anxiety disorder
Agoraphobia
Generalized anxiety disorder
Somatization disorder
Blood phobia
Body dysmorphic disorder