Separation Anxiety in Children Ages 4 through 9 with Oral Clefts

Abstract

Background

Psychosocial research on children with oral clefts (OCs), i.e., clefts of the lip, palate, or lip and palate, has suggested that these children may have higher rates of anxiety in general, but overall results have been equivocal. In this study we estimated the prevalence of separation anxiety disorder (SAD) in a population-based sample of children with OCs and identified associated risk factors.

Methods

Parents of 279 children with OCs, identified through three state birth defect registries, responded to a postal survey that included the Separation Anxiety subscale of the Screen for Child Anxiety-Related Emotional Disorders (SCARED) and items regarding the child's OC and its sequelae, parent and child health, parent mental health, family structure, and socioeconomic status indicators. Associations with SA were evaluated using bivariate and multivariate statistics.

Results

One quarter (24%) of the children screened positive for SAD, which was substantially higher than the U.S. child population estimates of 3% to 5%. OC-related impairments in speaking and eating more than doubled the risk of SAD, as did lower socioeconomic status and lower maternal health rating. Maternal mental health and marital status remained in the logistic model but were not significant.

Conclusions

Children with OCs appear to be at increased risk for SAD as measured by the SCARED instrument. OC-related problems with speech and eating more than doubled the risk of SAD. The use of targeted screening tools may help refine our understanding of psychosocial adjustment in children with OCs.

Keywords

childhood anxiety cleft lip cleft palate hearing loss oral clefts risk factors separation anxiety

Get full access to this article

View all access options for this article.

References

Allen

J.L.

Lavallee

K.L.

Herren

Ruhe

Schneider

DSM-IV criteria for childhood separation anxiety disorder: informant, age, and sex differences. J Anxiety Disord. 2010; 24: 946–952.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed. Washington, DC: American Psychiatric Association; 2000.

Bernstein

G.A.

Layne

A.E.

Egan

E.A.

Nelson

L.P.

Maternal phobic anxiety and child anxiety. J Anxiety Disord. 2005; 19: 658–672.

Berwick

D.M.

Murphy

J.M.

Goldman

P.A.

Ware

J.E.

Jr Barsky

A.J.

Weinstein

M.C.

Performance of a five-item mental health screening test. Med Care. 1991; 29: 169–176.

Birmaher

Brent

D.A.

Chiappetta

Bridge

Monga

Baugher

Psychometric properties of the screen for child anxiety related emotional disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry. 1999; 38: 1230–1236.

Birmaher

Khetarpal

Brent

Cully

Balach

Kaufman

Neer

S.M.

The screen for child anxiety related emotional disorders (SCARED): scale construction and psychometric characteristics. J Am Acad Child Adolesc Psychiatry. 1997; 36: 545–553.

Bittner

Egger

H.L.

Erkanli

Jane Costello

Foley

D.L.

Angold

What do childhood anxiety disorders predict?

J Child Psychol Psychiatry. 2007; 48: 1174–1183.

Bodden

D.H.

Bogels

S.M.

Muris

The diagnostic utility of the screen for child anxiety related emotional disorders-71 (SCARED-71). Behav Res Ther. 2009; 47: 418–425.

Briggs-Gowan

M.J.

Horwitz

S.M.

Schwab-Stone

M.E.

Leventhal

J.M.

Leaf

P.J.

Mental health in pediatric settings: distribution of disorders and factors related to service use. J Am Acad Child Adolesc Psychiatry. 2000; 39: 841–849.

10.

Bruckl

T.M.

Wittchen

H.U.

Hofler

Pfister

Schneider

Lieb

Childhood separation anxiety and the risk of subsequent psychopathology: results from a community study. Psychother Psychosom. 2007; 76: 47–56.

11.

Cartwright-Hatton

McNicol

Doubleday

Anxiety in a neglected population: prevalence of anxiety disorders in preadolescent children. Clin Psychol Rev. 2006; 26: 817–833.

12.

Choate

M.L.

Pincus

D.B.

Eyberg

S.M.

Barlow

D.H.

Parent-child interaction therapy for treatment of separation anxiety disorder in young children: A pilot study, Cogn Behav Pract. 2005; 12: 126–135.

13.

Cooper

P.J.

Fearn

Willetts

Seabrook

Parkinson

Affective disorder in the parents of a clinic sample of children with anxiety disorders. J Affect Disord. 2006; 93: 205–212.

14.

Cronk

N.J.

Slutske

W.S.

Madden

P.A.

Bucholz

K.K.

Heath

A.C.

Risk for separation anxiety disorder among girls: paternal absence, socioeconomic disadvantage, and genetic vulnerability. J Abnorm Psychol. 2004; 113: 237–247.

15.

Dallaire

D.H.

Weinraub

Predicting children's separation anxiety at age 6: the contributions of infant-mother attachment security, maternal sensitivity, and maternal separation anxiety. Attach Hum Dev. 2005; 7: 393–408.

16.

Dillman

D.A.

Mail and Internet Surveys: The Tailored Design Method. Hoboken, NJ: Wiley; 2007: 523.

17.

Ehringer

M.A.

Rhee

S.H.

Young

Corley

Hewitt

J.K.

Genetic and environmental contributions to common psychopathologies of childhood and adolescence: a study of twins and their siblings. J Abnorm Child Psychol. 2006; 34: 1–17.

18.

Feigon

S.A.

Waldman

I.D.

Levy

Hay

D.A.

Genetic and environmental influences on separation anxiety disorder symptoms and their moderation by age and sex. Behav Genet. 2001; 31: 403–411.

19.

Foley

D.L.

Pickles

Maes

H.M.

Silberg

J.L.

Eaves

L.J.

Course and short-term outcomes of separation anxiety disorder in a community sample of twins. J Am Acad Child Adolesc Psychiatry. 2004; 43: 1107–1114.

20.

Genisca

A.E.

Frias

J.L.

Broussard

C.S.

. National Birth Defects Prevention Study. Orofacial clefts in the national birth defects prevention study, 1997–2004. Am J Med Genet A. 2009; 149A: 1149–1158.

21.

Hammerness

Harpold

Petty

Menard

Zar-Kessler

Beiderman

Characterizing non-OCD anxiety disorders in psychiatrically referred children and adolescents. J Affect Disord 2008; 105: 213–219.

22.

Hirshfeld-Becker

D.R.

Masek

Henin

. Cognitive behavioral therapy for 4- to 7-year-old children with anxiety disorders: a randomized clinical trial. J Consult Clin Psychol. 2010; 78: 498–510.

23.

Hunt

Burden

Hepper

Stevenson

Johnston

Self-reports of psychosocial functioning among children and young adults with cleft lip and palate. Cleft Palate Craniofac J. 2006; 43: 598–605.

24.

Hunt

Burden

Hepper

Stevenson

Johnston

Parent reports of the psychosocial functioning of children with cleft lip and palate. Cleft Palate Craniofac J. 2007; 44: 304–311.

25.

Kessler

R.C.

Angermeyer

Anthony

J.C.

. Lifetime prevalence and age-of-onset distributions of mental disorders in the world health organization's world mental health survey initiative. World Psychiatry. 2007; 6: 168–176.

26.

Kessler

R.C.

Berglund

Demler

Jin

Merikangas

K.R.

Walters

E.E.

Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the national comorbidity survey replication. Arch Gen Psychiatry. 2005; 62: 593–602.

27.

Last

C.G.

Perrin

Hersen

Kazdin

A.E.

DSM-III-R anxiety disorders in children: sociodemographic and clinical characteristics. J Am Acad Child Adolesc Psychiatry. 1992; 31: 1070–1076.

28.

Lewinsohn

P.M.

Holm-Denoma

J.M.

Small

J.W.

Seeley

J.R.

Joiner

T.E.

Jr . Separation anxiety disorder in childhood as a risk factor for future mental illness. J Am Acad Child Adolesc Psychiatry. 2008; 47: 548–555.

29.

Merikangas

K.R.

J.P.

Brody

Fisher

P.W.

Bourdon

Koretz

D.S.

Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics. 2010; 125: 75–81.

30.

Merikangas

K.R.

Nakamura

E.F.

Kessler

R.C.

Epidemiology of mental disorders in children and adolescents. Dialogues Clin Neurosci. 2009; 11: 7–20.

31.

Millard

Richman

L.C.

Different cleft conditions, facial appearance, and speech: relationship to psychological variables. Cleft Palate Craniofac J. 2001; 38: 68–75.

32.

Monga

Birmaher

Chiappetta

Brent

Kaufman

Bridge

Cully

Screen for child anxiety-related emotional disorders (SCARED): convergent and divergent validity. Depress Anxiety. 2000; 12: 85–91.

33.

Muris

Dreessen

Bogels

Weckx

van Melick

A questionnaire for screening a broad range of DSM-defined anxiety disorder symptoms in clinically referred children and adolescents. J Child Psychol Psychiatry. 2004; 45: 813–820.

34.

Muris

Gadet

Moulaert

Merckelbach

Correlations between two multidimensional anxiety scales for children. Percept Mot Skills. 1998b; 87: 269–270.

35.

Muris

Merckelbach

Mayer

van Brakel

Thissen

Moulaert

Gadet

The screen for child anxiety related emotional disorders (SCARED) and traditional childhood anxiety measures. J Behav Ther Exp Psychiatry. 1998a; 29: 327–339.

36.

Muris

Steerneman

The revised version of the screen for child anxiety related emotional disorders (SCARED-R): first evidence for its reliability and validity in a clinical sample. Br J Clin Psychol. 2001; 40: 35–44.

37.

Parker

S.E.

Mai

C.T.

Canfield

M.A.

. National Birth Defects Prevention Network. Updated national birth prevalence estimates for selected birth defects in the United States, 2004–2006. Birth Defects Res A Clin Mol Teratol. 2010; 88: 1008–1016.

38.

Richman

L.C.

Eliason

Psychological characteristics of children with cleft lip and palate: intellectual, achievement, behavioral and personality variables. Cleft Palate J. 1982; 19: 249–257.

39.

Rumpf

H.J.

Meyer

Hapke

John

Screening for mental health: validity of the MHI-5 using DSM-IV axis I psychiatric disorders as gold standard. Psychiatry Res. 2001; 105: 243–253.

40.

Shear

Jin

Ruscio

A.M.

Walters

E.E.

Kessler

R.C.

Prevalence and correlates of estimated DSM-IV child and adult separation anxiety disorder in the national comorbidity survey replication. Am J Psychiatry. 2006; 163: 1074–1083.

41.

Simon

Bögels

S.M.

Screening for anxiety disorders in children. Eur Child Adolesc Psychiatry. 2009; 18: 625–34.

42.

Snyder

Pope

Psychosocial adjustment in children and adolescents with a craniofacial anomaly: diagnosis-specific patterns. Cleft Palate Craniofac J. 2010; 47: 264–272.

43.

Stewart

A.L.

Hays

R.D.

Ware

J.E.

Jr . The MOS short-form general health survey: reliability and validity in a patient population. Med Care. 1988; 26: 724–735.

44.

Suveg

Aschenbrand

S.G.

Kendall

P.C.

Separation anxiety disorder, panic disorder, and school refusal. Child Adolesc Psychiatr Clin North Am. 2005; 14: 773–795. ix.

45.

Tobiasen

J.M.

Hiebert

J.M.

Clefting and psychosocial adjustment. Influence of facial aesthetics. Clin Plast Surg. 1993; 20: 623–631.

46.

Ware

J.E.

Jr Sherbourne

C.D.

The MOS 36-item short-form health survey (SF-36): I. Conceptual framework and item selection. Med Care. 1992; 30: 473–483.

47.

Wehby

G.L.

Cassell

C.H.

The impact of orofacial clefts on quality of life and healthcare use and costs. Oral Dis. 2010; 16: 3–10.

48.

Wehby

G.L.

Pedersen

D.A.

Murray

J.C.

Christensen

The effects of oral clefts on hospital use throughout the lifespan. BMC Health Serv Res. 2012a March 9;12: 58.

49.

Wehby

G.L.

Tyler

M.C.

Lindgren

Romitti

Robbins

Damiano

Oral clefts and behavioral health of young children. Oral Dis. 2012b; 18: 74–84.

50.

Wren

F.J.

Berg

E.A.

Heiden

L.A.

Kinnamon

C.J.

Ohlson

L.A.

Bridge

J.A.

Birmaher

Bernal

M.P.

Childhood anxiety in a diverse primary care population: parent-child reports, ethnicity and SCARED factor structure. J Am Acad Child Adolesc Psychiatry. 2007; 46: 332–340.

51.

Yoon

P.W.

Rasmussen

S.A.

Lynberg

M.C.

. The National Birth Defects Prevention Study. Public Health Rep. 2001; 116(Suppl 1): 32–40.