Journal Mobile Options
Table of Contents
Vol. 44, No. 6, 2011
Issue release date: October 2011
Psychopathology 2011;44:354–361

Early Predictors of Separation Anxiety Disorder: Early Stranger Anxiety, Parental Pathology and Prenatal Factors

Lavallee K. · Herren C. · Blatter-Meunier J. · Adornetto C. · In-Albon T. · Schneider S.
aDepartment of Psychology, Universität Basel, and bKinder- und Jugendpsychiatrische Klinik Basel, Basel, Switzerland; cDepartment of Psychology, Ruhr-Universität Bochum, Bochum, Germany

Individual Users: Register with Karger Login Information

Please create your User ID & Password

Contact Information

I have read the Karger Terms and Conditions and agree.

To view the fulltext, please log in

To view the pdf, please log in


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.

Copyright / Drug Dosage

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in goverment regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.


  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.

    External Resources

  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.

    External Resources

  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.

    External Resources

  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.

    External Resources

  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.

    External Resources

  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.

    External Resources

  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.

    External Resources

  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.

    External Resources

  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.

Pay-per-View Options
Direct payment This item at the regular price: USD 38.00
Payment from account With a Karger Pay-per-View account (down payment USD 150) you profit from a special rate for this and other single items.
This item at the discounted price: USD 26.50