OBJECTIVES: This study aimed to evaluate preliminarily the clinical effects of cognitive-behavioral treatment in children with anxiety disorders. METHODS: Subjects were 11 children between 2nd and 6th grade with anxiety disorder. All subjects were diagnosed through Kiddie-Schedule for Affective Disorder and Schizophrenia Present and Lifetime Version (K-SADS-PL) interview. The CBT program consisted of sessions once a week (60min/session) for 14 weeks with parent education. RESULTS: Children and parents reported significantly improved social skills, social competence and decreased anxiety. However, there were no significant changes in children's negative thoughts and subjective depressive symptoms. CONCLUSION: Cognitive-behavioral treatment is expected to be effective in children with anxiety disorders such as generalized anxiety disorder, phobia, separation anxiety disorder, and obsessive-compulsive disorder.
Anxiety ; Anxiety Disorders ; Anxiety, Separation ; Child ; Humans ; Mental Competency ; Mood Disorders ; Parents ; Phobic Disorders ; Schizophrenia

Authors report a case of separation anxiety disorder, which developed as a side effect during haloperidol treatment of Tourette syndromes(TS). In this case, 14 years old boys developed attention deficit symptoms during his infancy. At 4th grade of primary school, he developed vocal tic, motor tic, and coprolalia. With 5mg/day of haloperidol treatment his symptoms of TS were subsided. During the treatment, he developed features of separation anxiety disorder, including dependence, pleading, clinging, and sadness. Symptoms of attention deficit and separation anxiety disorder were improved by 25mg/day of imipramine treatment. During haloperidol treatment of TS, careful observation may be needed whether separation anxiety disorder-like symptom develops.
Adolescent ; Anxiety, Separation ; Haloperidol* ; Humans ; Imipramine ; Tics ; Tourette Syndrome*

OBJECTIVES: The purpose of this study was to evaluate anti-depressive effects of exercise on child and adolescent and its association with brain derived neurotrophic factor (BDNF). METHODS: Twenty nine middle school boys (age 13.3±0.7) were divided into two groups, 15 boys for control group and 14 in the experimental group. The control group participated in a regular exercise program, 3 times a week for 15 weeks. During the same period, the experimental group participated in an aerobic exercise program specifically designed to enhance anti-depressive effect of exercise. Serum BDNF level and its performance of each group on the Beck Depression Index (BDI), Children's Depression Inventory (CDI), Screen for Child Anxiety Related Emotional Disorders (SCARED), Aggression Questionnaire (AK-Q), and Stroop task were compared before and after the exercise program. RESULTS: Scores of BDI, CDI, SCARED, and AK-Q were significantly lower in both groups after the exercise programs compared to those before the programs. The Stroop task performances were significantly improved after the programs. However, there were no significant differences between two exercise programs, except SCARED separation anxiety, AK-Q physical, and verbal aggression scores. Also, no association was found between serum BDNF level and anti-depressive effects of exercise. CONCLUSION: Our preliminary results suggest a possible effect of exercise on depression, anxiety, aggression, and cognition of child and adolescents.
Adolescent* ; Aggression ; Anxiety ; Anxiety, Separation ; Brain-Derived Neurotrophic Factor* ; Child ; Cognition ; Depression ; Exercise ; Humans ; Task Performance and Analysis

Separation anxiety (SA) is a serious behavioral problem in dogs. In this study, salivary cortisol was studied to determine if the owner's odor or voice could reduce SA in dogs. Twenty-eight dogs with SA were divided into three groups: group 1 (control), group 2 (with owner's clothes during the separation period; SP) and group 3 (a recording of the owner's voice was played during SP). The dog's saliva was collected after the owner and their dog were in the experimental room for 5 min (PRE). The dog was then separated from the owner for 20 min and saliva collected four times at intervals of 5 min (SP1-4). Finally, the owner was allowed back into the room to calm the dog for 5 min, after which saliva was collected (POST). Evaluation of salivary cortisol concentrations by ELISA revealed that the ratios of SP1 concentration to PRE or POST concentrations were significantly higher in group 1 than in group 2 or 3. Additionally, the concentrations of SP1-PRE and SP1-POST among groups differed significantly. These findings indicate that the owner's odor or voice may be helpful to managing stress in dogs with SA.
Acoustic Stimulation* ; Animals ; Anxiety, Separation* ; Clothing ; Dogs* ; Enzyme-Linked Immunosorbent Assay ; Hydrocortisone* ; Odors ; Physiology ; Problem Behavior ; Saliva ; Voice

OBJECTIVES: It has been known that children reved symptoms of Posttraumatic Stress Disorder (PTSD) after experiencing traumas similar to adults. But there are a few studies regarding the psychopathologies of PTSD in preschool children. Considering more active brain and psychological development in preschool children, it is expected that trauma of preschool children causes more serious psychopathologies than those of children with older ages or adults. This study aims to investigate psychopathologies of 9 preschool children experiencing a single, severe trauma, specifically in the respect of PTSD diagnosis. METHODS: Nine preschool children, 3-5 years old, experiencing physical injuries caused by attack from a psychotic patient during lunch time at kindergarten, were evaluated for clinical diagnoses through semi-structured interviews using Kiddie-Schedule for Affective Disorders and Schizophrenia (K-SADS) and Research Diagnostic Criteria (RDC for Kiddies) of PTSD for preschool children. RESULTS: Five (56% by DSM-IV) and Six (67%, by RDC) out of 9 children were diagnosed as to have PTSD. Among those children with PTSD, four (44%) showed Separation Anxiety Disorder (SAD) and one (17%) showed Major Depressive disorder (MDD) as comorbid diagnoses. On subclinical level, two of 9 children (22%) suffered from separation anxiety, seven (78%) from aggressive behaviors, and two (22%) from depressive mood. Sleep disturbances (89%) and reexperiencing of trauma (89%) were the most prominent symptoms of PTSD in preschool children. CONCLUSION: While preschool children showed profiles of PTSD symptoms similar to those of adults, it was critical to use more developmentally sensitive diagnostic tools for a better detection of psychopathologies. Young children experiencing severe trauma showed other comorbid psychopathologies along with PTSD. For proper diagnosis and intervention, it is important to make an accurate clinical diagnosis based on developmentally appropriate diagnostic process and tools.
Adult ; Anxiety, Separation ; Brain ; Child ; Child, Preschool* ; Depressive Disorder, Major ; Diagnosis ; Humans ; Lunch ; Mood Disorders ; Schizophrenia ; Stress Disorders, Post-Traumatic

BACKGROUND: Emergence agitation (EA) frequently occurs after desflurane anesthesia in children. Ketamine, because of its sedative and analgesic properties, might be useful for the management of separation anxiety and EA. We investigated the preventive effect of ketamine on separation anxiety and EA after desflurane anesthesia in children for brief ophthalmic surgery. METHODS: Sixty children, ranging in age from 2-8 years old, undergoing brief ophthalmic surgery were randomly allocated to one of the 3 groups: group C received normal saline, group K1.0 received ketamine 1.0 mg/kg intravenously before entering the operating room, or group K0.5 received ketamine 0.5 mg/kg 10 min before the end of the surgery. Before induction, the separation anxiety score was evaluated. Extubation time, post-anesthesia care unit stay time, postoperative nausea and vomiting, emergence agitation, and pain were assessed. RESULTS: The group K1.0 had a lower separation anxiety score compared with groups K0.5 and C. Extubation time in group K0.5 was significantly prolonged compared with groups K1.0 and C. The incidence of EA and the modified Children's Hospital of Eastern Ontario Pain Scale were significantly lower in group K1.0 and group K0.5 compared to group C, but there was no significant difference between groups K1.0 and K0.5. CONCLUSIONS: In children undergoing brief ophthalmic surgery with desflurane anesthesia, ketamine 1.0 mg/kg administered before entering the operating room reduced separation anxiety, postoperative pain, and incidence of EA without delay in recovery.
Anesthesia ; Anesthesia, General ; Anxiety, Separation ; Child ; Dihydroergotamine ; Humans ; Incidence ; Isoflurane ; Ketamine ; Ontario ; Operating Rooms ; Pain, Postoperative ; Postoperative Nausea and Vomiting

An 11-year-old, toy poodle dog was presented with dermatologic lesions and mammary gland tumor (MGT) evaluation. A solitary, lobulated MGT (size 2.5 x 3.5 cm) was affecting the 5th left mammary gland. Firm, oval plaque skin lesions were present on the left dorsal carpal area. The skin lesions were alopecic and salivary staining. The dog had historical separation anxiety and excessive licking of skin lesions were observed. Based on the clinical and histopathologic examinations, MGT was diagnosed with mammary complex adenoma and the skin lesions were diagnosed with acral lick dermatitis. Behavior modification treatment using oral clomipramine was effective.
Adenoma ; Animals ; Anxiety, Separation ; Behavior Therapy ; Child ; Clomipramine* ; Dermatitis* ; Dogs* ; Humans ; Mammary Glands, Human ; Play and Playthings ; Skin

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is a heterogeneous disorder with contradictory findings about smell detection function. It is not clear if the parent perceived behavior related to olfactory function is associated with age, gender, severity of ADHD, and cooccurring symptoms of anxiety and oppositional behavior in children with ADHD. METHODS: Participants were a clinical sample of 104 children and adolescents with ADHD using DSM-IV diagnostic criteria by a semi-structured interview. Parent perceived behavior related to olfactory processing function was assessed trough a questionnaire. The parent reported Olfactory Functioning Checklist was used to evaluate "seeking behavior and over-responsiveness to smell (SSBO)" and "smell detection ability (SDA)". RESULTS: ADHD and separation anxiety symptoms count (severity) predicted the SDA scale score. None of the variables of gender, age, ADHD subtypes, co-morbidity with oppositional defiant disorder (ODD), and symptom count of ODD predicted SSBO and SDA scales' scores. CONCLUSION: Parent reported behavior related to olfactory detection impairment increased with higher ADHD and anxiety severity. It is independent of age and gender.
Adolescent ; Anxiety ; Anxiety, Separation ; Attention Deficit and Disruptive Behavior Disorders ; Attention Deficit Disorder with Hyperactivity ; Automatic Data Processing ; Checklist ; Child ; Diagnostic and Statistical Manual of Mental Disorders ; Humans ; Parents ; Surveys and Questionnaires ; Smell

In recent years, health care cost containment concerns have resulted in an increase in outpatient (or same-day) surgery. Many procedures previously performed on an inpatient surgery basis have been shifted to outpatient settings. Anesthesia for outpatient surgery is exactly the same as inpatient anesthesia, except that the primary concern is the selection of patients who can be discharged safely on the day of surgery. The anesthesiologist should have a sound rational basis for choice of pharmacologic agents that are geared to expeditious patient discharge from the hospital. Cost concerns aside, outpatient surgery has many additional advantages in the pediatric setting. It minimizes the length of time the child is hospitalized, decreases separation anxiety, promotes parental involvement in the child's postoperative care in the more congenial environment of home, and decreases risk of nosocomial infection and iatrogenic illness.
Ambulatory Surgical Procedures ; Anesthesia* ; Anxiety, Separation ; Child ; Containment of Biohazards ; Cross Infection ; Health Care Costs ; Humans ; Inpatients ; Outpatients* ; Parents ; Patient Discharge ; Postoperative Care

OBJECTIVES: The Hinman Syndrome is a condition representing urinary voiding dysfunction in a neurologically intact child. This syndrome probably is an acquired behavioral and psychosocial disorders. We present a case presenting voiding dysfuntion with no neurologic etiology. CASE: The department of urology consulted the department of psychiatry for a psychiatric evaluation of a 14-year-old girl with a history of recurrent urinary tract infections, enuresis, and urinary dribbling since early childhood. She visited the emergency room because of severe abdominal pain and hematuria. She was admitted to the department of urology. Neurological tests showed no abnormality, but a retrograde cystogram showed free vesicoureteral reflux to the level of the dilated intrarenal collecting systems. Marked blunting and dilatation of the calices suggested longstanding urinary flow obstruction. She had a history of separation anxiety disorder and was very competetive, perfectionistic, and nervous. She also had very poor relationships with her friends and had difficulties in managing them. After admission, she had stent operation and cystostomy. Antidepressant and anxiolytic medications with supportive psychotherapy were administered to treat anxiety, tension and depression. Gradually, her depressive symptoms and voiding difficulties improved. CONCLUSIONS: Psychological factors such as a perfectionistic and obsessive personality, a history of severe separation anxiety, stressors from poor interpersonal relationships and the failure of an entrance examination seem to have contributes to the development and exacerbation of the urinary dysfunction. Pharmacotherapy and supportive psychotherapy may be effective in treating associated psychiatric problems of these patients with hinman syndrome.
Abdominal Pain ; Adolescent ; Anxiety ; Anxiety, Separation ; Child ; Cystostomy ; Depression ; Dilatation ; Drug Therapy ; Emergency Service, Hospital ; Enuresis ; Female ; Friends ; Hematuria ; Humans ; Psychology ; Psychotherapy ; Stents ; Urinary Tract Infections ; Urology ; Vesico-Ureteral Reflux