Treatment of separation anxiety disorder with graduated exposure and reinforcement targeting school attendance: a controlled case study

A six-year, nine-month old girl with school avoidance and a variety of other anxiety symptoms was diagnosed with Separation Anxiety Disorder (SAD). SAD was treated using graduated exposure with positive reinforcement for approximations of independent school attendance. Treatment focused on systematically shaping increased duration of school attendance while fading mother's proximity and time spent in the classroom and in transit to and from school. A changing criterion single-subject research design was used to demonstrate functional control of the treatment over the child's school attendance. Follow-up indicated that treatment gains were maintained at two- and nine-months post-treatment. SAD is discussed as a childhood disorder involving fear and avoidance of separation from parents in a variety of situations, one of which may be attending school. The importance of differentiating SAD from school phobia and other anxiety disorders is discussed.