form of treatment found to be ideal for older children with sad. the theory behind this technique is that the child's dysfunctional thoughts, attitudes, and beliefs are what leads to anxiety and causes anxious behavior. children who are being treated with cognitive procedures are taught to ask themselves if there is "evidence" to support their anxious thoughts and behaviors. they are taught "coping thoughts" to replace previously distorted thoughts during anxiety-inducing situations such as doing a reality check to assess the realistic danger of a situation and then to praise themselves for handling the situation bravely. examples of such disordered thoughts include polarized thinking, overgeneralization, filtering (focusing on negative), jumping to conclusions, catastrophizing, emotional reasoning, labeling, "shoulds", and placing blame on self and others. sometimes therapists will involve parents and teach them behavioral tactics such as contingency management. medication the use of medication is applied in extreme cases of sad when other treatment options have been utilized and failed. however, it has been difficult to prove the benefits of drug treatment in patients with sad because there have been many mixed results. despite all the studies and testings, there has yet to be a specific medication for sad. medication prescribed for adults from the food and drug administration (fda) are often used and have been reported to show positive results for children and adolescents with sad. there are mixed results regarding the benefits of using tricyclic antidepressants (tcas), which includes imipramine and clomipramine. one study suggested that imipramine is helpful for children with "school phobia," who also had an underlying diagnosis of sad. however, other studies have also shown that imipramine and clomipramine had the same effect of children who were treated with the medication and placebo. the most promising medication is the use of selective serotonin reuptake inhibitors (ssri) in adults and children. several studies have shown that patients treated with fluvoxamine were significantly better than those treated with placebo. they showed decreasing anxiety symptoms with short-term and long-term use of the medication. prognosis discomfort from separations in children from ages 8 to 14 months is normal. children oftentimes get nervous or afraid of unfamiliar people and places but if the behavior still occurs after the age of six and if it lasts longer than four weeks, the child might have separation anxiety disorder. about 4% of children have the disorder. separation anxiety disorder is very treatable especially when caught early on with medication and behavioral therapies. helping children with separation anxiety to identify the circumstances that elicit their anxiety (upcoming separation events) is important. a child's ability to tolerate separations should gradually increase over time when he or she is gradually exposed to the feared events. encouraging a child with separation anxiety disorder to feel competent and empowered, as well as to discuss feelings associated with anxiety-provoking events promotes recovery. children with separation anxiety disorder often respond negatively to perceived anxiety in their caretakers, in that parents and caregivers who also have anxiety disorders may unwittingly confirm a child's unrealistic fears that something terrible may happen if they are separated from each other. thus, it is critical that parents and caretakers become aware of their own feelings and communicate a sense of safety and confidence about separation. longitudinal effects several studies aim to understand the long-term mental health consequences of sad. sad contributed to vulnerability and acted as a strong risk factor for developing other mental disorders in people aged 19–30. specifically disorders including panic disorder and depressive disorders were more likely to occur. other sources also support the increased likelihood of displaying either of the two psychopathologies with previous history of childhood sad. studies show that children who have separation anxiety at younger ages have more complex fear acquisition. this means that there is likely an interplay between associative and non-associative processes concerning fear and anxiety later in life. beyond mental health outcomes, sad has also been shown to impact other important areas of functioning as well. for preschool children, high and persistent levels of separation anxiety were shown to predict worse academic achievement, poorer physical health, and higher internalizing symptoms throughout middle-childhood and early adolescence. epidemiology anxiety disorders are the most common type of psychopathology to occur in today's youth, affecting from 5–25% of children worldwide. of these anxiety disorders, sad accounts for a large proportion of diagnoses. sad may account for up to 50% of the anxiety disorders as recorded in referrals for mental health treatment. sad is noted as one of the earliest-occurring of all anxiety disorders. adult separation anxiety disorder affects roughly 7% of adults, though it has also been shown to occur in between 23-42% of adults in clinical samples. it has also been reported that the clinically anxious pediatric population are considerably larger. for example, according to hammerness et al. (2008) sad accounted for 49% of admissions. research suggests that 4.1% of children will experience a clinical level of separation anxiety. of that 4.1% it is calculated that nearly a third of all cases will persist into adulthood if left untreated. research continues to explore the implications that early dispositions of sad in childhood may serve as risk factors for the development of mental disorders throughout adolescence and adulthood. it is presumed that a much higher percentage of children suffer from a small amount of separation anxiety, and are not actually diagnosed. multiple studies have found higher rates of sad in girls than in boys, and that paternal absence may increase the chances of sad in girls.