rates in girls. Children with separation an xiety disorder display particularly enhanced
sensitivity to respirat ory stimulation using CO2-enriched air.
Culture-Related Diagnostic Issues
There are cultural variations in  the degree to which it is co nsidered desirable to tolerate
separation, so that demands and opportunit ies for separation between parents and chil-
dren are avoided in some cultures. For exampl e, there is wide variation across countries
and cultures with respect to the age at which it  is expected that offspring should leave the
parental home. It is important to differenti ate separation anxiety disorder from the high
value some cultures place on strong interdependence among family members.
Gender-Related Diagnostic Issues
Girls manifest greater reluctance to attend or  avoidance of school th an boys. Indirect ex-
pression of fear of separation may be more common in males than in females, for example,
by limited independent activity , reluctance to be away from  home alone, or distress when
spouse or offspring do things independently or when contact with spouse or offspring is
not possible.
Suicide Risk
Separation anxiety disorder in children may be associated with an increased risk for sui-
cide. In a community sample, the presence of mood disorders,  anxiety disorders, or sub-
stance use has been associated with suicidal ideation and attempts. However, this
association is not specific to separation anxi ety disorder and is found in several anxiety
disorders.
Functional Consequences of Separation Anxiety Disorder
Individuals with separation anxiety disorder often limit independent activities away from
home or attachment figures (e.g., in children, avoiding school, not going to camp, having