Skip to main content
SpringerLink
Log in

Separation Anxiety Disorder in Children and Adolescents

Epidemiology, Diagnosis and Management

  • Therapy in Practice
  • Published:
CNS Drugs Aims and scope Submit manuscript

Abstract

This paper provides an overview of the phenomenology, longitudinal outcome data, assessment and management of separation anxiety disorder (SAD) in children and adolescents.

SAD is qualitatively different from early worries, and is characterised by an abnormal reactivity to real or imagined separation from attachment figures, which significantly interferes with daily activities and developmental tasks. Different epidemiological studies indicate a prevalence of 4 to 5% in children and adolescents. In contrast to other anxiety disorders, 50 to 75% of children with SAD come from homes of low socioeconomic status. The severity of symptomatology ranges from anticipatory uneasiness to full-blown anxiety about separation, but children are usually brought to the clinician when SAD results in school refusal or somatic symptoms. School refusal is reported in about 75% of children with SAD, and SAD is reported to occur in up to 80% of children with school refusal. Longitudinal studies have suggested that childhood SAD may be a risk factor for other anxiety disorders, but whether this link is specific to, for example, panic disorder and agoraphobia, or whether SAD represents a general factor of vulnerability for a broad range of anxiety disorders is still debated.

Most relevant data are reported on nonpharmacological treatments (psychoeducational, behavioural, cognitive-behavioural, family and psychodynamic), and these are the first choice approach in SAD. Controlled studies show efficacy of cognitive-behavioural therapy in children with anxiety disorders and specifically in SAD-school phobia, supporting this approach as the best proven treatment. Pharmacotherapy should be used in addition to behavioural or psychotherapeutic intervention when the child’s symptoms have failed to respond to those treatments, and he/she is significantly impaired by the symptoms. Selective serotonin (5-hydroxytryptamine; 5-HT) reuptake inhibitors (SSRI) have a good adverse effect profile and may be considered as first choice drugs in SAD. When different SSRIs fail to improve symptomatology, a trial with a tricyclic antidepressant (TCA) is indicated, with careful monitoring of cardiac functioning. Because of the adverse effect profile and the potential for abuse and dependence, benzodiazepines should be used only when a rapid reduction of symptomatology is needed, until the SSRI or the TCA have begun to be effective (few weeks). Buspirone should be considered in children who have not responded to other treatments. Further research is needed to confirm efficacy of newer antidepressants (venlafaxine, mirtazapine, nefazodone) in childhood anxiety disorders.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Table I
Table II
Table III

Similar content being viewed by others

References

  1. Field T. Attachment and separation in young children. Annu Rev Psychol 1996; 47(4): 541–61

    Article  PubMed  CAS  Google Scholar 

  2. Last CG, Perrin S, Hersen M, et al. DSM-III-R anxiety disorders in children: sociodemographic and clinical characteristics. J Am Acad Child Adolesc Psychiatry 1992; 31(6): 1070–6

    Article  PubMed  CAS  Google Scholar 

  3. Manassis K, Bradley S, Goldberg S, et al. Attachment in mothers with anxiety disorders and their children. J Am Acad Child Adolesc Psychiatry 1994; 33(8): 1106–13

    Article  PubMed  CAS  Google Scholar 

  4. Sheckhar A, Keim SR. The circumventricular organs form a potential neural pathway for lactate sensitivity: implications for panic disorder. J Neurosci 1997; 17(24): 9726–35

    Google Scholar 

  5. Kagan J, Snidman N, Arcus D. Childhood derivatives of high and low reactivity in infancy. Child Dev 1998;69(6): 1483–93

    PubMed  CAS  Google Scholar 

  6. Pine DS, Gran J. Childhood anxiety: integrating developmental psychopathology and affective neuroscience. J Child Adolesc Psychopharmacol 1999; 9(1): 1–12

    Article  PubMed  CAS  Google Scholar 

  7. Shaffer D, Fisher P, Dulkan MK, et al. The NIMH Diagnostic Interview Schedule for Children Version 2.3 (DISC 2.3): description, acceptability, prevalence rates, and performance in the MACA study. J Am Acad Child Adolesc Psychiatry 1995; 35: 865–77

    Article  Google Scholar 

  8. Verhulst FC, van der Ende J, Ferdinand RF, et al. The prevalence of DSM-III-R diagnoses in a national sample of Dutch adolescents. Arch Gen Psychiatry 1997; 54(4): 329–36

    Article  PubMed  CAS  Google Scholar 

  9. Costello EJ, Angold A, Burns BJ, et al. The Great Smoky Mountains Study of Youth: goals, design, methods, and the prevalence of DSM-III-R disorders. Arch Gen Psychiatry 1996; 53(12): 1129–36

    Article  PubMed  CAS  Google Scholar 

  10. Bowen RC, Offord DR, Boyle MH. The prevalence of overanxious disorder and separation anxiety disorder: results from the Ontario Child Health Study. J Am Acad Child Adolesc Psychiatry 1990; 29(5): 753–8

    Article  PubMed  CAS  Google Scholar 

  11. Anderson JC, Williams S, McGee R, et al. DSM-III disorders in preadolescent children. Prevalence in a large sample from the general population. Arch Gen Psychiatry 1987; 44(1): 69–76

    CAS  Google Scholar 

  12. McGee R, Feehan M, Williams S, et al. DSM-III disorders in a large sample of adolescents. J Am Acad Child Adolesc Psychiatry 1990; 29(40): 611–9

    Article  PubMed  CAS  Google Scholar 

  13. Bird HR, Canino G, Rubio-Stipec M. Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico. The use of combined measures. Arch Gen Psychiatry 1988; 45(12): 1120–6

    CAS  Google Scholar 

  14. Lewinsohn PM, Hops H, Roberts RE, et al. Adolescent psychopathology: I. Prevalence and incidence of depression and other DSM-III-R disorders in high school students. J Abnorm Psychol 1993; 102(1): 133–44

    CAS  Google Scholar 

  15. Breton JJ, Bergeron L, Valla JP, et al. Quebec Child Mental Health Survey: prevalence of DSM-III-R mental health disorders. J Child Psychol Psychiatry 1999; 40(3): 375–84

    Article  PubMed  CAS  Google Scholar 

  16. Prior M, Sanson A, Smart D, et al. Psychological disorders and their correlates in an Australian community sample of preadolescent children. J Child Psychol Psychiatry 1999; 40(4): 563–80

    Article  PubMed  CAS  Google Scholar 

  17. Last CG, Francis G, Hersen M, et al. Separation anxiety and school phobia: a comparison using DSM III criteria. Am J Psychiatry 1987; 144(5): 653–7

    PubMed  CAS  Google Scholar 

  18. Velez CN, Johnson J, Cohen P. A longitudinal analysis of selected risk factors for childhood psychopathology. J Am Acad Child Adolesc Psychiatry 1989; 28(6): 861–4

    Article  PubMed  CAS  Google Scholar 

  19. American Psychiatric Association. Diagnostic and statistical manual for mental disorders. 4th ed. Washington, DC: American Psychiatric Association, 1994

    Google Scholar 

  20. World Health Organization. The tenth revision of the international classification of diseases and related health problems (ICD-10). Geneva: World Health Organization, 1992

    Google Scholar 

  21. Francis G, Last CG, Strauss CC. Expression of separation anxiety isorder: the role of age and gender. Child Psychiatry Hum Dev 1987; 18(2): 82–9

    Article  PubMed  CAS  Google Scholar 

  22. Last CG, Strauss CC, Francis G. Comorbidity among childhood anxiety disorders. J Nerv Ment Dis 1987; 175(12): 726–30

    Article  PubMed  CAS  Google Scholar 

  23. Masi G, Favilla L, Mucci M, et al. Symptomatology and comorbidity of generalized anxiety disorder in children and adolescents. Compr Psychiatry 1999; 40(3): 210–5

    Article  PubMed  CAS  Google Scholar 

  24. King N, Ollendick TH, Tonge BJ. School refusal: assessment and treatment. Needham Heights (MA): Allyn & Bacon, 1995

    Google Scholar 

  25. Klein RG, Last CG. Anxiety disorders in children. Newbury Park (CA): Sage, 1989

    Google Scholar 

  26. Borchardt CM, Giesler J, Bernstein GA, et al. A comparison of inpatient and outpatient school refusers. Child Psychiatry Hum Dev 1994; 24(4): 255–64

    Article  PubMed  CAS  Google Scholar 

  27. Black B. Separation anxiety disorder and panic disorder. In: March JS, editor. Anxiety disorders in children and adolescents. New York: Guilford, 1995: 212–34

    Google Scholar 

  28. Deltito JA, Hahn R. A three-generational presentation of separation anxiety in childhood with agoraphobia in adulthood. Psychopharmacol Bull 1993; 29(2): 189–93

    PubMed  CAS  Google Scholar 

  29. Berg I, Jackson A. Teenage school refusers grow-up: a follow-up study of 168 subjects, ten years on average after in-patient treatment. Br J Psychiatry 1985; 147: 366–70

    Article  PubMed  CAS  Google Scholar 

  30. Flakierska-Praquin N, Lindstrom M, Gillberg C. School phobia with separation anxiety disorder: a comparative 20- to 29-year follow-up study of 35 school refusers. Compr Psychiatry 1997; 38(1): 17–22

    Article  PubMed  CAS  Google Scholar 

  31. Silove D, Manicavasagar V. Adults who feared school: is early separation anxiety specific to the pathogenesis of panic disorder? Acta Psychiatr Scand 1993; 88(6): 385–90

    Article  PubMed  CAS  Google Scholar 

  32. Silove D, Harris M, Morgan A, et al. Is early separation anxiety a specific precursor of panic disorder-agoraphobia? A community study. Psychol Med 1995; 25(2): 405–11

    Article  PubMed  CAS  Google Scholar 

  33. Silove D, Manicavasagar V, O’Connel D, et al. Reported early separation anxiety symptoms in patients with panic and generalized anxiety disorders. Aust NZJ Psychiatry 1993; 27(3): 489–94

    Article  CAS  Google Scholar 

  34. Manicavasagar V, Silove D, Hadzi-Pavlovic D. Subpopulations of early separation anxiety: relevance to risk of adult anxiety disorder. J Affect Disord 1998; 48(2–3): 181–90

    Article  PubMed  CAS  Google Scholar 

  35. Bradley SJ, Hood J. Psychiatrically referred adolescents with panic attacks:presenting symptoms, Stressors and comorbidity. Am Acad Child Adolesc Psychiatry 1993; 32(4): 826–9

    Article  CAS  Google Scholar 

  36. Biederman J, Faraone SV, Marrs A, et al. Panic disorder and agoraphobia in consecutively referred children and adolescents. J Am Acad Child Adolesc Psychiatry 1997; 36(2): 214–23

    Article  PubMed  CAS  Google Scholar 

  37. Masi G, Favilla L, Mucci M, et al. Depressive comorbidity in children and adolescents with generalized anxiety disorder. Child Psychiatry Hum Dev 2000; 30(3): 205–15

    Article  PubMed  CAS  Google Scholar 

  38. Capps L, Sigman M, Sena R, et al. Fear, anxiety, and perceived control in children of agoraphobic parents. J Child Psychol Psychiatry 1996; 37(4): 445–52

    Article  PubMed  CAS  Google Scholar 

  39. Pine DS, Cohen P, Gurley D, et al. The risk for early adulthood anxiety and depressive disorders in adolescents with anxiety and depressive disorders. Arch Gen Psychiatry 1998; 55(1): 56–64

    Article  PubMed  CAS  Google Scholar 

  40. Tyrer P, Tyrer S. School refusal, truancy, and adult neurotic illness. Psychol Med 1974; 4(4): 416–21

    Article  PubMed  CAS  Google Scholar 

  41. Van der Molen GM, Van den Hout MA, Van Dieren AC, et al. Childhood separation anxiety and adult-onset panic disorders. J Anxiety Disord 1989; 3: 97–106

    Article  Google Scholar 

  42. Aronson TA, Logue CM. On the longitudinal course of panic disorder: developmental history and predictors of phobic complications. Compr Psychiatry 1987; 28(4): 344–55

    Article  PubMed  CAS  Google Scholar 

  43. Lipsitz JD, Martin LY, Mannuzza S, et al. Childhood separation anxiety disorder in patients with adult anxiety disorder. Am J Psychiatry 1994; 151(6): 927–9

    PubMed  CAS  Google Scholar 

  44. Silove D, Manicavasagar V, Curtis J, et al. Is early separation anxiety a risk factor for adult panic disorder? a critical review. Compr Psychiatry 1996; 37(3): 167–79

    Article  PubMed  CAS  Google Scholar 

  45. Battaglia M, Bertella S, Politi E, et al. Age of onset of panic disorder: influence of familial liability to the disease and of childhood separation anxiety disorder. Am J Psychiatry 1995; 152(9): 1362–4

    PubMed  CAS  Google Scholar 

  46. Manicasavagar V, Silove D. Is there an adult form of separation anxiety disorder? Abrief clinical report. Aust NZJ Psychiatry 1997; 31(2): 299–303

    Article  Google Scholar 

  47. Fagiolini A, Shear MK, Cassano GB, et al. Is lifetime separation anxiety a manifestation of a panic spectrum? CNS Spectrums 1998; 3(4): 63–72

    Google Scholar 

  48. Prior M. Childhood temperament. J Child Psychol Psychiatry 1992; 33(1): 249–79

    Article  PubMed  CAS  Google Scholar 

  49. Martin C, Cabrol S, Bouvard MP, et al. Anxiety and depressive disorder in fathers and mothers of anxious school-refusing children. J Am Acad Child Adolesc Psychiatry 1999; 38(7): 916–22

    Article  PubMed  CAS  Google Scholar 

  50. Orvaschel H. Schedule for Affective Disorders and Schizophrenia for School-Age Children - Epidemiologic Version 5 (K-SADS-E-5). Fort Lauderdale (FL): Nova Southeastern University, 1995

    Google Scholar 

  51. Reich W. Diagnostic Interview for Children and Adolescents — Revised DSM-IV version. Toronto: Multi-Health Systems, 1997

    Google Scholar 

  52. Kashani JH, Orvaschel H. A community study of anxiety in children and adolescents. Am J Psychiatry 1990; 147(3): 13–8

    Google Scholar 

  53. Masi G, Favilla L, Mucci M, et al. Panic disorder in clinically referred children and adolescents. Child Psychiatry Hum Dev 2000; 31(2): 139–51

    Article  PubMed  CAS  Google Scholar 

  54. Birmaher B, Brent DA, Chiappetta L, et al. Psychometric properties of the Screen for Child Anxiety Related Emotional Disorders (SCARED): a replication study. J Am Acad Child Adolesc Psychiatry 1999; 38(10): 1230–6

    Article  PubMed  CAS  Google Scholar 

  55. March JS, Parker JDA, Sullivan K, et al. The multidimensional anxiety scale for children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry 1997; 36(4): 554–65

    Article  PubMed  CAS  Google Scholar 

  56. Hamilton M. The assessment of anxiety states by rating. Br J Med Psychol 1959; 32: 50–5

    Article  PubMed  CAS  Google Scholar 

  57. Kovacs M. The Children’s Depression Inventory (CDI) Manual. North Tonawanda (NY): Multi-Health Systems, 1992

    Google Scholar 

  58. King N, Ollendick TH. Treatment of child phobias. J Child Psychol Psychiat 1997; 38(4): 389–400

    Article  PubMed  CAS  Google Scholar 

  59. Blagg N, Yule W. The behavioral treatment of school refusal — a comparative study. Behav Res Ther 1984; 22(2): 119–27

    Article  PubMed  CAS  Google Scholar 

  60. Kendall PC. Treating anxiety disorders in children: results of a randomized clinical trial. J Consult Clin Psychol 1994; 62(1): 100–10

    Article  PubMed  CAS  Google Scholar 

  61. King NJ, Tonge BJ, Heyne BJ, et al. Cognitive-behavioral treatment of school-refusing children: a controlled evaluation. J Am Acad Child Adol Psychiatry 1998; 37(4): 395–403

    Article  CAS  Google Scholar 

  62. Last CG, Hansen MS, Franco N. Cognitive-behavioral treatment of school phobia. J Am Acad Child Adolesc Psychiatry 1998; 37(4): 404–11

    Article  PubMed  CAS  Google Scholar 

  63. Mendlowitz SL, Manassis K, Bradley S, et al. Cognitive-behavioral group treatments in childhood anxiety disorders: the role of parental involvement. J Am Acad Child Adolesc Psychiatry 1999; 38(10): 1223–9

    Article  PubMed  CAS  Google Scholar 

  64. Bemporad J. Psychoanalysis and psychodynamic psychotherapy. In: Wiener JM, editor. Textbook of child and adolescent psychiatry. Washington, DC: American Psychiatric Press, 1991; 571–5

    Google Scholar 

  65. Bernstein GA, Garfinkel BD, Borchardt CM. School phobia: pattern of family functioning. J Am Acad Child Adolesc Psychiatry 1990; 29(1): 24–30

    Article  PubMed  CAS  Google Scholar 

  66. American Academy of Child and Adolescent Psychiatry. Practice parameters for the assessment and treatment of children and adolescents with anxiety disorders. J Am Acad Child Adolesc sychiatry 1997; 36Suppl.10: 69S–84S

    Google Scholar 

  67. Gittelman-Klein R, Klein DF. Controlled imipramine treatment of school phobia. Arch Gen Psychiatry 1971; 25: 204–7

    Article  Google Scholar 

  68. Klein RG, Koplewicz HS, Kanner A. Imipramine treatment of children with separation anxiety disorder. J Am Acad Child Adolesc Psychiatry 1992; 31(1): 21–8

    Article  PubMed  CAS  Google Scholar 

  69. Berney T, Kolvin I, Bhate SR, et al. School phobia: a therapeutic trial with clomipramine and short-term outcome. Br J Psychiatry 1981; 138: 110–8

    Article  PubMed  CAS  Google Scholar 

  70. Bernstein GA, Garfinkel BD, Borchardt CM. Comparative studies of pharmacotherapy for school refusal. J Am Acad Child Adolesc Psychiatry 1990; 29(5): 773–81

    Article  PubMed  CAS  Google Scholar 

  71. Ryan ND, Puig-Antich J, Cooper TB, et al. Imipramine in adolescent major depression: plasma levels and clinical response. Acta Psychiatr Scand 1986; 73: 275–88

    Article  PubMed  CAS  Google Scholar 

  72. Ryan ND, Last C, BirmaherB, et al. Imipramine and cognitive therapy for children and adolescents with school phobia. 15th National Conference of the Anxiety Disorders Association of America, Pittsburgh, PA, 1995

  73. Bernstein GA, Borchardt CM, Perwien AR, et al. Imipramine plus cognitive-behavioral therapy in the treatment of school refusal. J Am Acad Child Adolesc Psychiatry 2000; 39(3): 276–83

    Article  PubMed  CAS  Google Scholar 

  74. Leonard HL, Meyer MC, Swedo SE, et al. Electrocardiographic changes during desimipramine and clomipramine treatment in children and adolescents. J Am Acad Child Adolesc Psychiatry 1995; 34(11): 1460–8

    Article  PubMed  CAS  Google Scholar 

  75. Manassis K, Bradley S. Fluoxetine in anxiety disorders. J Am Acad Child Adolesc Psychiatry 1994; 33(5): 761–2

    Article  PubMed  CAS  Google Scholar 

  76. Birmaher B, Waterman GS, Ryan N, et al. Fluoxetine for childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry 1994; 33(7): 993–9

    Article  PubMed  CAS  Google Scholar 

  77. Fairbanks JM, Pine DS, Tancer NK, et al. Open fluoxetine treatment of mixed anxiety disorders in children and adolescents. J Child Adolesc Psychopharmacol 1997; 7(1): 17–29

    Article  PubMed  CAS  Google Scholar 

  78. Guy W. ECDEU assessment manual of psychopharmacology. DHEW Publication ADM 76-338. Rockville (MD): NIMH, Psychopharmacology Research Branch, 1976

    Google Scholar 

  79. Vitiello B, RUPP Anxiety Study Group. A multisite double blind placebo-controlled trial of fluvoxamine for children and adolescents with anxiety disorders. 40th Annual Meeting for the New Clinical Drug Evaluation Unit (NCDEU), Boca Raton (FL), 2000

  80. Simeon JG, Ferguson HB, Knott V, et al. Clinical, cognitive, and neurophysiological effects of alprazolam in children and adolescents with overanxious and avoidant disorder. J Am Acad Child Adolesc Psychiatry 1992; 31(1): 29–33

    Article  PubMed  CAS  Google Scholar 

  81. Graae F, Milner J, Rizzotto L, et al. Clonazepam in childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry 1994; 33(3): 372–6

    Article  PubMed  CAS  Google Scholar 

  82. Kutcher SP, Reiter S, Gardner DN, et al. The pharmacotherapy of anxiety disorders in children and adolescents. Psychiatr Clin North Am 1992; 15(1): 41–67

    PubMed  CAS  Google Scholar 

  83. Kranzler HR. Case study: use of buspirone in an adolescent with overanxious disorder. J Am Acad Child Adolesc Psychiatry 1988; 27(6): 789–90

    Article  PubMed  CAS  Google Scholar 

  84. Simeon JG, Knott VJ, Thatte S, et al. Pharmacotherapy of childhood anxiety disorders. Pediatr Neuropharmacol 1992; 15Suppl. 1 PtA: 229A–30A

    Article  Google Scholar 

  85. Simeon JG, Knott VJ, DuBois C, et al. Buspirone therapy of mixed anxiety disorders in childhood and adolescents: a pilot study. J Child Adolesc Psychopharmacol 1994; 4: 159–70

    Article  Google Scholar 

  86. Coffey BJ. Anxiolytics for children and adolescents: traditional and new drugs. J Child Adolesc Psychopharmacol 1990; 1: 57–83

    Article  PubMed  CAS  Google Scholar 

  87. Linet LS. Tourette syndrome, pimozide, and school phobia: the neuroleptic separation anxiety syndrome. Am J Psychiatry 1985; 142(5): 613–5

    PubMed  CAS  Google Scholar 

  88. Mikkelsen EJ, Detlor J, Cohen DJ. School avoidance and school phobia triggered by haloperidol in patients with Tourette’s disorder. Am J Psychiatry 1981; 138(12): 1572–6

    PubMed  CAS  Google Scholar 

  89. Hannah GL, Fluent DE, Fischer DJ. Separation anxiety in children and adolescents treated with risperidone. J Child Adolesc Psychopharmacol 1999; 9: 277–83

    Article  Google Scholar 

  90. Falkai P. Mirtazapine: other indications. J Clin Psychiatry 1999; 60 Suppl. 17: 36–40

    Google Scholar 

  91. Feighner JP. Overview of antidepressants currently used to treat anxiety disorders. J Clin Psychiatry 1999; 60 Suppl. 22: 18–22

    Google Scholar 

  92. Sheehan DV. Venlafaxine extended release (XR) in the treatment of generalized anxiety disorder. J Clin Psychiatry 1999; 60 Suppl. 22: 23–8

    Google Scholar 

  93. Kearney CA, Silverman WK. The evolution and reconciliation of taxonomic strategies for school refusal behavior. Clin Psychol 1996; 3: 339–54

    Article  Google Scholar 

  94. Birmaher B, Yelovich AK, Renaud J. Pharmacologic treatment for children and adolescents with anxiety disorders. Pediatr lin North Am 1998; 45: 1187–204

    Article  CAS  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Division of Child Neurology and Psychiatry, University of Pisa - IRCCS Stella Maris, Via dei Giacinti 2, 56018, Calambrone, Pisa, Italy

    Gabriele Masi, Maria Mucci & Stefania Millepiedi

Authors
  1. Gabriele Masi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Maria Mucci
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Stefania Millepiedi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Gabriele Masi.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Masi, G., Mucci, M. & Millepiedi, S. Separation Anxiety Disorder in Children and Adolescents. Mol Diag Ther 15, 93–104 (2001). https://doi.org/10.2165/00023210-200115020-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00023210-200115020-00002

Keywords

Search

Navigation