Separation Anxiety Disorder

What is it?

Difficulty separating from parents or caregivers is normal for young children. However, separation anxiety disorder causes a child or adolescent anxiety when she is separated from parents or caregivers and that fear interferes with age-appropriate behavior.  Symptoms are typically noticeable in preschool and early grammar school; rarely, it becomes problematic in early adolescence.

Signs and Symptoms

A child may have separation anxiety disorder if she is extremely attached to her parents and feels like her family is in danger if she is separated from them. She might have a hard time saying goodbye to parents, being alone in the house, or sleeping in a dark room, because she is worried that something will happen to her or her family. Physical symptoms, including stomachaches, headaches, and dizziness, may manifest in anticipation of separation. At school, she may phone or text her parents because she feels an overwhelming need to know where her parents are. At home, she may shadow a parent constantly. The child can have extended absences from school or may avoid activities like playdates or parties. Younger children are mostly anxious at separation, while older children develop more anticipatory anxiety.

Diagnosis and Treatment

Separation anxiety disorder is very treatable, particularly when diagnosed early. For a diagnosis, a clinician looks for a child’s distress in being separated from—or anticipating separation from—parents or caregivers that’s excessive for his age and prevents him from participating in age-appropriate activities. The child must have the symptoms for at least 4 weeks.

Psychotherapy is the first-line treatment for the majority of separation anxiety cases; cognitive behavioral therapy is very successful. Contingency management, which involves a “contract” and “rewards” system – for example, the child doesn’t cry when dropped off at school – has been very successful. Progress can be slow.

In more severe cases, medication may be prescribed to alleviate a child’s distress and facilitate therapy.  SSRIs, or selective serotonin reuptake inhibitors, have been effective; anti-anxiety medications—like benzodiazepines – are also effective, but can be habit forming.

What are the risk factors for children?

Separation anxiety appears to be hereditary. It may be triggered by stress, trauma, or changes in environment—a move to a new home or school, a death or divorce in the family.

Many children with one anxiety disorder also have another and are more likely to be depressed. There is a strong correlation between separation anxiety in children and a future diagnosis of panic disorder, and between separation and social anxiety disorders.