Separation Anxiety Disorder Basics
In this guide you’ll learn the signs and symptoms of separation anxiety disorder, how it’s diagnosed and how it’s treated.
Separation Anxiety: What Is It?
Children with separation anxiety disorder experience extreme distress when they are separated from parents or caregivers. Difficulty separating is normal in early childhood development; it becomes a disorder if the fear and anxiety interfere with age-appropriate behavior. Symptoms of separation anxiety disorder commonly become noticeable in preschool and early grammar school, but in rare cases it becomes problematic later, in early adolescence.
What Is Separation Anxiety?
Separation Anxiety: What to Look For
Children with separation anxiety disorder experience extreme anxiety when they are separated from a caregiver to whom they are attached. While separation anxiety can be developmentally appropriate for young children, the anxiety that children with separation anxiety disorder experience is unusual for their age and development.
Some symptoms parents might notice include:
- Difficulty saying goodbye to parents
- Fear that something bad will happen to a family member during separation
- Tantrums when faced with separation
- Overwhelming need to know where parents are, and be in touch with them by phone or texting
- Shadowing one parent constantly around the house
- Vivid nightmares about family tragedy
- Physical symptoms in anticipation of separation, like stomachaches, headaches and dizziness
- Extended absences from school and avoidance of playdates
Younger children are mostly anxious at the time of separation, while older kids develop more anticipatory anxiety.
Separation Anxiety: Risk Factors
Separation anxiety disorder may be triggered by stress, trauma or changes in the environment, such as a move to a new home or school, or a death or divorce in the family. Some children may also be genetically predisposed to developing the disorder.
Separation Anxiety: Diagnosis
For a diagnosis of separation anxiety disorder, a clinician looks for distress in being separated from parents or caregivers that is excessive for a child’s age and prevents him from participating in age-appropriate activities. To meet diagnostic criteria, the symptoms the child demonstrates must be persistent, lasting for at least four weeks, and cause impairment in his ability to function at school and with friends.
Separation Anxiety: Treatment
Separation anxiety disorder is treated by behavioral therapy. In more severe cases, children who don’t respond well to therapy may also benefit from medication.
Psychotherapeutic: Treatment for separation anxiety disorder typically involves cognitive behavioral therapy, or CBT. This is a treatment approach that helps children learn to understand and manage their fears. Exposure therapy, a specialized form of CBT, might also be used. Exposure therapy works by carefully exposing children to separation in small, controlled doses, helping to reduce their anxiety over time. CBT also teaches kids coping skills that they can rely on when they are feeling anxious.
Because parents can inadvertently reinforce anxiety when they are comforting anxious children, treatment frequently also involves parent training on how to respond to anxiety. Some clinicians also recommend contingency management, which is a way to reinforce brave behavior by rewarding children for meeting their treatment goals.
Pharmacological: When therapy is not enough to help a child manage her symptoms, she may be prescribed a medication to alleviate her distress and make therapy more effective. A variety of medications have been shown to be effective in treating separation anxiety disorder; the first-line medication is one of the SSRIs, or selective serotonin reuptake inhibitors. Typical anxiolytics — or anti-anxiety medications — like the benzodiazepines are also effective, though they can be habit forming.