Quick Guide to Separation Anxiety Disorder

Separation anxiety disorder is a mental health disorder that causes children to become extremely upset when they are separated from parents or caregivers. They worry that something bad will happen to their parents during the separation. It’s normal for young kids to have some trouble separating, but this anxiety is more extreme. With separation anxiety disorder, fear and anxiety get in the way of normal life, like going to school or to playdates.  

Symptoms of separation anxiety disorder usually show up in preschool and early elementary school. In rare cases it can show up later, like when a child starts middle school. 

The anxiety that children with separation anxiety disorder feel is much more than what is normal for their age.  

Signs that a child might have separation anxiety disorder include: 

• Problems saying goodbye to parents 

• Fear that something bad will happen to a family member during separation 
• Tantrums when they have to leave parents or caregivers  
• Overwhelming need to know where parents are, and be in touch with them by phone or texting 
• Constantly following one parent around the house 
• Nightmares about bad things happening to family members  

• Physical symptoms like stomachaches, headaches and dizziness 
• Refusing to go to school or on playdates 

Younger children are mostly anxious at the time of separation. Older kids get anxious when they think about an upcoming separation. 

A diagnosis of separation anxiety requires anxiety at being separated from parents or caregivers that is beyond what is considered normal for a child’s age. The symptoms have to show up most of the time for at least four weeks and cause serious problems in the child’s daily life. 

Treatment for separation anxiety disorder usually involves  cognitive behavioral therapy, or CBT. This is a treatment that helps children learn to understand and manage their fears. Exposure therapy, a specialized form of CBT, is often used to treat anxiety. Exposure therapy works by carefully exposing children to separation in small doses, which helps them learn to tolerate the anxiety, and feel less anxious over time.  

Parent training can be helpful to make parents feel more confident and comfortable about supporting their kids during treatment. There is also a relatively new form of treatment called SPACE — Supportive Parenting for Anxious Childhood Emotions — in which the clinician works only with parents to change the way they respond to the behavior of their anxious child. That, in turn, helps reduce the child’s anxiety.

When therapy is not enough, a child may be given medicine to lessen their symptoms and help make therapy more effective. The most common drug to treat separation anxiety disorder is an antidepressant medication called an SSRI. Occasionally anti-anxiety medications are used but they can be habit-forming.