What is separation anxiety disorder?

Separation anxiety disorder (SAD) is defined as excessive worry and fear about being apart from family members or individuals to whom a child is most attached. Children with separation anxiety disorder fear being lost from their family or fear something bad happening to a family member if they separated from them. Symptoms of anxiety or fear about being separated from family members must last for a period of at least four weeks to be considered SAD. It is different than stranger anxiety, which is normal and usually experienced by children between 7 and 11 months of age. Symptoms of SAD are more severe than the normal separation anxiety that nearly every child experiences to some degree between the ages of 18 months and 3 years of age.

What causes separation anxiety disorder?

Anxiety disorders are believed to have biological, family, and environmental factors that contribute to the cause. A chemical imbalance involving two chemicals in the brain (norepinephrine and serotonin) most likely contributes to the cause of anxiety disorders. While a child or adolescent may have inherited a biological tendency to be anxious, anxiety and fear can also be learned from family members and others who frequently display increased anxiety around the child. A traumatic experience may also trigger anxiety. The manner in which a person copes with anxiety may make it worse or better over time.

Who is affected by separation anxiety disorder?

All children and adolescents experience some anxiety. It is a normal part of growing up. However, when worries and fears are developmentally inappropriate concerning separation from home or family, separation anxiety disorder may be present. Reports indicate that SAD occurs equally in males and females. However, studies suggest that males experiencing symptoms of SAD are more likely than females to be referred for help and receive treatment.

The first symptoms of SAD usually appear around the third or fourth grade, but this is not always the case. Typically, the onset of symptoms occurs following a break from school such as holidays or an extended illness. It is estimated that about 4 percent of younger children have SAD, while the estimate for adolescents is slightly lower. Children of parents with an anxiety disorder are more likely to have an anxiety disorder.

What are the symptoms of separation anxiety disorder?

The following are the most common signs of SAD. However, each child may experience symptoms differently.

  • refusal to sleep alone
  • repeated nightmares with a theme of separation
  • excessive distress when separation from home or family occurs or is anticipated
  • excessive worry about the safety of a family member
  • excessive worry about getting lost from family
  • refusing to go to school
  • fearful and reluctant to be alone
  • frequent stomach aches, headaches, or other physical complaints
  • muscle aches or tension
  • excessive worry about safety of self
  • excessive worry about or when sleeping away from home
  • excessive “clinginess,” even when at home
  • symptoms of panic and/or temper tantrums at times of separation from parents or caregivers

The symptoms of separation anxiety disorder may resemble other conditions or psychiatric problems. Always consult a licensed mental health provider for a diagnosis.

How is separation anxiety disorder diagnosed?

A child psychologist or other qualified mental health professional usually diagnoses anxiety disorders in children or adolescents following a comprehensive psychiatric evaluation. Parents who note signs of severe anxiety in their child or teen can help by seeking an evaluation and treatment early. Early treatment can often prevent future problems.

Treatment for separation anxiety disorder

Specific treatment for separation anxiety disorder will be determined by your child’s clinician based on:

  • your child’s age, overall health, and medical history
  • extent of your child’s symptoms
  • your child’s tolerance for specific medications, procedures, or therapies
  • expectations for the course of the condition
  • your opinion or preference

Anxiety disorders can be effectively treated. Studies have found that about 96% of children with SAD who were referred for treatment were free from the disorder when re-evaluated 3-4 years later. Treatment should always be based on a comprehensive evaluation of the child and family. Treatment recommendations may include cognitive behavioral therapy (CBT) for the child, with the focus being to help the child or adolescent learn skills to manage his/her anxiety and to help him/her master the situations that contribute to the anxiety. CBT is the most studied psychosocial treatment for SAD. Many studies have demonstrated the general effectiveness of CBT for SAD. Some children may also benefit from treatment with antidepressant or anti-anxiety medication to help them feel calmer. Medication alone is never considered the treatment of choice given the highly likely of relapse for individuals who receive medication without psychotherapy. Parents play a vital, supportive role in any treatment process. Family therapy and consultation with the child’s school may also be recommended.

Prevention of separation anxiety disorder

Preventive measures to reduce the incidence of separation anxiety disorders in children are not known at this time. However, early detection and intervention can reduce the severity of the disorder, enhance the child’s normal growth and development, and improve the quality of life experienced by children or adolescents with separation anxiety disorder.

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