Separation Anxiety Disorder

It is common for toddlers through preschool-aged children to experience anxiety upon separation from their parents, as displayed by crying or clinging behavior. Usually, toddlers and young children can often be soothed or distracted from their anxiety. Their anxiety usually subsides as they become acquainted with the new environment. Some children continue to display separation anxiety long after it is expected or typical and may have separation anxiety disorder.

Separation anxiety disorder is characterized by age-inappropriate, excessive fear of being away from parents or home.  Children with this disorder experience great distress when they separate or anticipate separating from loved ones or home.  They continue to experience distress throughout the duration of the separation and may complain of physical symptoms, such as stomachaches or headaches.  Children with separation anxiety disorder often refuse to attend school, sleepovers, or play-dates, unless their parents attend with them. If they do attend activities without their parents, they may frequently “check-in” with their parents via telephone calls or texts. When they are at home with their parents, they may follow their parents around the house, become upset when they are in a different room from their parents, and sleep near or with their parents. Often, children with separation anxiety disorder worry about something bad happening to them or their parents during separation, such that they would never see their loved ones again. Approximately 4% of children have separation anxiety disorder. The onset of this disorder typically occurs in early or middle childhood and is more common in girls than boys.

 

References

  • Albano, A. M., Chorpita, B. F., & Barlow, D. H. (1996). Childhood anxiety disorders. In E.J. Marsh & R. A. Barkley (Eds.), Child psychopathology (pp. 196-241). New York: Guilford Press.
  • Beesdo, K., Knappe, S., & Pine, D. S. (2009). Anxiety and anxiety disorders in children and adolescents: Developmental issues and implications for DSM-V. Psychiatric Clinics of North America, 32(3), 483-542.
  • Last, C. G., Perrin, S., Herson, M., & Kazdin, A. E. (1992). DSM-III-R anxiety disorders in children: Sociodemographic and clinical characteristics. Journal of the American Academy of Child and Adolescent Psychiatry, 31, 1070-1076.
  • Shear, K., Jin, R., Ruscio, A. M., Walters, E. E., & Kessler, R. C. (2006). Prevalence and Correlates of Estimated DSM-IV Child and Adult Separation Anxiety Disorder in the National Comorbidity Survey Replication. American Journal of Psychiatry, 163, 1074-1083.

Symptoms

According to the DSM IV-TR, the following are symptoms of Separation Anxiety Disorder. It can be considered a problem if the child is struggling with three (or more) of these symptoms and that the symptoms are interfering with a child's functioning and last more than 4 weeks.

 
  • Recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated.
  • Persistent and excessive worry about losing, or about possible harm befalling, major attachment figures.
  • Persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped).
  • Persistent reluctance or refusal to go to school or elsewhere because of fear of separation.
  • Persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings.
  • Persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home.
  • Repeated nightmares involving the theme of separation.
  • Repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated .
 

Red Flags

These are some red flags that can be seen in Separation Anxiety Disorder
 
  • Cries, screams or begs to stay even in routine separations from home, parents and/or loved ones (like when leaving for school or to a birthday party, or if a parent is going out for dinner or away overnight).
  • Worry about something bad happening to a parent or loved one if they are not together
  • Trouble separating at night, may attempt to sleep with parent or sibling
  • Physical symptoms (such as headaches, stomachaches, nausea or vomiting) when separation occurs, or in anticipation of separations
  • Fears of getting lost or being kidnapped
  • Doesn’t like to be alone in the house even on a separate floor – staying close to mom or dad and checking that they are present from time to time.
  • Disinterest in social activities; preference to spend time with parent
  • Nightmares about harm, danger, death, separation
  • Over-concern with loved one-needs reassurance that loved one is ok
  • Panics if parent late for pick ups; frequent reassurance about pick-up plan or checks the clock to see what time parent will be coming.
  • Inability to attend birthday parties, field trips independently, can’t stay for a sleepover
  • A lot of “safety behaviors” like carrying a cell phone in case they miss mom and want to talk to her, or making a plan to see mom in the middle of a party in case they miss her.
  • Trouble going to or staying in school (after 6 years old).
 

Symptom Checker

The Child Anxiety Tales program is an online parent-training program designed to equip parents with skills and strategies they’ll need to help their children better manage anxiety.

The program is based on the latest evidence in the treatment of child anxiety and on cognitive-behavioral principals shown to be effective in helping anxious youth. Child Anxiety Tales is an interactive and engaging program that can be completed at your own pace from the privacy and convenience of your own computer. It is not a treatment but an online educational program for parents.


Use the Symptom Checker
 

Online Tools For Parents

The Child Anxiety Tales program is an online parent-training program designed to equip parents with skills and strategies they’ll need to help their children better manage anxiety.

The program is based on the latest evidence in the treatment of child anxiety and on cognitive -behavioral principals shown to be effective in helping anxious youth. Child Anxiety Tales is an interactive and engaging program that can be completed at your own pace from the privacy and convenience of your own computer. It is not a treatment but an online educational program for parents.

 

Coping Cat Parents

CopingCatParents.com was developed to serve as a comprehensive and evidence-based resource on child and adolescent anxiety. Here you will get only information backed by research and tips and strategies that have evidence to support their use. We have brought together relevant resources, tools, and tips from the experts in the field that will be informative, and help you feel confident as you move forward in helping your child. Click on any of the links below to learn more: