Separation Anxiety Disorder

Separation anxiety disorder (SAD) is characterized by recurrent and extreme distress when a child is expecting or experiencing separation from home or from loved ones. This is different from developmentally typical separation anxiety, which is often observed in infants and toddlers (between 6 and 18 months of age) upon separating from their parent or caregiver.

Children with SAD may worry about losing their parents and/or getting lost or harm coming to themselves or their caregivers during separation. They may refuse to go to certain places (e.g., school) because of fears of separation, or become extremely fearful when they are left alone, even inside their own homes. These children and adolescents may also refuse to sleep alone, experience nightmares about separation, or experience physical complaints (such as headache, stomachache, dizziness) when separated from their parents.

All children and adolescents experience some anxiety. It is a normal part of growing up. However, when worries and fears concerning separation from home or family are developmentally inappropriate, separation anxiety disorder may be present. SAD occurs equally in males and females.

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 concerning separation from home or family are developmentally inappropriate, Separation Anxiety Disorder may be present. SAD occurs equally in males and females. 

Symptoms and Types

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

• Refusal to sleep alone
• Excessive distress when separation from home or family occurs or is anticipated
• Excessive worry about the safety or health of a family member
• Excessive worry about safety of self
• Excessive worry about getting lost from family
• Refusing to go to school
• Fearfulness and reluctance to be alone
• Frequent stomachaches, headaches, or other physical complaints
• Inability to sleep away from home or excessive worry while sleeping away from home
• Difficulty staying with sitters, even when they are familiar to the child
• Excessive "clinginess," even when at home
• Symptoms of panic and/or temper tantrums at times of separation from parents or caregivers

Diagnosis and Tests

A child psychologist or other qualified behavioral health professional usually diagnoses anxiety disorders in children or adolescents following a comprehensive diagnostic evaluation. Parents who note symptoms of severe anxiety in their child or teen can help by seeking an evaluation and treatment as soon as possible. Early treatment may help prevent future problems.

SAD is diagnosed when a child’s anxiety causes significant impairment in important areas of functioning (such as at school, with friends, and at home). The problem must last for at least 4 weeks and be present before the child is 18 years of age.

Treatment for separation anxiety disorder

Studies that have been done with children and adolescents have shown that cognitive-behavioral therapy (CBT) can be a very effective treatment for anxiety. CBT is a short-term, problem-focused approach. Children and parents are educated about the role of anxiety in the specific symptoms the child is experiencing. The goal of CBT is to help the child manage emotional distress, physical symptoms, negative thoughts, and problematic behaviors that often accompany anxiety in ways that promote bravery. With CBT, children with SAD are taught to learn to recognize the physiological symptoms of anxiety, to use realistic “self-talk” rather than negative self-talk, and to “face their fears” in a stepwise manner. Parents are included to provide reinforcement and rewards for children’s success, and to learn to implement and practice the skills with their children at home and in the community.  When the symptoms are severe, antidepressant or antianxiety medication may be included as part of the treatment plan.