Separation Anxiety Disorder

What are the symptoms of separation anxiety disorder?

Children with SAD can’t just “put their worries aside” no matter how hard they try. They feel much more anxious, and for a much longer period of time, than other children in the same situations.

Common fears experienced by children with SAD Include:

• worry about separation
• worry about death or harm to a loved one
• worry about something bad happening to herself
• worry about being alone
• worry about sleep and nightmares

The consistent factor in any worry associated with SAD is that the child’s fear is unrealistic. What she fears will happen is very unlikely to happen.

Physical symptoms usually occur when there is a separation or anticipated separation. They may include:

• nausea and vomiting
• quick breathing or difficulty catching one’s breath
• muscle aches (especially stomach and headaches)
• fatigue

What causes separation anxiety disorder?

Nearly all children experience brief feelings of anxiety about being away from a parent and display clingy behavior. Typically these normal bouts occur when a child is between 18 months and 3 years old, although older children can have passing feelings of separation anxiety during times of stress. The difference between these normal feelings of anxiety and a disorder like SAD is that a child with separation anxiety disorder will experience an extended and extensive period of fear and distress about being apart from familiar people and places and the degree of anxiety or fear is notably out of proportion to the reality of the situation. Anxiety disorders like SAD are linked to biological, family and environmental factors.

• Biological factors: The brain has special chemicals, called neurotransmitters, that send messages back and forth to control the way a person feels. Serotonin and dopamine are two important neurotransmitters that, when “out of whack,” can cause feelings of anxiety.
• Family factors: Just as a child can inherit a parent’s hair color, a child can also inherit that parent’s anxiety. In addition, anxiety may be learned from family members and others who are noticeably stressed or anxious around a child. Parents can also contribute to their child’s anxiety without realizing it by the way they respond to their child. For example, allowing a child to miss school when they are anxious about going likely causes the child to feel more anxious the next school day.
• Environmental factors: A traumatic experience (such as a divorce, illness, or death in the family) may also trigger the onset of separation anxiety disorder.

How is separation anxiety disorder diagnosed?

A child may be diagnosed with separation anxiety disorder if symptoms:

• are present for at least six months
• cause significant distress for the child
• do not go away, no matter how much the child tries to relax or stop worrying
• impair functioning at home, at school, or with peers

If my child is diagnosed with an anxiety disorder, what happens next?

The clinician who evaluates your child will make recommendations for treatment. These may include: parent guidance, especially around keeping the child involved in her activities, child therapy, and, sometimes, anti-anxiety medication.

How do we treat SAD?

Treatment for separation anxiety disorders vary from child to child, and your child’s therapist will work with you to determine the best approach for your child’s symptoms and circumstances. Treatment may include parent guidance, therapy, and/or medication.

Psychotherapy, with parent and child involved, is an effective method of overcoming the disproportionate anxiety that is the calling card of SAD. An experienced mental health professional uses therapy to help your child practice healthy responses to anxiety, replacing the damaging practices of worry and avoidance learned before. Therapy sessions help you and your child:

• how to recognize and vocalize worry and fear
• techniques (such as breathing and imaging a relaxing scene) to reduce physical symptoms of anxiety
• new thought patterns to replace the destructive ones; instead of a worry thought the child can remember “I will be okay. I did it before, I can do it again"
• to approach feared situations in steps so that the child is practicing and experiencing success when separated from her parents.

There are many different medications used to help control anxiety. A prescribing clinician (psychiatrist or nurse practitioner) will choose a medication if needed that will work best to help your child.

What is the long-term outlook for a child with a separation anxiety disorder?

With proper treatment, the majority of children diagnosed with separation anxiety disorder experience a reduction or elimination of symptoms. Symptoms of SAD can recur when new developmental challenges emerge. When treatment is started early and involves the parent as well as the child, the child’s chance of recovery without multiple recurrences improves.