Separation Anxiety

When Your Child Can’t Live Without You, Ever

Many of us have experienced the tears our children shed when we drop them off for their first day of preschool or kindergarten, or take them to a babysitter. We’ve also grown accustomed to their fear of the dark, or of being alone in certain situations. Because children of all ages experience some degree of anxiety during their development, these fears are expected; in fact, they are a normal part of the child’s development. But when the episodes become so persistent that they interfere with the child’s ability to attend school, develop friendships, or even sleep in a separate room, it could be an indication of separation anxiety disorder.

Separation anxiety disorder is only one of several types of anxiety disorders. The others include generalized anxiety disorder, social phobia, and obsessive-compulsive disorder. The overall group of disorders known as anxiety disorders is more prevalent than virtually all other mental disorders of childhood and adolescence. The one-year prevalence of anxiety disorders in children ages 9 to 17 is 13 percent.

About four percent of children and young adolescents suffer from separation anxiety disorder, with it being more common among girls. The disorder may be over-diagnosed in children and teenagers who live in dangerous neighborhoods and have reasonable fears of leaving home. The remission rate with separation anxiety disorder is high. However, there are periods where the illness is more severe and other times when it is less so.ⁱ

Children with separation anxiety may cling to their parents and commonly have trouble falling asleep by themselves. When separated, children suffering from separation anxiety disorder may fear the loss of their parents. This includes fears such as losing their parents through an accident, illness, or other way. No matter what is imagined, the child fears losing their parent(s) permanently. The child’s overwhelming need to stay close to the parents or home can make it difficult for them to attend school or camp, stay at friends’ houses, or even be in a room by themselves. Fear of separation can also lead to dizziness, nausea, or palpitations, and is often associated with the symptoms of depression: withdrawal, apathy, or difficulty in concentrating. Children suffering from separation anxiety disorder often fear that they or a family member might die, and experience nightmares or fears at bedtime.

Older individuals with separation anxiety disorder may have difficulty moving or getting married and may, in turn, worry about separation from their own children and partner.

Although the cause of separation anxiety disorder isn’t known, some risk factors have been identified. Affected children tend to come from families that are very close-knit. The disorder might develop after a stress such as death or illness in the family or a move. Trauma, especially physical or sexual assault, might bring on the disorder. The disorder sometimes runs in families, but the exact role of genetic and environmental factors has not been established.

Since it’s normal for kids to show distress to a degree when they are separated from parents in certain instances, such displays of anxiety aren’t automatically a sign of separation anxiety disorder; rather, it may simply be a healthy and typical reaction under the circumstances. There are, however, a few ways in which you can make the goodbyes a little easierⁱⁱ:

• Adjust Your Timing. Try not to start day care/child care with a person that your child is unfamiliar with between the ages of eight months and one year. This is when separation anxiety is most likely to first present itself. Also avoid leaving your child when they’re tired, hungry, or restless; instead, try to schedule drop-offs after naps and meal times.
• Practice Separations and Introductions Gradually. If you plan to leave your child with a new babysitter, invite that person in advance so they can spend some time with your child while you are present. If you’re going to be using day care for the first time, or switch from one care center to another, go with your child to the new place together before the child is left there for care. Practicing leaving your child along with a care giver for short periods of time before full-fledged care begins also helps acclimatize them to the new surroundings and people in your absence.
• Stay Calm and Consistent. Having a good-bye routine in which you remain calm and say a loving but firm good-bye transfers confidence to your child. Reassure your child that you’ll be back. Explain how long it’ll be before you return in terms that can be understood, given the age of your child. Some ages don’t have a fully-developed understanding of time, so use events such as lunch time or nap time that they can relate to. Give your child your undivided attention when saying good-bye, and then leave. Don’t give in to the temptation of turning around for one last look or go back for another hug; it will only aggravate any anxiety the child might feel. Establishing a pattern of firm but loving good-byes and happy reunions provides the stability and confidence to which the child will most likely respond positively.

In most instances a child’s fear of separation will pass with experience; on the other hand, if separation anxiety is a concern, early identification, diagnosis, and treatment can help the child reach his or her full potential and minimize the disorder’s harmful effects.

Treatment for separation anxiety disorder can include some form of psychotherapy, behavioral therapy, or prescription medication. Children who exhibit persistent signs of separation anxiety disorder should be evaluated by a mental health professional who specializes in treating children. Such an evaluation may include psychological testing and consultations with other specialists. If a diagnosis of separation anxiety disorder is made, a comprehensive treatment plan is developed with the family and – whenever clinically appropriate – the child’s input.

There is ample reason to remain optimistic even with the diagnosis of separation anxiety disorder: Although each child’s case is different and has its own unique factors, this type of disorder typically responds well to treatment.

ⁱ National Institute of Mental Health statistics.

ⁱⁱ Adapted from Nemours Foundation; kidshealth.org; D’Arcy Lyness, Ph.D., ed.