Separation Anxiety Disorder

Does your child hover around you like a shadow? Does he or she refuse to let you go out without her? Does she get upset or refuse to go to school or a friend’s house without you? Your child may suffer from Separation Anxiety.

Separation Anxiety Disorder (SAD) is the most common anxiety disorder among children and affects 2-3% of grade-school children. It involves excessive distress over day-to-day separation from parents, home or other familiar situations, and unrealistic fears of harm to loved ones. Seventy-five to eighty percent of the children who refuse to go to school have separation anxiety. Whereas normal separation fears are outgrown by age 5 or 6, SAD usually begins between the ages of 7 and 11. It often occurs fairly abruptly among children who previously had no problems with separation. Separation Anxiety Disorder (SAD) is diagnosed only if fears persist, with very extreme reactions, beyond that expected for the age of the child. A ten-year-old who cries and clings to a parent, refuses to go to school, or is afraid to stay at a friend’s house may be showing signs of Separation Anxiety Disorder (SAD). Children with Separation Anxiety Disorder (SAD) may beg for reassurance when a parent is away even briefly, cower from any opportunity to be separated, and sometimes even follow them from room to room. When questioned, they may disclose worries about parents or other family members getting hurt or killed, and may feel responsible for protecting them from harm.

Signs and symptoms of Separation Anxiety Disorder

  • Extreme, disproportionate distress over separation from loved ones
  • Unwillingness to leave home, attend school, or go on outings
  • Unrealistic worry about harm to self or loved ones
  • Frequent seeking of reassurance regarding safety of self and loved ones Crying, clinging, nausea, vomiting or tantrums in anticipation of separation
  • Reluctance to be alone, especially at night
  • Nightmares about harm and danger
  • Symptoms for at least four weeks

Indications of SAD in school

School refusal and tardiness are common indicators of Separation Anxiety Disorder (SAD). Once in school, a child with Separation Anxiety Disorder (SAD) may be agitated, restless and nervous, and complain of stomachaches, headaches or nausea. The child may make frequent trips to the nurse’s office, and ask to call her parent or to go home. The child may not eat or drink in school, and may ask for repeated reassurance about safety. Phone calls to “check in” with parents may bring reprieve. Usually, the child experiences tremendous relief when the parent takes her home.

Helping your child overcome Separation Anxiety

  • Remain calm, matter of fact and firm during routine separations.
  • Don’t hover, question or reassure excessively.
  • Limit reassurance to one or two times.
  • Use the Parent-Teacher Log to communicate between home and school.
  • Limit check-in visits or phone calls when the child is in school.
  • Allow a transitional object for comfort until the child masters anxiety.
  • Limit the child’s ability to leave school and return home.
  • Remove the comforts of staying home or returning home from school.
  • Use the Feeling Thermometer as an index of intensity and change in emotions.
  • Teach calming self-talk when upset.
  • For the child who has been out of school, plan a gradual return to school.
  • Seek opportunities to separate from the child for increasing lengths of time.
  • Create opportunities for repetition and practice.
  • Encourage independent activities and self-reliance.
  • Reward independence and initiative.
  • Set a positive example; role model the behavior the child is expected to learn.
  • Make You And Me Alone (YAMA) time to increase positive interactions.
  • Praise any efforts in the direction of separation.
  • Use tangible rewards for any effort in the right direction.
  • Be consistent in the child management approach at home and at school.

If your child’s separation fears persist despite your interventions, seek consultation with a qualified mental health professional.

– Proliance Center would like to thank: Aureen Pinto Wagner, Ph.D. Copyright © 2002 for the use of the above material.

What Is the Treatment for Separation Anxiety Disorder (SAD)?

Most mild cases of Separation Anxiety Disorder (SAD) do not need medical treatment.  However, in more severe cases of Separation Anxiety Disorder (SAD), or when the child refuses to go to school, treatment may be needed.  There are three goals of treatment for Separation Anxiety Disorder (SAD).  They include reducing anxiety in the child, developing a sense of security in the child and the caregivers, and educating the child and family/caregivers about the need for natural separations.  Treatment options for Separation Anxiety Disorder (SAD) that may be used include psychotherapy and/or medications.

Psychotherapy (a type of counseling) is the main treatment approach for Separation Anxiety Disorder (SAD), where the goal is to help the child tolerate being separated from the caregiver without the separation causing distress or interfering with function. A type of therapy called cognitive-behavioral therapy works to reshape the child’s thinking in Separation Anxiety Disorder (SAD), so that the child’s behavior becomes more appropriate.  Family therapy also may help teach the family about Separation Anxiety Disorder (SAD) and help family members better support the child during periods of anxiety.

Medication: Antidepressant medications may be used to treat severe cases of Separation Anxiety Disorder (SAD).

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