Separation Anxiety Disorder

What is separation anxiety disorder?

• Separation anxiety disorder, also called SAD, is a fear-based anxiety problem seen in school-aged children. It appears as excessive worrying or a fearful, even panic attack, reaction to a separation event. With this condition your child becomes too anxious when he may be separated from something familiar. This may be a short or long separation from his home or someone he feels close to emotionally. All young children go through a normal period of having separation anxiety. This usually lasts from around 10 months of age up to the early preschool years. With SAD, your child's separation anxiety lasts beyond what is expected for his age and may slowly get worse over time. It can also appear suddenly, often starting around 7 to 9 years of age.
  
  
• When your child has SAD, he becomes worried, nervous, or fearful at the thought of being separated. This can be separation from people or places that he knows and is comfortable with. He may get homesick easily, try to avoid going to school, or get a school phobia (strong, ongoing fear). He may show his emotions very easily or have problems getting along with friends. He may be very demanding, forward, or pushy, and in need of your undivided attention all the times. He may throw tantrums when he starts to feel that he will get separated. He may show anger or try to hit the person forcing the separation. Your child may also react by being well behaved, obedient, and eager to please.

What causes separation anxiety disorder?

The exact cause of SAD is not known. SAD may appear after a major stress in your child's life. This may come from the loss of a loved one or pet, or from an illness. Moving to a new neighborhood or school may also cause stress to your child. Other factors that may increase your child's risk of having SAD include the following:

• Behavior copied from parents who show too much fear and anxiety.
  
  
• Coming from a close-knit family or a single-parent home.
  
  
• Having a close family member with SAD, or an anxiety or depressive disorder.
  
  
• Having allergic conditions, such as asthma, or skin or nasal allergies.
  
  
• Having parents who are too protective, too controlling, or too critical.

What are the signs and symptoms of separation anxiety disorder?

Signs and symptoms of SAD may come and go over time. You child may show any of the following:

• Excessive worrying or acting out around separation: Spends a lot of time worrying or becomes very upset when separation happens or is about to happen.
  
  
• Ongoing thoughts of bad events happening:
  
  
  • Being lost from family: Constantly worries that something bad will take him away from you. He may often fear that he might get lost or be kidnapped. He may not like traveling alone away from the house or from places he knows.
    
    
  • Loss of loved ones: Constantly worries about losing you or other loved ones. He worries that harm may happen to you, such as have an accident or getting sick. Your child may always want to know where you are and stay in touch, such as phone calls.
  
  
• School and social avoidance behavior: Constantly does not want to or refuses to attend school or camp, or to stay at friends' homes. He may not want to do events away from home. He may have few social activities and would rather spend his time with you.
  
  
• Being alone fears: Ongoing fear or desire not to be alone, or being without a loved one at home or elsewhere. Your child may cling to you, stay close, or follow you around.
  
  
• Sleeping alone fears: Ongoing desire or refusal to go to sleep alone without you near him, or when away from home. Your child may insist that you stay with him until he falls asleep. During the night, he may move to your bed or sleep outside your bedroom door. He may report strange things, such as seeing people or scary creatures, that go away when you are present.
  
  
• Nightmares: Repeated nightmares about separation or other fears, such as danger, harm, or death affecting him or a loved one.
  
  
• Physical complaints: Repeated complaints of physical symptoms when separation occurs or is expected. These may include stomachaches, nausea (upset stomach), or vomiting (throwing up). Your child may also complain of headaches, pounding or fast heartbeat, dizziness, or feeling faint.

How is separation anxiety disorder diagnosed?

• Your child's caregiver will ask you and your child questions. These include information about your child's health history, behavior, and fears and worries. He will ask if any other family members have had anxiety disorders or other mental health problems. He may want to know how your child is doing at school and with other activities. Different tests may be done to check for medical conditions that may be causing your child's symptoms.
  
  
• Your child's caregiver will assess your child's behavior, fears, and worries in looking for signs and symptoms of SAD. If your child has three or more of the signs or symptoms of SAD, he may have this disorder. To have this disorder the signs and symptoms must have been present for at least four weeks. They must also be bad enough to cause problems in his learning, social skills, and other areas of life. Your child's anxiety should not be caused by another mental health disorder.

How is separation anxiety disorder treated?

• Therapies:
  
  
  • Cognitive behavioral therapy: This is therapy that works to change how you act by changing how you think. With a therapist, your child learns to control bad thoughts and replace them with good ones. Your child learns how to change his behavior by looking at the results of his actions. He learns that certain behaviors (actions) have good or bad results, and good behaviors are often rewarded. He may also be taught how to relax through special exercises. Caregivers also help your child face his fears and decrease his anxiety through exposure.
    
    
  • Parent training: You may be given special training to help you cope and handle your child's anxieties. This training can also help you control your own anxiety.
    
    
  • Psychotherapy: This is a type of counseling that is usually done in a series of meetings or talks. Psychotherapy may be attended by you, your child, and your family. These meetings may help everyone to better understand SAD. Your child's caregiver may also include your child's teachers or people that are close to him during these talks.
  
  
• Medicines:
  
  
  • Anti-anxiety medicine: This medicine may be given to help your child feel less nervous.
    
    
  • Anti-depressant: This medicine is given to decrease or prevent symptoms of depression. It can also be used to treat other behavior problems.

What can I do to help my child with separation anxiety disorder?

• Be a positive role model for your child. Learn to control your own anxiety. Your child learns from watching your behavior. He may be more likely to face his fears if he sees that you can do it. Be careful that your actions do not support or strengthen your child's separation anxiety behavior. These actions may include checking on your child often, avoiding anxiety-causing situations, or allowing your child's sympathy-seeking behavior. Talk to your child's caregiver if you are having trouble handling your own anxiety.
  
  
• Learn more about SAD. Read about SAD. The more you know about your child's condition, the better you can help him. Work with your child's teacher to help your child in school.
  
  
• Set rules that do not change. Having clear and simple rules may help change how your child thinks and acts. Have set limits and routines that are always followed. An example may be making your child attend school even if he wants to refuse. When needed, you may use an attention-based consequence, such as limited time with you at night. Praise and reward your child when his behavior is less anxious and when he is able to control his anxiety.

What are the risks for my child that may come with having separation anxiety disorder?

Your child's separation anxiety could get worse if left untreated. He may have problems with his school learning, friendships, and relationships. His education may be broken up, delayed, or made shorter by his absences from school. He is more likely to have at least one other type of anxiety disorder. These can include phobias and panic disorder. He may also develop other serious problems, such as depression. He may have an increased risk for abusing alcohol when he is a teenager. Having SAD also may increase his risk for having other anxiety disorders as an adult.

When should I call my child's caregiver?

Call if:

• You and your child cannot make it to your next meeting with his caregiver.
  
  
• Your child cannot eat or is eating more than usual.
  
  
• Your child is not able to sleep well or is sleeping more than usual.
  
  
• Your child's SAD prevents him from doing most of his daily activities.
  
  
• You have questions or concerns about SAD or your child's medicine.

When should I seek immediate care?

Seek care immediately or call 911 if:

• Your child feels like hurting himself or others.
  
  
• Your child just had a seizure (convulsion).
  
  
• Your child has trouble breathing, chest pains, or a fast heartbeat.

Where can I find support and more information?

Accepting that your child has separation anxiety disorder can be hard. Your child's condition may make you feel angry, sad, or frightened. These feelings are normal. Talk to your child's caregivers and your family or friends about your feelings. Your child's caregivers can help your family better understand how to support your child with SAD. You and your family may join a support group. Contact the following for more information:

• American Academy of Child and Adolescent Psychiatry
  3615 Wisconsin Avenue NW
  Washington , DC 20016
  Phone: 1- 202 - 966-7300
  Web Address: http://www.aacap.org
  

• Anxiety Disorders Association of America (ADAA)
  8730 Georgia Avenue, Suite 600
  Silver Spring , MD 20910
  Phone: 1- 240 - 485-1001
  Web Address: http://www.adaa.org
  

Care Agreement

You have the right to help plan your child's care. Learn about your child's health condition and how it may be treated. Discuss treatment options with your child's caregivers to decide what care you want for your child.

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The above information is an educational aid only. It is not intended as medical advice for individual conditions or treatments. Talk to your doctor, nurse or pharmacist before following any medical regimen to see if it is safe and effective for you.

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