Separation Anxiety

Jerry Kennard Health Pro
  • Summer at last. For many kids it's a time of freedom and adventure as they look forward to the long hot days and space from adults. For others the mere thought of something like summer camp evokes sheer terror. They cannot contemplate being separated from their parents for a few minutes, let alone days or weeks. These could well be signs of separation anxiety.


    Very young children frequently show signs of emotional distress when separated from a parent. This is perfectly normal and merely reflects the developmental stage of the child who has no real sense of time or understanding of the permanence of relationships. As children get older such anxieties normally subside.

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    Some older children retain features of excessive anxiety. They constantly seek out the company of parents' and feel profound distress to the point of having diarrhea, vomiting, stomach cramps and headaches, if separated. These are all signs of separation anxiety disorder (SAD). In some circumstances the parent may find difficulties undertaking everyday activities like shopping. The simple act of stepping into the changing room to try on an item of clothing can result in their child begging, screaming and pleading with them not to be left alone.


    To receive a diagnosis of SAD, a child must display at least three of the following symptoms for a period of at least four weeks:


    Excessive anxiety about separation from the attachment figure.

    Unrealistic fear that the attachment figure will be harmed.

    Reluctance to attend school.

    Persistent refusal to go to sleep unless the attachment figure is nearby.

    Persistent avoidance of being alone.

    Nightmares involving themes of separation.

    Repeated physical complaints when separated.

    Excessive distress when separation is anticipated.


    It is more common for such children to come from close-knit families but certain other factors are understood to have a bearing such as death in the family or some form of trauma.


    It is important not to trivialize or belittle the emotional experiences of the child. Avoid comments such as, "you're too old to behave like this", or "don't be stupid", or "grow up". They simply act to undermine further the lack of confidence the child is already experiencing.


    Your own mood and general demeanor is an important factor. If you become anxious or angry as a result of you child's anxiety, it will add fuel to an already emotional moment and tells the child that something is wrong. Remain calm but acknowledge the distress of the child. Use comments such as, "I know you're upset but I have to go upstairs to make the beds - I'll be back in ten minutes".


    Tips, such as the one's previously mentioned, are part of a package of strategies that can be learned via a structured treatment package. Cognitive behavioral therapy is one of the most frequently used and most effective forms of treatment. Behavior therapy emphasizes positive reinforcement for any behaviors that approximate towards adaptive coping. Behavior reflecting separation anxiety will not be punished, but will not receive rewards. Parents will probably also be given guidance as to how best to observe and acknowledge steps in the right direction, as well as ways to help with the treatment of anxiety.


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    Medication is rarely used in cases of separation anxiety except in the most severe cases. There are no medications specifically approved by the FDA for the treatment of SAD although serotonin reuptake inhibitors (SSRI's) have received some favorable reports. If left untreated the risk of panic disorder, other anxiety-related disorders and depression increases.


    For more information, the American Academy of Child and Adolescent Psychiatry provide an extensive resource of information on their website. Check out this FAQs page about childhood fears, from the American Academy of Pediatrics.

Published On: June 24, 2009