Julie and her son Nicky stood in the school yard on the first day of kindergarten. Nicky talked to the other children but never moved more than a few feet away from Nicky. Since it was the first day, when the bell rang, the teacher invited the parents to walk their children to the classroom and Julie did; but a few minutes later when Julie tried to leave, Nicky began to cry. He hung tightly to Julie’s leg, sobbing uncontrollable. Finally, after about 15 minutes, Julie pulled her away and left. She thought it would get easier the next day but this ritual continued, every day for the first month of school.
While young children often are emotionally distressed when separated from a parent, Nicky began to feel sick even at the thought of going to school. His complained of stomach aches, couldn’t eat and started having headaches. Nicky may have separation anxiety disorder (SAD).
Symptoms of Separation Anxiety
According to the Diagnostic and Statistical Manual (IV edition), separation anxiety disorder is "developmentally inappropriate and excessive anxiety concerning separation from home or from those whom the individual is attached."
To be diagnosed with SAD, a child must experience at least 3 of the following symptoms for at least 4 weeks:
1. Recurrent excessive distress when separation from home or major attachment figures occurs or is anticipated
2. Persistent and excessive worry about losing, or about possible harm befalling, major attachment figures
3. Persistent and excessive worry that an untoward event will lead to separation from a major attachment figure (e.g., getting lost or being kidnapped)
4. Persistent reluctance or refusal to go to school or elsewhere because of fear of separation
5. Persistently and excessively fearful or reluctant to be alone or without major attachment figures at home or without significant adults in other settings
6. Persistent reluctance or refusal to go to sleep without being near a major attachment figure or to sleep away from home
7. Repeated nightmares involving the theme of separation
8. Repeated complaints of physical symptoms (such as headaches, stomachaches, nausea, or vomiting) when separation from major attachment figures occurs or is anticipated
Children with SAD often resist or refuse to go to school, worried that some tragedy will befall their parents while they are separated. When separated, children with SAD spend much of their time excessively worrying about whether their parents are safe.
Treatment for Separation Anxiety
When left untreated, the risk of developing panic disorder, other anxiety disorders or depression increases. Even so, medication is rarely the first line of treatment for children with SAD. Cognitive behavioral therapy (CBT) is used more often and has been found to be more effective. This type of therapy works to change thinking processes and to provide positive reinforcement for any steps a child takes to managing their anxiety levels. Therapists also frequently work with parents, giving them strategies to help their child manage anxiety.
Tips for Parents
Don’t trivialize or demean your child because of separation anxiety. Statements such as "grow up" or "get over it" or "stop acting like a baby" will only further hurt your child, making them feel more alone and insecure.
Watch your own reactions. If you become nervous or anxious because of your child’s behavior, it can fuel his anxiety. Calmly acknowledge their anxiety and explain that you must leave. Tell him where you are going, reassure your child that you will return and, if possible, let him know when you will return.
Let your child know that everyone is nervous on their first day of school. Many times, children with SAD believe they are the only person that feels the fear of going to school. Your child may feel better knowing he is not the only one who is scared and these feelings are normal.
Show confidence in your child. Even if you are worried about whether your child will have a hard time going off to school, let him know you believe he will do fine and have fun at school. He will be more willing to believe this if you believe it.
Talk about other times your child has managed when you had to go out. If you have gone shopping or out with your spouse for the evening, remind your child that he got through that time and he will make it through the school day as well.
Include your child in preparing for school. Take your child shopping for supplies and clothes. Have your child help to pack his back pack and lunch or snack for the first day of school. Keep this time positive, talking about all the fun times he will have at school.
Don’t drag out the good-byes. While this is hard, you don’t want to leave a crying child, dragging it out can increase his anxiety and yours. Give him a hug, a reminder that you believe in him, and reassurance you will be waiting for him when the school day is over.
"Childhood Anxiety Disorders," 2000, Susan Jo Pelmutter, M.D., American College of Neuropsychopharmacology
 Separation Anxiety Disorder, 1994, Diagnostic and Statistical Manual, American Psychiatric Association