Separation Anxiety Disorder

Separation Anxiety Disorder

Separation Anxiety Disorder

Natural separation anxiety only turns into a condition called separation anxiety disorder (SAD) if symptoms persist after the age of three, they are intense or prolonged, and they interfere with school and/or other daily activities.

Babies and toddlers can get upset and cry if they are separated from their parents and other caregivers even for a few minutes, which is a normal part of childhood development. Children usually grow out of separation anxiety by the age of three.

SAD can impact family life negatively, limiting the frequency and extent of family activities and frustrating parents and siblings with the amount of attention the child with SAD requires.

Prevalence

SAD is a fairly common condition that affects 3% – 5% of children, and it is considered to be a general indicator of potential mental health and mood disorder issues.

Symptoms of Separation Anxiety Disorder:

Symptoms of SAD which are excessive for the child’s developmental age are seen when a child is separated from their parent, caregiver, or close authority figure. Separation anxiety symptoms can appear like other health issues, so it is important to have the child visit a doctor to find out exactly what needs to be addressed.

SAD is characterized by anxiety-related behaviors such as:

  • Excessive clinging to parents
  • Frequent, prolonged, and emotionally charged crying
  • Refusing to engage in activities or tasks that necessitate separation from loved ones
  • Frequent illnesses like stomach issues, vomiting, or headaches
  • Panic attacks or criteria for other conditions
  • Prolonged, intense, and violent temper tantrums
  • Refusing to attend school or a particular class
  • Performance issues at school
  • Reduced or no ability to interact normally with other children
  • Avoiding experiences or situations that are crucial to typical child development
  • Refusing to sleep on one’s own
  • Frequent nightmares

Panic attacks and panic disorder can be associated with separation anxiety disorder — the individual may have repeated experiences of intense and sudden terror, fear, or anxiety that escalate within a few minutes.

SAD symptoms can contribute toward:

  • Recurring, excessive anxiety about being separated from home or loved ones, or even the thought of separation
  • Recurring and excessive distress about the perceived potential loss of a loved one
  • Recurring and excessive distress about anticipated bad situations that could result in separation
  • Not leaving the home for fear of separation from loved ones
  • Recurring and excessive medical complaints like stomach issues or headaches when separated from loved ones

For some people, SAD symptoms can persist into the teenage years or into adulthood.

Causes of Separation Anxiety Disorder:

A family history of anxiety or depression, low socioeconomic status, overprotective parents, moving to a new home, and switching schools are all factors that can render a child vulnerable and at increased risk of developing SAD.

Risk factors for separation anxiety include:

  • History of depression and/or anxiety in the family
  • Low SES (socioeconomic status)
  • Timid or shy disposition
  • No or very sparse appropriate parental connection
  • Excessively protective parents
  • Parents getting a divorce
  • Death of a close member of the family
  • Changing schools
  • Moving house
  • Issues making friends or dealing with peers
  • Early exposure to mature media content such as horror movies
  • Adopting anxiety and fear responses modeled by family members

Diagnosis of Separation Anxiety Disorder:

Children with three or more of the symptoms listed in the symptoms section could be diagnosed with SAD. The child’s doctor may want additional testing, including a psychological evaluation done while exploring the child’s feelings and thoughts, in order to rule out other conditions or disorders.

The doctor may also want to watch the child interact with their parents before making the diagnosis so they can assess the impact of the parenting style on the child’s capacity to handle anxiety.

Roughly 33% of children diagnosed with SAD will be diagnosed with a fear-related mental illness later as an adult.

Treatment for Separation Anxiety Disorder:

Typically, psychotherapy is used in the treatment of SAD, with the goal of helping a child deal with anxiety in a positive way. Currently, separation anxiety disorder is not something treatable with medications. Antidepressants are sometimes used in older children with SAD, but they must be monitored closely for adverse effects.

Ideally, parents, therapists, and teachers work together to facilitate a supportive and safe environment during and after treatment. This includes understanding the symptoms if the disorder, knowing what encouraging the child toward interacting with peers safely looks like, and providing the child a safe place to go to when anxious —at home and at school.

  • Counseling / therapy – A counselor or therapist does one-on-one therapy with the child to address the root and symptoms of the anxiety issues.
  • Cognitive-behavioral therapy – This teaches children coping strategies such as breathing and relaxation techniques. CBT is the most effective therapy for separation anxiety disorder.
  • Parent-child interaction therapy – This form of treatment has three main categories:

    • (CDI) Child-directed interaction – focuses on improving the relationship quality between the parent and the child, with the goal of boosting the child’s sense of safety.
    • (PDI) Parent-directed interaction – parents learn to improve their communication skills with their child, with the goal of better managing poor behavior.
    •  (BDI) Bravery-directed interaction – parents learn the triggers for their child’s anxiety through the development of a bravery ladder — illustrated scenarios that cause the child anxiety. A system is created to reward the child’s positive reactions to anxiety.
  • Parent training – Teaches methods of self-care and parenting skills to address the frustration of having very little time for any other children, themselves, or the relationship with their spouse. Siblings can be angry, jealous, and/or resentful due to the lack of time and attention being spent on them.
  • Treating normal separation anxiety
    Symptoms of separation anxiety are typically first noticeable between eight months old and one year old, and in the majority of cases, SAD symptoms will be gone between the age of two and three years old.
    Even if your child doesn’t meet all the criteria for a SAD diagnosis, there are still things you can do to make their life more enjoyable by making them feel safer and reducing the potential triggers. These steps include:

    • Rather than start with a two-week vacation, do practice separations and increase the duration over time.
    • When possible, schedule your exits for after the child has had a nap or just eaten.
    • Make goodbye a quick and low-key event.
    • Do everything in your control to return at agreed times.
    • Have a minder come to your home so the surroundings are familiar.
    • If your child has to go somewhere else, make sure they bring something they cherish with them.
    • When possible, use the same caregiver.
    • Be sensitive to the child’s capacity to be more terrified by TV content than its content rating may suggest. Cut down or eliminate scary television.

Realize that this transition may not happen in the first week, but be as consistent as possible with your changes.

Symptoms of Separation Anxiety Disorder:

Symptoms of SAD which are excessive for the child’s developmental age are seen when a child is separated from their parent, caregiver, or close authority figure. Separation anxiety symptoms can appear like other health issues, so it is important to have the child visit a doctor to find out exactly what needs to be addressed.

SAD is characterized by anxiety-related behaviors such as:

  • Excessive clinging to parents
  • Frequent, prolonged, and emotionally charged crying
  • Refusing to engage in activities or tasks that necessitate separation from loved ones
  • Frequent illnesses like stomach issues, vomiting, or headaches
  • Panic attacks or criteria for other conditions
  • Prolonged, intense, and violent temper tantrums
  • Refusing to attend school or a particular class
  • Performance issues at school
  • Reduced or no ability to interact normally with other children
  • Avoiding experiences or situations that are crucial to typical child development
  • Refusing to sleep on one’s own
  • Frequent nightmares

Panic attacks and panic disorder can be associated with separation anxiety disorder — the individual may have repeated experiences of intense and sudden terror, fear, or anxiety that escalate within a few minutes.

SAD symptoms can contribute toward:

  • Recurring, excessive anxiety about being separated from home or loved ones, or even the thought of separation
  • Recurring and excessive distress about the perceived potential loss of a loved one
  • Recurring and excessive distress about anticipated bad situations that could result in separation
  • Not leaving the home for fear of separation from loved ones
  • Recurring and excessive medical complaints like stomach issues or headaches when separated from loved ones

For some people, SAD symptoms can persist into the teenage years or into adulthood.

Causes of Separation Anxiety Disorder:

A family history of anxiety or depression, low socioeconomic status, overprotective parents, moving to a new home, and switching schools are all factors that can render a child vulnerable and at increased risk of developing SAD.

Risk factors for separation anxiety include:

  • History of depression and/or anxiety in the family
  • Low SES (socioeconomic status)
  • Timid or shy disposition
  • No or very sparse appropriate parental connection
  • Excessively protective parents
  • Parents getting a divorce
  • Death of a close member of the family
  • Changing schools
  • Moving house
  • Issues making friends or dealing with peers
  • Early exposure to mature media content such as horror movies
  • Adopting anxiety and fear responses modeled by family members

Diagnosis of Separation Anxiety Disorder:

Children with three or more of the symptoms listed in the symptoms section could be diagnosed with SAD. The child’s doctor may want additional testing, including a psychological evaluation done while exploring the child’s feelings and thoughts, in order to rule out other conditions or disorders.

The doctor may also want to watch the child interact with their parents before making the diagnosis so they can assess the impact of the parenting style on the child’s capacity to handle anxiety.

Roughly 33% of children diagnosed with SAD will be diagnosed with a fear-related mental illness later as an adult.

Treatment for Separation Anxiety Disorder:

Typically, psychotherapy is used in the treatment of SAD, with the goal of helping a child deal with anxiety in a positive way. Currently, separation anxiety disorder is not something treatable with medications. Antidepressants are sometimes used in older children with SAD, but they must be monitored closely for adverse effects.

Ideally, parents, therapists, and teachers work together to facilitate a supportive and safe environment during and after treatment. This includes understanding the symptoms if the disorder, knowing what encouraging the child toward interacting with peers safely looks like, and providing the child a safe place to go to when anxious —at home and at school.

  • Counseling / therapy – A counselor or therapist does one-on-one therapy with the child to address the root and symptoms of the anxiety issues.
  • Cognitive-behavioral therapy – This teaches children coping strategies such as breathing and relaxation techniques. CBT is the most effective therapy for separation anxiety disorder.
  • Parent-child interaction therapy – This form of treatment has three main categories:

    • (CDI) Child-directed interaction – focuses on improving the relationship quality between the parent and the child, with the goal of boosting the child’s sense of safety.
    • (PDI) Parent-directed interaction – parents learn to improve their communication skills with their child, with the goal of better managing poor behavior.
    •  (BDI) Bravery-directed interaction – parents learn the triggers for their child’s anxiety through the development of a bravery ladder — illustrated scenarios that cause the child anxiety. A system is created to reward the child’s positive reactions to anxiety.
  • Parent training – Teaches methods of self-care and parenting skills to address the frustration of having very little time for any other children, themselves, or the relationship with their spouse. Siblings can be angry, jealous, and/or resentful due to the lack of time and attention being spent on them.
  • Treating normal separation anxiety
    Symptoms of separation anxiety are typically first noticeable between eight months old and one year old, and in the majority of cases, SAD symptoms will be gone between the age of two and three years old.
    Even if your child doesn’t meet all the criteria for a SAD diagnosis, there are still things you can do to make their life more enjoyable by making them feel safer and reducing the potential triggers. These steps include:

    • Rather than start with a two-week vacation, do practice separations and increase the duration over time.
    • When possible, schedule your exits for after the child has had a nap or just eaten.
    • Make goodbye a quick and low-key event.
    • Do everything in your control to return at agreed times.
    • Have a minder come to your home so the surroundings are familiar.
    • If your child has to go somewhere else, make sure they bring something they cherish with them.
    • When possible, use the same caregiver.
    • Be sensitive to the child’s capacity to be more terrified by TV content than its content rating may suggest. Cut down or eliminate scary television.

Realize that this transition may not happen in the first week, but be as consistent as possible with your changes.